Aging in Place in Your Rhode Island Community

Published in RINewsToday on May 2, 2022

As the graying of the nation’s population continues, older persons are choosing to live out their remaining years remaining in their communities in their homes, whenever possible. A new just-released study of adults age 50 and older from the AP-NORC Center for Public Research and the SCAN Foundation, finds a majority of older persons would like to age in place and are confident they can access needed services that will allow them to stay at home in their community for as long as possible.  

Gathering Thoughts About Aging in Place

According to this new national study released last week, two-thirds of the respondents think their communities meet their needs for accessing services like health care, grocery stores and social opportunities. The researchers found that all types of health care services are widely perceived as easy to access in their communities, and most feel that local health care understand their needs (79%) and take their concerns seriously (79%).

But, a closer examination of the small proportion of older Americans (Blacks and Hispanics) who feel less prepared and less supported in their community raises concerns about equity in access to the resources necessary to age in place.

However, the study reported that a few respondents say they had a hard time accessing needed services because of communication obstacles like a language barrier (11%), cultural barrier (8%) or age gap (8%); issues with affordability (15%); or issues of respect for their religious (4%) or cultural (3%) background. 

Those in urban areas—and suburban areas especially—describe their communities as having more supports for aging in place than those in rural areas. Older adults in suburban areas see their communities as doing the best job with meeting needs for healthy food, internet access, and the kinds of foods they want to eat. Suburban areas are also seen as better than rural areas in particular at meeting needs for health care and social activities. Older rural Americans are less likely than those living elsewhere to use a range of services simply because they aren’t available in their area. They are less likely to feel that community services are easy to get and designed for people their age than those in urban or suburban communities as well. And they are less likely to think a variety of health care services would be easy for them to access.

Income disparities are also associated with access to critical aging services. Those with incomes of $50,000 and below are less likely than those earning more to have access to services that are in their language (73% vs. 82%), close by or easy to get to (58% vs. 65%), respectful of their religious beliefs (57% vs. 65%), or designed for people their age (53% vs. 63%). When it comes to medical services, they are also less likely to have easy access to dental care, physical therapy, pharmacies, nursing homes, and urgent care than those earning more.

Additionally, those age 65 and older generally feel more prepared and report better access to important community services than those ages 50-64.

Aging in Place in the Ocean State 

For older adults aging in place, in their own homes, is by far the preferred model, says Mary Lou Moran, Director, Pawtucket Division of Senior Services at the Leon Mathieu Senior Center. “In fact, the theme of this year’s federal observance of Older Americans Month “Age My Way” focuses specifically on this very topic. The coordination, accessibility, and connection to services and programs is critical to the successful delivery of services and is where much work needs to be done,” she says. 

Moran says that senior centers located in communities throughout the state deliver needed information and assistance to older adults on accessing the needed  services to age in place.  Social isolation, access to transportation, food and housing insecurity, economic stability, and connectivity to services, are obstacles to enabling a person to stay in the community in their homes, adds Moran.

Over the years, Rhode Island’s inadequate Medicaid rates have become major obstacles to allowing a person to stay at home. However, recent state legislation, H 7616, to recreate a Department of Healthy Aging, spearheaded by Reps Carson, Ruggiero, McLaughlin, Contvriend, Speakman, Ajello and Potter, addresses some of the challenges that service providers are facing when trying to assist individuals to age in place. Moran adds, as the number of older adults continues to grow exponentially, the time has come to fully put the needs of our elders in the fore front to enable them to age with choice, dignity and respect.

According to Maureen Maigret, policy consultant and Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, “Rhode Island is fortunate to have a number of government-funded programs that help older adults to age in place.” These programs include Meals on Wheels home-delivered meals program; Medicaid home and community services including home care, adult day services; assisted living and self-directed programs; Caregiver respite and support services; Home Modification grants to help make homes accessible; and elder transportation assistance for those age 60+ for medical trips, to get to adult day.  She also mentioned the Office of Healthy Aging’s Home Cost Share program for persons age 65+ and persons underage 65 with dementia who are not Medicaid eligible with income up to 250% of the federal poverty level and the wonderful programs offered at the state’s senior centers.

