Senior Agenda Coalition of RI zeros in on key aging legislation 

Published in RINewsToday on May 30, 2022

As the General Assembly winds down, the Senior Agenda Coalition of Rhode Island (SACRI) is tracking 16 House and Senate Bills along with FY 24 Budget Articles that have an impact on the state’s senior population. In a legislative alert, SACRI details a listing of 16 House and Senate bills and FY23 Budget Articles relating to care givers, mobile dental services, supplemental nutrition, housing, tax relief and home care worker wages. 

The state’s largest organization of aging groups is focusing and pushing for passage of the following four bills during the upcoming weeks.

SCARI puts on its radar screen S-2200/H-7489 to push for passage. The legislation (prime sponsors Senator Louis DiPalma (D-District 12) and Representative Julie Casimiro (D-District 31), establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24-member advisory committee, to provide review and recommendations for rate setting, and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.  

Meanwhile, DiPalma and Casimiro have also introduced S-2311/H-7180 to require a 24-member advisory committee to provide review/recommendations for rate setting/ongoing review of social service programs licensed by state departments/agencies and Medicaid. The House and Senate Finance Committees have recommended these measures be held for further study.

Ratcheting Up the Pay for Rhode Island’s Home Care Workers

In testimony on April 28th, SACRI’s Executive Director Bernard J. Beaudreau says, “Because payment levels for services have not been updated in years, especially in our current inflation ,levels, the low-pay level of direct care workers has created workforce shortages, impoverished workers and has put at risk our ability to provide proper care for our aging elder population.”

“Shamefully, an estimated 1 in 5 Rhode Island home care workers live in poverty and most have insufficient incomes to meet their basic needs,” says Beaudreau, calling for enactment of this bill to raise the wages of the lowest paid care workers as a top priority. 

S-2200 was referred to the Senate Finance Committee and companion measure, H 7489, was referred to the House Finance committees for review.  After hearings in their respective chambers, both bills are being held for further study. 

At press time, the Rhode Island General Assembly is hammering out its state budget for Fiscal Year 2023, taking effect July 1, 2022, to June 30, 2023.  SACARI calls on the state to make it a budgetary priority to address Rhode Island’s home care crisis.

According to Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, who also serves SACRI as a volunteer policy adviser and Board Member, says that the Governor’s budget calls for suspending use of an estimated $38.6 million in state funds which, by law, should be used to enhance home and community-based services. This law, says Maigret, is referred to as the “Perry-Sullivan” law after its sponsors.

Maigret calls for these funds to be used to increase home care provider rates so they may be fair and competitive to home care workers and increase rates for independent providers.  Many of these workers are low-income, women, and women of color, she says.

Lowering the property taxes for Rhode Island’s low-income seniors

SACRI also calls for the Rhode Island General Assembly to provide property tax relief for low-income seniors and Social Security Disability Income (SSDI) recipients. As housing costs rise and property taxes increase, more older Rhode Islanders with limited or fixed incomes and those on SSDI are becoming housing tax burdened, says the Providence-based the aging advocacy coalition. 

In SACRI’s legislative alert, Maigret calls for the passage of H-7127 and S-2192, with primary sponsors Representative Deborah Ruggiero (D-District 74) and Senator Cynthia Armour Coyne (D-32), charging that Rhode Island’s property tax relief law needs urgent updating.

Rhode Island’s Property Tax Review Law, sometimes referred to as the Circuit Breaker Law, needs serious updating. Initially the law was enacted to help provide property tax relief for persons aged 65 and over and to those on SSDI, says Maigret.  It is currently available to those with incomes up to $30,000 (set in 1999) and provides a credit or refund up to $415 against a person’s state taxes owed.  Both homeowners and renters are eligible to a apply. 

H-7127 and S-2192 would make hundreds of older Rhode Islanders eligible to participate by increasing the income cap from $30,000 to $ 50,000. Maigret notes that if these bills pass, a person with household incomes of $35,000 who is not eligible now could be eligible to get a refund of up to $850 next year. “These changes would provide direct relief against high property taxes and make Rhode Island more in line with our neighboring states of Connecticut and Massachusetts,” she says.

