Tag Archives for Alliance for Better Long-Term Care

Governor’s Budget is Silent Regarding Many Senior Issues

Published in Pawtucket Times on March 24, 2003

Many of Gov. Don Carcieri’s policy initiatives can be found sprinkled throughout Fiscal Year 2004 Budget address.

While Carcieri’s 3,200-word speech identified his administration’s priorities – that is, maintaining human services, investing in education and creating jobs and fixing the state’s crumbling roads and bridges- it was silent on issues of interest to aging advocates and seniors.

At an AARP debate of gubernatorial candidates, Carcieri was asked if he would budget $15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing home residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million, for a total increase of $ 30 million.

At the debate, Carcieri acknowledged it would be difficult to find $15 million to fix the system because of the state’s looming budget deficit.

After a first read, Alfred Santos, executive director of the Rhode Island Health Care Association, found the recently released administration budget did not allocate the $ 15 million in new funding to allow nursing facilities to be reimbursed for the actual cost of care that they provide to frail residents.

Santos hopes to schedule a meeting with Gov. Carcieri and his policy staff to discuss Medicaid reimbursement and staffing issues.

“One of the biggest disappointments for seniors in the governor’s budget is his failure to include funding to allow more low-income persons to choose Medicaid waiver-funded assisted living,” noted Maureen Maigret, who serves as Lt. Governor Fogarty’s director of policy and executive director of the state’s Long-Term Care Coordinating Council.

“This has been a priority for the senior advocacy community, and the governor was supportive of this funding during his campaign,” says Maigret.

Maigret told All About Seniors that more than a year ago, the federal government had approved an additional 180 units in the state’s Medicaid assisted living waiver to respond to Rhode Islander consumer demands.

“Failure to fund these units is short-signed in terms of saving taxpayer dollars and denies low-income seniors the option to choose a less restrictive care setting,” said Maigret, who calls the state’s current assisted living waiver program a great success.

According to Maigret, in the last fiscal year, there was a decrease in state-funded nursing home use of about 50,000 days and an increase in Medicaid funded Assisted Living of about the same number of days. “We have reached the funding cap for these Medicaid-funded assisted-living units and have a waiting list of 35 persons,” she said, noting that some of these persons will now be forced to enter nursing facilities at twice the cost of the state.

Meanwhile, Maigret added that the governor’s budget does not address the dire need of more regulatory staff in the Health Department to monitor assisted living and enforce state standards.

On the other hand, the Rhode Island Pharmaceutical Assistance for the Elderly Program (RIPAE) is intact, Maigret said.

“With the costs of prescription drugs increasing at such alarming rates, RIPAE is a vital safety net for thousands of Rhode Island seniors.

Maigret noted that changes this year in Blue Chip and United Health senior plans may further impact many seniors’ accesses to prescription drugs, as these plans have new features which limit benefits for brand name drugs. Legislation proposed by Fogarty and introduced by Sen. Elizabeth Roberts and Rep. Peter Ginaitt will address this pharmaceutical issue, she said.

Finally, Maigret said senior advocates must watch other areas of the state budget that will ultimately impact seniors. Some community grants, such as those that support senior centers, are targeted for 10 percent cuts. While nursing homes are in line for an annual cost of living increase (COLA) in their Medicaid rates, no similar COLA is included for home and community care providers.

Maigret added the governor’s budget cuts about $ 10 million (state and federal funds) to continue its efforts of downsizing the Eleanor Slater Hospital Cranston campus, with a proposal to close two more wards. To offset these closures, the budget includes about $ 800,000 to fund about 20 more nursing home placements and new funds to increase capacity to serve persons with mental illness in community residential settings.

The push to get residents back into the community concerns Roberta Hawkins, state ombudsman and executive director of the Alliance for Better Long-Term Care. She opposes the closure of wards because there are persons in the community who require a higher level of care, a level that is only available at the Eleanor Slater Hospital.

Hawkins noted the administration budget does not include Medicaid funding to pay for dental services to seniors in the community and those residing in nursing facilities.

“The short-sidedness of this fiscal policy ultimately will increase care costs when the resident must be hospitalized for malnutrition, dehydration and bed sores, all caused by dental problems,” Hawkins said. “On a human level, who would want to constantly suffer from pain all night because of a toothache or gum problems?” she added.

Sandy Centazao, president and CEO of Meals on Wheels of Rhode Island, is still waiting to see if Carcieri will ultimately institutionalize her nonprofit group’s funding rather than continue to allocate it as a legislative grant. She expects this decision to be made before the enactment of the state’s FY 2004 budget on July 1.