However, Maigret says that for some of these services such as home care there may be wait lists due to worker shortages. (People can find out about these programs or to find out what benefits they may be entitled to by calling the POINT at 401-462-4444).

There are also private services available for almost any service needed to help people age in place if they have the financial means to pay for them,” says Maigret.  

The National Village to Village Movement Comes to Rhode Island

While some of these volunteer programs in RI may offer some type of services such as transportation, a relatively new initiative has come to Rhode Island. “The Village Common of Rhode Island (TVC) provides a variety of supports through the efforts of almost 200 trained and vetted volunteers,” says Maigret. 

Maigret says that the goal of TVC is to help older persons to stay in their own homes and connected and engaged with their community. “This “neighbor helping neighbor” model started 20 years ago in Beacon Hill Boston and now there are 300 nonprofit “villages” operating across the country. TVC supports include transportation, running errands, home visits and telephone assurance, minor home repairs and light yard work, assistance with technology, and a virtual caregiver support program. A robust weekly calendar offers virtual events, and a monthly newsletter keeps members and guests informed. All this is done with a lean 1.5 person staff, a working board of directors and almost 200 volunteers,” she notes. 

“I had heard about the “village” model some years back and supported efforts to start a “village” in Rhode Island, she says. “It amazes me that a small band of committed volunteers were able to put all the pieces in place to operationalize a “village” and to see what has been accomplished. There are now active “villages” in Providence, Barrington, Edgewood/Cranston and Westerly with almost 300 members and more “villages” are under development. One of the priority goals of the Board is to reach out to underserved neighborhoods in our urban and rural areas to listen to people and find out what is important to them and what type of “village” program might work in their area,” she says. 

“We know that transportation is a huge issue for folks living in our rural areas and that is a huge concern. And, based on findings of the 2021 RI Life Index: Older Adults in Rhode Island(from RI Blue Cross Blue Shield//Brown University School of Public Health), we know that older persons of color living in our core cities have lower perceptions of community life, access to healthcare and experience lower food security and access to technology,” adds Maigret.  

“Research on the fairly new “village” programs shows promise in fostering feelings of being connected to others and suggest older women living alone with some disability most likely to experience improved health, mobility and quality of life (https://pubmed.ncbi.nlm.nih.gov/28509628/.),” says Maigret, noting that this is an important finding as Rhode Island has such a high portion of older adults living alone.

TVC President Anne Connor (74) says she has been a member and volunteer since 2015. “That we are volunteer supported is noteworthy and having an Executive Director, Caroline Gangji, (formerly acting Executive Director at Age Friendly RI), improves our ability to serve our members”, says the retired librarian and paralegal.

As TVC founder Cy O’Neil once said, ” …you don’t create a fire house when the house is burning.”  TVC is more than services – it is the relationships we build that are key to our success, says Connor.  

For details about The Village Common Rhode Island, go to https://www.villagecommonri.org/.

For specifics programs and services offered by the Rhode Island Office of Healthy, go to  https://oha.ri.gov/.  

It Takes a Village to Age in Place

Published in Senior Digest, February 2015

The simple act of joining his good friend, Reverend James Ishmael Ford, of the First Unitarian Church of Providence, for a quick cup of coffees piqued Cy O’Neil’s curiosity and led him on a journey to learn more about a new care option popping up around the nation, one that allows aging baby boomers to age in place right in the comfort of their home.

During their coffee chats, Ford, a native of California, began talking about his upcoming retirement, planning to return to his home state to be near his children.  But, he stressed the importance that his new California community must be located near a village.