Finally, Executive Director Beaudreau testified on May 17th before the House Finance Committee, calling for the passage of H-7616, Reinstating the Department of Healthy Aging. “The time is long overdue for the state to re-invest in serving the needs of aging population,” he says, noting that “the state’s total population of 65 years and older has grown by 20% from 152,283 in 2010 to 182,486 today.”

Beaudreau testified that the “data clearly indicates that Rhode Island should be increasing plans, resources and services to meet the need of the state’s aging population, not cutting back.” The state’s budget has not kept up with the growth needed in the Office of Healthy Aging, charged with overseeing the state’s programs and services for older Rhode Islanders. “Additional funding is needed for increasing the Department’s staffing capacity and increasing financial support of Senior Centers serving thousands of older Rhode Islanders every say,” he adds.

But do not forget oral health of seniors, says SACRI.  According to the aging coalition, the importance of accessing quality oral health care in nursing homes is key to a nursing facility resident’s health, well-being and quality of life. Poor oral health care results in a higher incidence of, pneumonia cardiovascular disease diabetes, bone loss and cancer; all situations increasing the frequency of accessing medical care resulting in higher costs. 

Improving oral health care to Rhode Island’s seniors and special populations

SACRI calls for the passage of S-2588 and H-7756, bills that would provide for reimbursement for patient site encounter mobility dentistry visits to be increased to $180 per visit. The state’s reimbursement for mobile dentistry site visits began in 2008, only in nursing homes, but failed to provide funding for dental care in other settings. 

These bills would also expand the availability of this service to additional community-based group homes, assisted living facilities, adult day health and intellectual and developmental disability day programs. Passage of these bills will increase access to special populations who have difficulty in accessing basic dental services.

S-2588, referred to the Senate Finance Committee, was held for further study.  The House companion measure is scheduled to be heard on May 28th at a House Finance Committee hearing. 

Reimbursement for this service has not increased since it was initially funded over 14 years ago and does not cover the cost of delivering this critical service, says SACRI.

SACRI says “Make your voice heard!  Call House Speaker Joseph Shekarchi (401 222-2466) and Senate President Dominick J. Ruggerio (401 222-6555) and your legislative delegation to urge supporting SACRI’s priority legislation. 

To see a listing of SACRI’s 2022 Priority Legislation, go to https://img1.wsimg.com/blobby/go/049a7960-1c2a-4880-afdd-8d1e0e283acc/downloads/SACRI%20Bill%20Tracker%202022.pdf?ver=1653052514912.

For more details about SACRI, go to https://senioragendari.org/

Watching over Nursing Homes once again – time for mandated Boosters

Published on December 20, 2021 in RINewsToday

Colder weather is keeping people more indoors now, and Thanksgiving and pre-Christmas gatherings are drawing people together in groups, small and large. Like other states across the country, Rhode Island is seeing a growing transmission of the COVID-19 Delta, and now Omicron variants. Some national sources say Rhode Island’s case rate is the highest.

According to WPRI’s COVID-19 tracking page, 73.7% of Rhode Island’s population, totaling 1,097,379 are fully vaccinated, 9.2 % are partially vaccinated, and 17 % have received no vaccination at all. “But some back-of-the-envelope math based on the state’s tally of daily doses shows nearly 251,000 people have received booster shots or third doses. And earlier this week, RI Gov. McKee publicly said the number is closer to 260,000 people,” says WPRI.

Taking a Snapshot of Vaccination Rates in Rhode Island’s Facilities

Just days ago, AARP Rhode Island called for increased boosters in the state’s nursing homes after releasing its new analysis of the latest data from AARP’s Nursing Home COVID-19 Dashboard.  The Dashboard revealed that only 54% of nursing home residents and 19% of staff in 79 Rhode Island nursing homes have received a COVID- 19 booster.