With a looming recession and a nation at war, Carcieri and the General Assembly must ultimately make difficult decisions as to how to slice the state’s FY 2004 budget. The state’s final budget must  provide the funding and adequate resources to enable long-term care providers to take care of the state’s burgeoning older population. It’s the right thing to do, even n times of uncertainly.

Retiring Senior Advocate Played Key Role in Shaping Long-Term are Policy Debates  

Published in Pawtucket Times on November 18, 2002

Sheila Cabral Sousa, a long-time and well-respected senior advocate, leaves her post as executive director of the Rhode Island Association of Facilities and Services for the Aging to become a broker with statewide Residential properties.

Sousa has played a key role in shaping the Ocean State’s long-term care policy during her 12-year tenure representing nonprofit providers who operate nursing facilities, assisted living facilities and senior housing sites.

Sousa’s professional life experience would help her to successfully lead a major statewide nonprofit provider group, providing a continuum of  long-term care services to Rhode Island’s vulnerable elderly.

As a teenager, Sousa dreamed of becoming a lawyer. Once she received her bachelor of education degree from Rhode Island College, the young woman entered the Suffolk University School of Law in Boston.

Ultimately, she would complete a four-year night program, receiving a J.D. in 1971. Eight years in private practice would sharpen her legal skills, skills that would become valuable in helping her to lobby and shape public policy.

In 1979, a job offers given to her husband brought the young couple to Washington, D.C. Briefly, Sousa owned an operated an antique and collectible store in Alexandria, Va., until she found employment in the federal government.

While working for the Veterans Administration, her experience working on the Board of Veterans Appeals gave her a working knowledge of medical issues.

After the couple divorced, Sousa came back home to Rhode Island in 1986, where she would become the field manager for the Richard Licht campaign.  Her efforts helped him to become Lieutenant governor. From there, she became executive director of the Rhode Island Mental Health Association, a position that would give her an understanding of mental health issues in Rhode Island and a familiarity with the state legislature.

In 1989, Sousa would take the helm of the Rhode Island Association of Facilities and Services for the Aging (RIAFSA)

For 13 years, she would give credibility and recognition to the views of the nonprofit provider group to lawmakers, state policy makers and to the general public.  As executive director, Sousa would not represent one segment of the long-term care continuum, but the full spectrum, from nursing facilities, assisted-living facilities to senior housing.

Sousa leaves her position with many admirers.

“Enormously intelligent,” “quick-witted” and “a very committed advocate for social justice, women’s issues and the elderly” are traits used to describe Sousa, as quoted by Maureen Maigret, director of public policy for Lt. Gov. Charles Fogarty.

“Sousa was not afraid to push people to really examine all the policy issues. She really forced one to take a look at all the angles of an issue to make sure the best results happened,” said Maigret, whose personal and professional friendship with Sousa spans back to the 1970s.

According to Maigret, Sousa has a strong interest in elderly housing issues and has called for the need of supportive housing services to be offered to the residents.

“Through Sousa’s efforts, the Rhode Island Housing Resources Commission wrote a report looking at the need for supportive housing for the elderly and those with disabilities,” Maigret stated, adding that this report will be released in the near future.

Adds Susan Sweet, a consultant to nonprofit agencies and an elder rights advocate who is also a longtime friend of Sousa, “She can pierce the babble of irrationality with her quick and sharp wit and is never afraid to do so. She is fearless and funny, smart and compassionate. Quite a combination, adds Sweet.

“Wherever she spends her time, she will bring her considerable strengths to it and it will do well and do good things,” added Sweet.

Steve Horowitz, CEO of East Greenwich-based St. Elizabeth Community and RIAFSA’s past president told All About Seniors that Sousa is “a dynamic person” and a “visionary,’ and that she was the nonprofits first and only executive director.

“She was instrumental in bringing RIAFSA to the table when the state discussed policy issues,” he said.

“She didn’t look at an issue as to how it would affect us today, but how it would impact RIAFSA down the road,” said Horowitz.

Furthermore, Sousa had a tough job because she worked with only a part-time assistant.

“If you see her accomplishments over the years, you would think we had a staff of five people-based on all the work that was done,” noted Horowitz.

Roberta Hawkins, executive director of the Alliance for Better Long-Term Care and the state ombudsman, called Sousa a tireless woman who worked extremely hard on behalf of her nonprofit providers without ever losing sight of the elderly clients that they served.