O’Neil was intrigued and began Googling for information on specific villages, one was the The Beacon Hill Village.  He quickly got the concept.  Villages are created by membership-driven grass-roots organizations, with volunteers and paid staff, who coordinate access to affordable services, transportation, health and wellness programs, home repairs, social and educational activities, and other day-to-day needs enabling older persons to remain connected to their neighborhood community throughout the aging process.

According to Village to Village Network, there are now over 120 villages operating across the nation, in Canada, Australia and the Netherlands, with over a 100 additional Villages being developed.

Like many aging baby boomers, sixty-five-year old O’Neill did not want to leave his comfortable home in his later years, but stay put in his long-time Oakhill neighborhood.  The Village on Providence’s Eastside might just be the way to assist neighbors working together to successfully keep each other right in their homes, far away from assisted living facilities or nursing homes.

Creating Providence Village

Last February, O’Neill and several friends, over pot luck dinners, began  brainstorming how the Village concept could be brought to the Ocean State. One of the oldest Village organizations, The Beacon Hill Village, was established in Boston in 2001.  Why couldn’t the successfully run, The Beacon Hill Village, be replicated right here in Rhode Island, they asked.

Three pot luck dinners along with a larger event that drew over 30 attendees, resulted in a group of nine people who decided to launch an effort to create what they call the Providence Village.  This group consisted of a writer, editor, a geriatrician, college educators and administrators, people with business backgrounds, and artists.

“Rhode Island is the only state that does not have a village yet,” quips O’Neil.  There have been other attempts to bring The Village concept to Rhode Island but the failed,” he believes.

O’Neil, Boston College’s associate director for long-range planning and capital, notes that the Providence Village is still in the exploratory phase, gathering information.  The Steering Group is reaching out to Eastside Community in Providence through a survey on its website (http://providencevillageri.org/take-our-survey/) to identify the types of programs and services needed and identifying potential partners.  When completed, the Steering Group will move the organization into development phase where “serious planning begins to take place,” adds O’Neil.  At this phase, member benefits will be determined, organizational partners identified, and an operational, business and marketing plan developed.  .

“So far our responses have been very positive,” observes O’Neil.  “We’re energized by these responses and are very committed to rolling up our sleeves to make Village Providence work,” he says, noting that the Steering Group wants to create more opportunities to get more people involved to make Providence Village a reality.

Thoughts From Steering Group Members

Pat Gifford, MD, a retired geriatrician who is certified in hospice and palliative care who has practiced for over 30 years, brings her medical expertise and understanding of aging issues to the Steering Group.  The sixty-six year old Laurel Mead resident sees the village movement targeted to aging baby boomers.  “The Village is not a social service agency to take care of frail people,” she notes, but a “way of organizing people to take care of each other, often involving volunteering and a measure of paying-it-forward.”

Gifford, who brings extensive experience about the Village movement to the Steering Group, would like to write and teach on health and wellness issues for the members of the Providence Village, especially providing support to self-supportive groups for those with chronic diseases.  “It’s up to the Board of Village members if they are interested in these efforts,” she says.

According to Gifford, the key to Providence Village being a success is garnering strong grass roots support.  “It is important for people to go to visit our web site and complete our survey, so that we can understand the needs and desires of our unique community,” she adds.

A Final Note…

“The village movement is one of many approaches to senior living that AARP encourages,” said AARP State Director Kathleen Connell. “It’s impractical for many people to simply remain in the family homestead forever. It’s not ‘Aging in Place’ if the place isn’t right for you. Most people talk about downsizing as if it is all there is to be said about housing options. It’s not true, and we’re happy to see growing awareness that less house to maintain is really only part of the solution.

“One’s house and one’s home are two different things. You can choose another house, but people are most comfortable when they make a new home in an environment where they feel comfortable and live in proximity to the services and support they require as they age. AARP calls these livable communities and they are aligned with the thinking behind the village movement.

“Rhode Island does not have unlimited space to build new retirement communities. We need a balance of traditional senior housing development and the creative thinking and the adaptive use of existing housing.“

For more details about Providence Village go to http://providencevillageri.org/.

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

 

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