“With holiday gatherings on the horizon, these numbers are a cause for concern for state policy makers, as more than a year and a half into the pandemic, rates of COVID-19 cases in nursing homes are rising again nationally, along with increased community spread,” says AARP Rhode Island. While case rates declined slightly compared to the same time period last month, in AARP’s dashboard, looking week to week, the number of cases increased each week during the four weeks ending November 2, notes the state’s largest aging advocacy group serving more than 132,000 members aged 50 and older.

The Rhode Island-specific AARP Nursing Home Database says that resident cases grew from a rate of 0.64 per 100 residents in mid-October to 1.19 in mid-November. Staff cases decreased slightly from a rate of 0.96 to 0.82 during this same time period. Nursing home resident deaths from coronavirus rose slightly from a rate of 0.06 in mid-October to 0.11 in mid-November.

“COVID-19 continues to infiltrate America’s nursing homes with more than 1,500 new nursing home resident deaths nationally for the third consecutive month,” said AARP’s Rhode Island State Director Catherine Taylor. “Increasing vaccination rates—including boosters — among nursing home residents and staff is key to protecting our loved ones and getting the pandemic under control,” she says.

“AARP calls on nursing homes, state and federal authorities, and others to increase access to and receipt of COVID-19 boosters for both nursing home staff and residents,” Taylor added.

“As new variants emerge and vaccine immunity wanes, the low number of residents and staff who have received a booster creates an unacceptable level of risk since the disease spreads so easily in these environments,” says Tayler, urging Gov. Dan McKee “to prioritize the state’s most vulnerable population and take immediate action to addresses the relatively low percentage of nursing home residents and staff who have not received COVID-19 booster shots.”

According to AARP Rhode Island, while the percentage of residents and staff who have received boosters remain low, rates of those fully vaccinated—those who have received two COVID-19 shots—continue to slowly rise as of November 21. In Rhode Island, 99.10% of nursing home staff are fully vaccinated (the highest rate of any state in the nation) and 94.10% of nursing home residents.

The number of Rhode Island facilities reporting a shortage of nurses or aides rose sharply from 34.7% to 41.7% in the four weeks ending November 21, says the advocacy group. 

Rhode Island’s high vaccination rates can be tied to Rhode Island mandating all healthcare workers be vaccinated by Oct. 1, 2021, say John E. Gage, President and CEO of the Rhode Island Health Care Association. When the 30 day-compliance period ended, those who were unvaccinated were banned from entering the state’s healthcare facilities, he says, noting that termination resulted from failure to follow a reasonable policy set forth by their employer in compliance with Health Department’s emergency order. 

Yet, in at least one large nursing home facility, RINewsToday has learned, staff who refused to be vaccinated were either moved to non-patient-facing positions, or already worked in those positions, and allowed to keep working. An administrator said they are still working on encouraging 100% vaccination. Residents also have the right to refuse vaccination, and masks are required for patients outside of their rooms.

Families visiting had been restricted to the lobby, and at one time received a test in the parking lot prior to being able to enter. Today they are still screened for temperature, and they must wear a mask and complete a health symptom questionnaire. After a federal regulation went into effect several weeks ago easing access for families to visit, the screening also eased up and now tests are not required.

Any patient who is positive for COVID is moved to a quarantine area until fully recovered, and regular testing for patients and staff continues.

Some nursing homes are allowing families to take their loved one’s home for a Christmas holiday and then return after being with outside family and friends.

Gage notes that Rhode Island is ranked at No. 11 of states at a booster rate among residents of 54.1% compared to a national average of 38.4%.  Staff are boosted at 19.1% (#16) compared to a national average of 15.0%.  “Remember, individuals are not eligible for a booster until six months after their second dose of the vaccine series.  This will preclude some residents and staff, he says, stressing more credit should be given to the state’s health care facilities having the highest vaccine rates among staff and the second highest vaccination rate among residents.

