Funding for Seniors in Raimondo’s FY 2020 Budget Blueprint

Published in the Woonsocket Call on January 27, 2019

By Herb Weiss

Almost two weeks ago, Democratic Governor Gina Raimondo formerly unveiled her $9.9 billion budget proposal to the Rhode Island General Assembly. The House and Senate Finance Committees then begin the task of holding hearings on budget plan, getting feedback from the administration and the public. Once the revised estimates of tax revenue and social-services spending is available in May, negotiations seriously begin between Raimondo, the House Speaker and Senate President to craft the House’s budget proposal. Lawmakers will hammer out and pass a final state budget for the fiscal year that begins July 1.

Local media coverage of Raimondo’s ambitious spending initiatives zeroed in on her call for expanding free tuition to Rhode Island College and adding some public pre-kindergarten, increasing minimum wage from $ 10.50 to $ 11.10 per hour, allowing mobile sports betting and legalizing recreational marijuana.

But, Raimondo’s budget proposal gives state lawmakers a road map for what programs and services are needed for a state with a graying population.

According to Meghan Connelly, DEA’s Spokesperson, a nearly 60 percent increase in the State’s population of residents aged 65 and older from the years 2016 to 2040 highlights the need for continued investments in programs servicing Rhode Island’s older adults and their family caregivers.

Connelly says Raimondo’s budget proposal, released on January 17, elevates Elderly Affairs from a division under the Department of Human Services to an Office within the Executive Office of Health and Human Services. The governor shifts financing for the office and 31.0 FTE positions to EOHHS to accomplish this recommended action.

“The projected increase in the state’s senior population – from 174,000 in 2016 to 265,000 by 2040 – coupled with the proven impact of community-based supports and services, highlights the need for continuing to invest in helping our seniors remain home, connected to their families and networks. Support of aging-related health-promotion initiatives are essential to maintain a high quality of life for Rhode Island seniors while minimizing aging-related healthcare costs,” says Connelly

“We are focused on making it easier for older adults to live independent, fulfilling lives for as long as possible,” said Michelle Szylin, Acting Director of the Division of Elderly Affairs. “The Co-Pay expansion [in the governor’s proposed budget] enables additional older adults to age-in-place, remaining safely in their homes and engaging in their communities.”

The Co-Pay expansion enables additional older adults to age-in-place, remaining safely in their homes and engaging in their communities. The governor’s proposal to expand the state’s Co-Pay program [by $ 550,000] will allow more seniors to reside in their communities, staying connected to their family and network of friends and neighbors.

Providing access to the Co-Pay program to individuals earning up to 250% of the Federal Poverty Level will allow more seniors to age-in-place with a better quality of life and delay nursing home admission. The DEA Co-Pay program was established in 1986 as an option for elders who would otherwise be ineligible for subsidized home and community care assistance because they did not qualify for the Rhode Island Medical Assistance program.

Recognizing the importance of the state’s Elderly Transportation Program to keep older Rhode Islander’s independent, Raimondo’s budget proposal calls for additional funding of $1.8 million from general funds to support the State’s elderly transportation program. This program provides non-emergency transportation benefits to Rhode Islanders age 60 and over who do not have access to any means of transportation. The program provides transportation to and from medical appointments, adult day care, meal sites, dialysis/cancer treatment and the Insight Program.

Raimondo’s proposed budget also increases Health Facilities regulation staffing to increase the number of inspections to state-licensed health care facilities. The governor recommends a $327,383 increase in restricted receipt funds for 3.0 FTE positions. These positions will bolster existing staffing to increase the number of inspections to state-licensed healthcare facilities.

The Governor’s proposed FY 2020 budget also through the Rhode Island Public Transit Authority continues to subsidize the transit of elderly and disabled Rhode Islanders through the Rhode Island Public Transit Authority.

Raimondo’s proposed budget also continues the support for the Independent Provider model P model with almost $200,000 in general revenue funds budgeted (about $770,000 all funds) to cover implementation costs. The goal of this model is to increase workforce capacity and create a new option for delivery of direct support services for both seniors and people with developmental disabilities.

Finally, the governor’s FY 2020 budget also allocates funding to an array of programs and services for seniors. Here’s a sampling: $800,000 to support the state’s senior centers through a grant process (the amount was doubled last year); $ 530,000 to support Meals on Wheels; $ 85,000 to implement security measures in elderly housing complexes; $ 169,000 for the long-term care ombudsman through the Alliance for Better Long Term Care, which advocates on behalf of residents of nursing homes, assisted living residences and certain other facilities, as well as recipients of home care services; and $ 500,000 funds the state’s Home Modifications program at Governor’s Commission on Disabilities.