“I will miss her tenacious nature and wonderful sense of humor. Her sense of humor brought levity to intense policy decisions, observes Hawkins.

While Sousa worked hard, she also enjoyed life, too. She is a great cook and has a love for Irish country dancing and music and playing poker, her colleagues say. She is also quite an interior decorator, with an eye for color, too.

Sousa, 60, is not  turning her attention toward her new challenging mountains to climb.

“It’s tie to try new career options,” she said.

Some people say that everyone is replacement.” But in Sousa’s case, and to those who have come to love and admire her, the person who takes the helm of RIAFSA will have big shoes to fill.

A farewell party for Sousa will be held on Thursday, Nov 21, 2002, from 4 to 6 pm, ag Green Tea, 5600 Post Road, East Greenwich. For more information, call Steve Horowitz at 471-6069.

Morgan Health Center receives Prominent Award

Published in Pawtucket Times on July 1, 2002

Patient abuse, financial exploitation, Medicaid fraud, and poor nursing care.

In many cases, these activities are often picked up by the print and electronic media across the state.

The nursing facility industry will tell you that “bad news can sell a lot of newspapers.” In many cases, stories about good patient care, a loving staff and facilities that deliver high standards of care do not even reach the pages of a newspaper talk show or nighttime newscast.

Here’s a story that hopefully will be picked up and reported by Rhode Island’s print and electronic media.

The Joint Commission on Accreditation of Health Care Organizations (JCAHO) has awarded Johnston-based Morgan Health Center with Accreditation by Full Standards of Compliance for providing quality long-term care and subacute services.

Nearly  2,300 nursing facilities across the nation are JCAHO accredited every three years, notes JACHO spokesperson Charlene Hill.

Hill says that only five percent of these facilities receive the survey’s highest designation, that is, Accreditation with Full Standards Compliance.

In the Ocean State, 19 facilities out of 96, have been JCAO-accredited Only Morgan Health Center and The Clipper Home in Westerly, have obtained JCAHO’s highest designation.

What does JCAHO accreditation really mean to the consumer”

“JCAHO standards, in many cases, exceed federal nursing facility requirements,” Lois Richard, administrator of Morgan Health Center, tells All About Seniors,

Here’s an example of the difference between federal regulatory requirements and JCAHO. Federal law does not require a nursing facility to implement a process to accredit members of its medical staff, she says. However, JCAHO accreditation requires that facilities determine if physicians have hospital privileges, validate that they care malpractice insurance, actually have a medical license and practice within the scope of their license.

Ricard added JCAHO also requires that registered nurses, licensed practical nurses and certified nursing assistants also be credentialed in what they do. “Their skills and techniques are monitored annually or whenever necessary,” she said.

According to JCAHO, its accreditation process is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

JCAHO uses standards to conduct a survey every three years that is evaluative, consultative, and educational. The primary goal of this survey is to assist a facility to identify and correct potential problems and improve the safety and quality of care and services provided.

During the survey, information, is collected through  observation, interviews with residents and staff and document reviews. The survey measures the organization’s against objective, state-of-the-art standards contained in the Comprehensive Accreditation Manual for Long-Term Care.

Richard said her facility now enters its third accreditation cycle. The 120-bed skilled nursing facility sought its initial accreditation in 1996.

For Roberta Hawkins, state ombudsman and executive director of the Alliance for Better Long-Term Care, it is no surprise that Morgan Health Center was awarded JCAHO’s highest designation. Lois Richard is “personally vested in the facility,” Hawkins said. “It is more than just a 9-to-5 job, that’s what makes the difference,” she says.

The next survey is scheduled for 2005. Richard said to get another perfect scored, “you have to be doing what is expected of you every day.”

“As a JCAHO accredited facility, you’re consistently looking at what you do to identify the problems in order to respond proactively before they occur,” says Richard.

“You can’t let things fall through the cracks. If you do , things will start slipping,” she notes.

For their successful effort of reaching the highest level of JCAHO accreditation, Morgan Health Center, and its staff must be commended for their efforts. Positive stories about nursing facility care might even reduce the fear that seniors experience when they have to consider nursing facility care for their loved ones or for themselves.

Editors and news directors might believe that a negative story about poor care in nursing facilities might shed light on an issue that needs to be addressed by public officials.

While this is true, it is now time to give as much weight to stories that recognize the hard efforts of nursing facility staff who strive against incredible odds (from inadequate Medicaid reimbursement  to chronic staffing shortages) to provide higher standards of care.

The way I look at it, allocating more print space or air tie to recognize facilities providing quality of care is only-balanced journalism.