Gubernatorial Candidates Put Spotlight on Rhode Island’s Fragmented LTC Continuum

Published in RINewsToday on August 8, 2022

Last week, hundreds of seniors and aging advocates gathered at East Providence High School to learn more about aging policy positions from 6 Rhode Island Gubernatorial candidates. Many more watched virtually as the event was streamed online.

During the 143-minute forum, the invited Gubernatorial candidates (five Democratic and one Republican, gave two-minute responses to seven questions previously given to them and hammered out by the Senior Agenda Coalition of Rhode Island (SACRI) and its 17 cosponsors, that would elicit how each, if elected Governor, would fix Rhode Island’s fragmented long-term care continuum and provider payment systems.

According to Bernard J. Beaudreau, Executive Director of the Providence-based SACRI about 300 seniors and aging advocates came to personally see the Gubernatorial candidates outline their position on aging issues. Multiple platforms on Facebook and YouTube were promoted by a variety of senior advocacy groups that resulted in the over 300 virtual audience. Some held “watch parties” at one or more of the 12 senior centers, with approximately 135 people participating from throughout the state.

Before the forum began at 10:00 a.m., Deborah Burton, Executive Director of RI Elder Info, one of the forum’s sponsors, provided the welcome, explaining why it was so important for older voters to understand the aging agenda of the next Rhode Island Governor and their commitment to funnel funding and resources to the state’s aging program and services. “The policies of the incoming Governor will impact a large number of baby boomers in the state,” said Burton, noting that the Gen X’s, often forgotten, are right behind them. “We need to have a system [long-term care continuum] in place that is effective, that is funded, and is what we need and want as we age,” she said.

“It was very evident that these candidates came prepared and took the forum and all the issues impacting older Rhode Islanders very seriously,” said a very pleased Beaudreau.

Talking the Talk about Senior Issues

Here is a sampling of policy issues touched on by the candidates:

The attending candidates gave their thoughts as to how they would rebuild and sustain a viable workforce of nursing homes and homecare providers.

Two term Secretary of State Nellie Gorbea said she felt that we, as a society, do not value caregiving. She called for investing in the workforce of nursing home providers by increases tothe state’s Medicaid rates. The educational sector can become a pipeline to “nurture and grow” jobs for this sector, she said.

Governor Dan McKee stated he addressed staffing issues at home health agencies and nursing homes by expanding the Wavemaker Fellowships to include healthcare workers and increasing reimbursement rates for home health agencies by $ 900,000 annually. McKee also noted that in last year’s budget it gave the state’s nursing facilities a cost-of-living increase to ensure funding to increase their workforce.

Healthcare provider businesswoman Ashley Kalus, a Republican candidate, also called for increasing the Medicaid reimbursement rate. “Respect long-term care as a career choice which means there needs to be a path from home health care aide, to certified nursing assistant, licensed practical nursing, registered nurse and Nurse Practitioner through apprenticeship and training programs,” she said.

Former CVS Executive Helena Foulkes supports expanding Medicaid, but we must hold the nursing homes accountable to make sure that the increases of state funding go to workers and not to equity owners of nursing homes.

Healthcare advocate Dr. Luis Daniel Luis Muñoz says we should increase reimbursement rates for providers. He calls for the creation of a state-based medical school to create more dental professionals and physicians. “That is how we can increase the providers necessary to serve Rhode Islanders,’ he says.

Former Secretary of State Matt Brown blamed Rhode Island’s staffing shortage on the General Assembly slashing Medicaid reimbursement rates over the years. He called for an increase in Medicaid reimbursement rates and increasing minimum wage to direct care workers in Medicaid nursing facilities to $20 per hour. This would attract workers from Southern Massachusetts, he predicted.

The attending candidates also gave their thoughts as to their strategies for Medicaid rebalancing and the program’s expansion to improve home and community-based care opportunities along with ensuring financial viability of nursing homes.

Muñoz called for a targeted approach to supplementing wages for providers taking care of seniors, noting that “twenty dollars is not a livable wage. We lost the culture of taking care of people,” he said, “but it will take money, increasing providers; but programmatically the state needs to make a commitment to expand its community and home-based programs working with multiple departments, to bring back this culture of care.”