Nursing Facility Provides Take a Hit

Raimondo’s proposed budget plan seeks to freeze the state’s Medicaid payment rates to hospitals, slashing funding by an estimated $15 million overall for the year, and to limit the rate increase for nursing homes to 1%, costing them nursing home providers about $4 million.
“We are beginning the budget process with a 1 percent increase in the COLA (Cost of Living Adjustment), says Scott Fraser, President and CEO of Rhode Island Health Care Association (RIHCA), warning that “this is not enough.”

“Since 2012, nursing facility costs have risen 21.6 percent while Medicaid payment rates have only gone up by 9.6 percent, adds Fraser, noting that by statute, rates are supposed to be adjusted annually for inflation. “We will be advocating for additional funding for nursing facilities throughout the remainder of the budget process,” he warns.

Jim Nyberg, Director LeadingAge RI, an organization representing not-for-profit providers of aging services, joins with RIHCA in calling on Rhode Island lawmakers to restore the full inflation adjustment. “Ongoing increases in minimum wage (up 42 percent since 2012) make it harder for publicly funded providers to compete for skilled workers,” says Nyberg, noting that most of his nonprofit nursing homes have 60 percent to 70 percent of their residents on Medicaid. “A rate increase is needed help nursing homes recruit and retain the direct care workers that are so critical to providing quality care,” he says.

“Since 2016, our nursing homes and consumers have been severely disrupted by UHIP, financially and operationally. The ongoing problems with Medicaid application approvals and payments has resulted in significant increases in staff workload just to maintain operations, let alone the impact on cash flow and financial stability, adds Nybrg.

Nyberg’s group is also advocating to expand the CoPay program for individuals under the age of 65 with dementia. “This has been proposed in the past but not included in this budget. We think that such an expansion will help this at-risk population for whom no publicly-funded programs and services currently exist,” he says.

Lawmakers, AARP Rhode Island Gives Comments

AARP Rhode Island is encouraged to see that the Governor placed an increase in the State Budget for the Department of Elderly Affairs home healthcare Co-Pay program,” said AARP Rhode Island Advocacy Director John DiTomasso. “By increasing the income eligibility from 200% of the poverty level to 250%, more older Rhode Islanders will be able to obtain home care services at reduced hourly rates,” he added. “This will help large numbers of people to extend the time they can age in place in their home and in their community rather than in more costly state-paid long-term care facilities,” says DiTomasso.

Senate President Dominick J. Ruggerio says, “Upon a first look at the budget, I am very pleased that some of the Senate’s top priorities are incorporated. The Governor had to close a significant deficit, and difficult choices had to be made. However, the budget is a statement of priorities, and initiatives like the no-fare bus pass program for low-income seniors and disabled Rhode Islanders are a priority for us in the Senate. I am very pleased to see this program funded in the budget, along with many other services for seniors, and I look forward to deeper analysis of all aspects of the budget in the months ahead.”

AddsD House Speaker Nicholas Mattiello, “The House Finance Committee will soon begin holding public hearings and reviewing every aspect of the Governor’s budget proposal. We will make certain that the level of care and services to older adults will be maintained and hopefully enhanced. We are facing significant budget challenges this year, but we will always keep the needs of our seniors at the forefront of the discussions.”

Older Rhode Islanders and aging groups must continue to push the House to at a minimal maintain the governor’s senior agenda. Hopefully, as Mattiello said, senior programs and services can be enhanced.

For a Senate Fiscal Analysis of Raimondo’s FY 2020 budget, go to http://www.rilegislature.gov/sfiscal/Budget%20Analyses/FY2020%20SFO%20Governor’s%20Budget%20-%20First%20Look.pdf.

Financial Exploitation of Elderly Must Be Addressed

Published in Pawtucket Times, February 7, 2015

 Professor Philip Marshall, Coordinator of the Historic Preservation Program at Roger Williams University in Bristol, entered Room 562 in the Dirkson Senate Building not to testify on historic preservation policy, as he often did, but to share a family tragedy.  Marshall’s testimony detailed how his grandmother, New York philanthropist Brooke Astor, was financially exploited in her later years by his father.

Brooke Astor, a philanthropist, socialite and writer, was presented the Presidential Medal of Freedom by President Bill Clinton in 1998, for her generous giving of millions of dollars to social and cultural cause.  Marshall, one of four witnesses who came before the U.S. Senate Special Committee on Aging this past Wednesday, would say, that his 105 year old grandmother, who died on August 13, 2007, was considered to be “New York’s First Lady,” and a “humanist aristocrat with a generous heart.”