According to Gage, the data released by the Centers for Medicare and Medicaid Services on Nov. 28, 2021 showed 99.38% of all workers in Rhode Island facilities are vaccinated – the highest (#1) vaccination rate for nursing homes in the country. Residents in Rhode Island nursing homes are 95.02% vaccinated – the second highest rate in the country.

To Booster or Not Booster, that is the Question

“With vaccines mandated in healthcare facilities and proof of vaccination being required to enter public places under the new Executive Order, it seems this would be a reasonable requirement for visitors to nursing homes,” says Gage, noting that this is not allowed according to the most recent guidance issued by the Centers for Med Centers for Medicare and Medicaid Services.

As to mandating booster shots for nursing facility staff, however, Gage warns, “staffing is at a crisis level already. We cannot afford to lose more staff with another mandate,” he says.

“The first rounds of vaccines were given most commonly by third-party sources such as CVS medical staff who came into the homes, similar as they do every year for flu shots”, said one nursing home administrator to RINewsToday – “For the boosters, we did them using our own staff, and ordering our supply from the RI Department of Health.”  Boosters were advised to be given 4-5 months from original vaccination completion – yet in the nursing homes most didn’t get them until 8 to 9 months – as late as the end of October.

However, Joseph Wendelken, Rhode Island’s Department of Health’s Public Information Officer, says that CVS and Walgreens are working to make COVID-19 vaccine booster doses available to all nursing facilities,. “If any facility is looking for additional support getting residents and workers vaccinated, we can provide that support,” he says.

Wendelken notes that there is a requirement for nursing home workers to complete a primary COVID-19 vaccine series, but there is no [federal or state] requirement for booster doses. “The data are becoming clearer and clearer that – especially with the Omicron variant – booster doses are absolutely critical,” says Wendelken.

“Residents [of nursing homes and assisted living facilities] were among the first to get vaccinated so that means their immunity has waned and boosters are needed to avert significant outbreaks and deaths,” says  Maureen Maigret, former director of the R.I. Department of Elderly Affairs and chair of the Aging in Community Subcommittee of the Long Term Care Coordinating Council. “It is critical that booster shots are offered to all nursing home and assisted living residents especially now that visitation has opened up and visitors do not have to show proof of vaccination,” she says.

As of December 15th, the RI Department of Health Department shows at least 114 new cases in nursing homes and assisted living facilities in the past seven days, says Maigret. “We must  remember that over 1,700 residents died as a result of COVID in these facilities and providing booster shots is our best defense against more fatalities for this vulnerable population.”  

Even though it is not a federal policy, a growing number of state officials across the country are calling for the definition for being fully vaccinated to now include the booster shot. With Rhode Island seeing a surge in COVID-19 cases and an increase in hospitalizations due to Delta and Omicron variants spreading throughout the state, many (including this writer) express it’s time for Governor Dan McKee to now mandate booster shots for nursing facility staff.  More important, it must become a priority for the Rhode Island Health Department to make sure that every consenting nursing facility resident receives a booster, too.

President Biden is set to address the country on Tuesday, at a time to be announced. There is speculation whether the term “fully vaccinated” will now include not just the two original vaccinations but the booster as well.

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 at  www.aarp.org/nursinghomedashboard. For more information on how coronavirus is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes. Medicare.gov’s Care Compare website now offers information about vaccination rates within nursing homes and how they compare to state and national averages.

RI Nursing Homes with new cases (more than 5) in the past 14 days:

Berkshire Place, Providence – 10 to 15

Jeanne Juga Residence, Pawtucket – 5 to 9

Oak Hill Health Center, Pawtucket – 20 to 24

Pawtucket Falls Healthcare, Pawtucket – 10 to 14

Summit Commons, Providence – 5 to 9

West View Nursing, West Warwick – 10 to 14

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard. For more information on how coronavirus is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes. Medicare.gov’s Care Compare website now offers information about vaccination rates within nursing homes and how they compare to state and national averages.