Marshall, a resident of South Dartmouth, Massachusetts, told the panel his mother would never have wanted to be known as “one of America’s most famous cases of elder abuse.”

“Nor did she, while in the throes of dementia, choose to be victimized to be deprived, manipulated and robbed – all as a calculated ‘scheme to defraud,’ as later characterized by the Manhattan District Attorney,” said Dr. Marshall.

Astor’s financial exploitation “may be her greatest, most lasting legacy,” says  Marshall.

In his testimony, Marshall told the attending Senators that after a three-month battle for guardianship to protect his grandmother’s assets, a settlement was reached five days before the court date.  A criminal investigation launched by the Manhattan District Attorney after a potential forgery was referred to his Elder Abuse Unit, would later lead to the indictment in 2007 of his father and a lawyer, says Marshall.

Two years later, after a six-month criminal trial the jury would find Marshall’s father guilty on 13 of 14 counts against him.  All, but one, were held up on appeal.

“While my grandmother’s stolen assets were reclaimed, many elders never reclaim their money – or their lives,” observes Marshall.  “Here, for financial transactions, enhanced detection, mandatory reporting, and greater reporting of suspicious activity will help,” he says.

A Growing Epidemic

 In her opening statement, Senator Susan M. Collins, (R-Maine) who chaired, the Senate Aging Panel’s hearing, “Broken Trust: Combating Financial Exploitation Targeting Vulnerable Seniors,” warns that a growing epidemic of financial exploitation is happening – one that she estimates to cost seniors an estimated $2.9 billion in 2010, according to the Government Accounting Office.

Financial exploitation is a growing problem in Rhode Island, too, notes Senator Sheldon Whitehouse (D-RI), a member of the Senate Aging Panel. “Sadly, this number likely underestimates the cost to victims because older adults often do not report abuse, particularly when it involves a family member.”

Senator Whitehouse noted that this week’s Special Committee on Aging hearing examined the challenges to identifying and prosecuting fraud schemes and highlighted strategies to prevent the financial exploitation of seniors. “There are steps we can take to address this problem, and I strongly support the Older Americans Act, which recently advanced out of the HELP Committee and addresses financial exploitation and other forms of elder abuse,” he added.

“Over the past several years the Rhode Island State Police has experienced a steady increase in the number of complaints of elderly exploitation and larceny from individuals over sixty-five-years, says Colonel Steven O’Donnell, who oversees the Rhode Island State Police.  During the past six years his Agency has investigated 40 complaints amounting to a total loss to victims of over $1,000,000.00.

According to O’Donnell, in 2010, State Police investigated four complaints related to elderly exploitation and/or larceny.  Four years later, 14 complaints were investigated. “These increases may be attributed to the increased computer literacy of willing perpetrators and the increased accessibility to bank accounts online, which provides perpetrators the opportunity to conduct their criminal activity behind closed doors,” he says.

Combating Financial Exploitation

To ratchet up the protection of older Rhode Islanders against financial exploitation, Rhode Island Attorney General Peter Kilmartin and the Rhode Island General Assembly passed a bill last year that extends the statute of limitations for elder exploitation from three years to ten years. Kilmartin says the new law, sponsored by retired Representative Elaine A. Coderre (D-District 60, Pawtucket) and Senator Paul V. Jabour (D- District 5, Providence), gives law enforcement officials the necessary time to build a proper case for charging and subsequent prosecution, bringing it in line with other financial crimes.

“The law about financial exploitation is on the books—let’s enforce it,” says, Kathleen Heren, State Long Term Care Ombudsman, at the Warwick-based Alliance for Better Long Term Care. “What a sad world we are in where a senior or a disabled person loses everything they have scrimped and saved for to a greedy individual who, in the majority of cases, is a family member,” she adds.  Over the years she has also seen financial exploitation involving clergy, lawyers, bank tellers, brokers, and “people who you would never suspect would steal from a frail elder.”

“Many people who hear “elder abuse and neglect” [or financial exploitation] think about older people living in nursing homes or about elderly relatives who live all alone and never have visitors. But elder abuse and financial exploitation are not just problems of older people we never see. It is right in our midst, and as Attorney General, I am committed to doing all I can to protect all of the citizens of our state,” says Kilmartin.

“Many elders rely on others for assistance, but oftentimes think they can easily trust these helpers to handle their financial affairs, only to be robbed of their hard earned money,” says Kilmartin, noting that in some cases the perpetrator leaves the victim penniless.

Kilmartin notes that financial exploitation of elders is one of the most challenging crimes to investigate, charge and prosecute.  By the time law enforcement becomes aware of the abuse and investigates the matter, the statute of limitations has often expired.  “The statute of limitations needs to be more reasonable so these complicated cases can be prosecuted appropriately,” states Rhode Island’s Attorney General. “Seniors, especially those who must rely on others for care, were unnecessarily made more vulnerable by the previous short statute of limitations,” he says.

According to Kilmartin, The Office of Attorney General has a specialized unit of prosecutors and investigators that handle elder abuse cases.  Several years ago, the Elder Abuse Unit was created because of the large percentage of Rhode Islanders who were age 60 and over. The special needs of the older victims and the fact that elder abuse, neglect and exploitation crosses all racial, socio-economic, gender and geographic lines made the need for a special unit apparent.  Coupled with this fact that this age group is the State’s fastest growing demographic, crimes against older persons often times go unreported, presenting high temptation and low risk for prosecution.

In Rhode Island, there is a mandatory duty of all citizens to report a suspicion of elder abuse and/or elder financial exploitation. To report elder physical abuse and/or elder financial abuse, contact your local police, Rhode Island State Police or the Rhode Island Division of Elderly Affairs at (401) 462-3000 or dea.ri.gov.

Herb Weiss, LRI ’12 is a Pawtucket writer covering aging, health care and medical issues.  He can be reached at hweissri@aol.com or at 401 742-4372.

 

Susan Sweet Takes the Reins of AARP’s Community Educational Initiative

Published in Pawtucket Times, July 11, 2013 

            Accepting the challenge offered by organizers of Rhode Island AARP’s “You’ve Earned a Say”, veteran advocate and organizer, Susan L. Sweet, has come out of semi-retirement, stepping to the plate to coordinate a series of “community conversations”  to continue efforts of promoting dialogue throughout the OceanState on the future of Social Security and Medicare.

             After years of paying into Medicare and Social Security, AARP, a Washington, D.C.-based group representing 40 million Americans, believes that age 50 plus aging baby boomers and older persons deserve a voice in the Inside the Beltway debates that impacts their future retirement years.  “You’ve Earned a Say” is a AARP-led national conversation committed to providing people with critical information about the domestic policy proposals being debated in Congress — simply put without the political jargon and spin.

             Regional events to be held in Warwick, Pawtucket and elsewhere – free and open to all — will be scheduled throughout the summer into the fall as Congress and  President Barack Obama begin to weigh in on policy changes for these critical domestic programs.

             “Susan has a remarkable knack for encouraging people to become actively engaged in matters that deserve public attention and involvement,” said AARP State Director Kathleen Connell. “We are fortunate that she has agreed to take this on. She will bring great energy to AARP’s ‘You’ve Earned a Say’ outreach and engagement efforts. The fate of Social Security and Medicare is important to all Rhode Islanders and we hope many will take part in our forums. Working with our staff and other AARP volunteers, Susan will be a tremendous asset. She is a force of nature.”   After seeing her in action for over 18 years this columnist agrees.

             A veteran of the 1960s civil rights movement and the War on Poverty, Sweet joined the state Department of Community Affairs (DCA) in 1972, where she founded and led numerous Rhode Island Division of Women’s programs.  She worked with the General Assembly to secure the first state funding for Domestic Violence Shelters.  While at the DCA, she also wrote a grant, funded by federal dollars, to establish community health centers throughout the state.

             In the late ‘80s and ‘90s, Sweet was Associate Director of the R. I. Department of Elderly Affairs (DEA), creating and developing a number of award winning programs, including the RI Pharmaceutical Assistance to the Elderly Program, popularly known as RIPAE.  She initiated a first in the nation statewide Elder Housing Security program and various legislative and programmatic initiatives to assist elders in the state.

             Sweet, a Rumford resident, earned the monikor as the mother of RIPAE by initiating, planning, organizing, managing and finally directing the state program that would ultimately assist 32,000 Rhode Island  limited income seniors with state co-payment assistance for prescription drugs. After leaving the DEA, three attempts were made by sitting governors (both Independent and Republican) to eliminate the program and the advocate led all three successful efforts to restore RIPAE funding in the state budget.

             After retiring as DEA’s Associate Director in 2000, Sweet has been a consultant and lobbyist on Smith Hill for nonprofit agencies and an advocate for vulnerable populations and issues such as immigrants, domestic violence, homeless and seniors. Her clients have included the Senior Centers Directors Association, the Alliance for Better Long Term Care, International Institute, the Coalition Against Domestic Violence and others.

             On a personal note, Sweet, 72, cares for five adopted cats, all abandoned or abused, putters in her large backyard garden, spends time with two children and two grandchildren.  Being an expert on Roman history she reads many tomes on that era, and on world archeology and history.

Social Security on the Chopping Block

               Democratic President Obama and a Democrat-controlled Senate and a GOP House of Representatives are trying to reach a budget deal in the coming months. President Obama has proposed a change that would slash $127 billion from Social Security benefits over the next ten years, hurting many older beneficiaries who are already living on very tight budgets stretched far to thin by costly prescriptions, rising utilities, and increased health care costs. AARP and other aging groups are pushing hard against these cuts, mobilizing their troops to oppose. 

             Social Security is a self-financed program, not a piggy bank for deficit reduction, noting that aging baby boomers and seniors have paid into this pension program their entire working lives.  According to AARP polls, older Americans expect their elected representatives in Washington to fiscally secure Social Security for future generations and keep the promise Congress made 78 years ago: that this retirement program would provide a financial safety network in their later years.

             According to Sweet, the proposed chained CPI is a flawed policy that will hit Social Security beneficiaries in their pocketbook. Each year the Social Security Administration (SSA) makes the determination, based on market prices, whether to adjust the Social Security payment to beneficiaries and, if so, by how much.  The chained CPI is a formula that assumes that people will simply buy cheaper products.  “But that is not the case for seniors, whose greatest expenses are health care, utilities and other costs that can’t often be replaced,” So, the chained CPI is just a term that means that the average senior will lose more than $2,000 in the next 10 years and even more after that.  It also means that people reaching retirement age and/or planning for retirement will have even more of a reduction.

             Furthermore, Sweet finds it extremely disappointing that a Democrat President would offer, as an opening gambit in the budget process, a reduction in Social Security benefits by using a new and inappropriate method for computing Cost Of Living Adjustments (COLAs).  In fact, Social Security, a program that pays for itself and has never run a deficit, should not be used to offset deficits in other programs. We should be talking about how to strengthen the program, not reducing it, she states.

 State Pension Changes Hits Retirees, Too

             But, with Social Security COLA cuts looming if Congress takes legislative action to endorse chained CPIs, aging baby boomers in the OceanState who will shortly retire or those already receiving their municipal or state pension checks will see less retirement income because of actions of the Rhode Island General Assembly.

                 “Any additional loss of retirement income is certainly a concern for public employees who, as a result of the 2011 slashes in their promised retirement income,” said AARP’s Connell. “Lawmakers need to understand that there are earned benefits. People plan their retirement based on what they are told they can count on – whether it is a public or private pension, or Social Security. As we have said for the past two years, Congress and the President should not address the deficit by pursuing harmful cuts to Social Security and Medicare.” 

             Sweet agrees stating that “Rhode Island was at the very front of the attack on older folks with an extraordinary coup which stripped public service retirees and workers of hard earned compensation for their work. They called it “pension reform”, but that is not what it was.  Everyone knows that it is not fair to change the rules in the middle of the game and certainly not after the game is over.  But that is what is happening around the country, in private and public employment.”

             Social Security and other pensions are not “entitlement programs” but more like insurance programs that you pay into with the promise and expectation of a certain coverage, notes Sweet. The aging advocate asks: “Should the insurance company be allowed to change the benefits upon payout? Should government (state or federal) cut benefits to retirees absent the most pressing of circumstances?”

             But, certainly in the case of Social Security, there is no emergency, but rather a timely need to insure that the program can continue to fulfill its mission, she says.

             Robert A. Walsh, Jr., Executive Director of NEA, National Education Association Rhode Island, representing 12,000 members in education and in city and state government, refers to the recalculation of COLAs by using chained CPIs as “voodoo economics.”  While supporters of this recalculation policy note it reins in Social Security costs, they should at least be honest about the fact that it personally hits the retiree financially, right in their checks, he says.  “If you’re going to cut people’s COLAs, just be honest about it,” he says.

             Many of Walsh’s union members only receive their city or state pension as they are not eligible for Social Security benefits. People retired with certain expectations [as to what retirement income they had] and to make pension changes after they retire is patently unfair, says Walsh, noting they had no opportunity to plan for the decreased income.

             Throughout the nation there is a growing movement of aging baby boomers and seniors, fueled by AARP’s educational efforts, who tell Congress to simply  “Leave Social Security Alone”.  Strengthen it for future generations, they say.

             Sweet and millions of others tell Washington politicians that “Social Security is not a cookie jar to fund other programs.”   Sweet says you can make this known to Rhode Island’s Congressional Delegation, Senators Reed and Whitehouse, Representatives Cicciline and Langevin, by attending the upcoming “community conversations.”  Support their position opposing the change in the COLA and urge them to support Social Security by leaving it out of any budget deal, she urges. 

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