Brown warns that 87 percent of nursing homes are in risk of closing and the state must address this by increasing Medicaid rates so as to give these facilities the financial stability they need. As to home care, pay must be increased to direct home care workers. But do not forget about family caregivers.

“We do not have an adequate paid Family Leave program in the state,” he says. As Governor, Brown would call for creation of a program to give 16 weeks of adequate pay.

Kalus calls for seniors to be placed in the least restricted setting. There should be adequate senior housing available to allow a person to live independently in the community. “We must reimage the continuum of care,” says Kalus, stressing that different types of care must be working together.

According to Kalus, if you go to a hospital there should be an incentive to discharge you to a nursing home with rehab, if that is possible, and then provide an incentive to move a person to less restricted continuum of care from there, such as home care and then independent living. An organization, like an Accountable Care Organization, must ensure there are no incentives to keep you in one type of care environment, over a less restrictive one, she says.

McKee touted the $10 million dollars invested this year to rebalance the long-term care continuum. He announced that he plans to shortly issue an Executive Order to direct state agencies to review existing policies through a healthy aging lens and address accessibility and impacts on Rhode Island’s aging population. He will also direct state agencies to appoint a representative to the task force that will create a Statewide Aging Plan.

Foulkes called for the state to create a long-term comprehensive plan for providing programs and services for seniors. Politicians seem to implement short term fixes year to year, making small timeframe moves. She urges improving discharge planning and technology and compensating family members to keep seniors at home. Nursing home care should be changed to provide single rooms with single-use bathrooms to ensure their dignity of living in a nursing home, and prevent spread of infectious diseases, a lesson learned from the pandemic.

Gorbea says Rhode Island is “clearly off the mark” as to how it spends its Medicaid dollars on home care services. Twenty six percent of the state’s Medicaid budget is spent on home care, compared to many states allocating over 41 percent. “That’s where we have to go,” she says. “If you are going to encourage people to stay at home, you must have housing and transit options,” she notes.

In Retrospect…

“While there were similar opinions, each candidate presented their own perspective,” said SACRI’s Beaudreau, noting that he did not hear anything anyone said that would be objectionable to aging advocates. “We now have on record their pledge and commitment that there will be a plan and anaction agenda that will benefit all seniors of the state,” says Beaudreau, “if they are elected Rhode Island’s 77th Governor next November.

“It is clear we have a slate of very quality candidates,” says Beaudreau at the conclusion of the forum.

Maureen Maigret, chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee and SACRI Board Member stated, “the Forum exceeded my expectations in terms of attendance (in-person and virtual), and I consider it an absolute success.”

Maigret reported that all candidates supported: “making the Office of Healthy Aging a full cabinet/department with review of sufficiency of resources; expansion of Medicare Savings Program which I have been advocating for at least 5 years and adding a state COLA to SSI payments; requiring better data on minority older adult inclusion; addressing community living, housing and transportation needs of older persons and developing and implementing a comprehensive, interdepartmental strategic Plan on Aging.

What was most important is that this event made them really pay attention to the fact the state has a significantly growing number of older persons which calls for transformative change. By highlighting some policies needed to address these demographic changes and getting candidates on record in support of them, they can be held accountable,” says Maigret. “The other significant outcome was to have so many co-sponsors come together in support of the policies put forward,” she added.

“There needs to be immediate leadership and follow-thru with all appropriate stakeholders to design and implement a seamless state/local delivery system for “aging in place” services, including increased care payments and efficient reimbursement to providers,” says Vincent Marzullo, well-known aging advocate who served as a federal civil rights and national service administrator. “With vision and commitment, Rhode Island can be a more appealing retirement community by aggressively addressing healthcare disparities and elevating the RI Office on Healthy Aging to full Departmental status with broader authority/responsibilities. This conversation must now include our General Assembly leaders,” said Marzullo, a West Warwick resident who serves on SACRI’s Board.

Co-sponsoring this event was a broad coalition of 18 service providers and advocates: 

A Community Together, Alzheimer’s Association of RI, Carelink, Community Partners Network of RI, Economic Progress Institute, Leading Age RI, NAACP Providence Branch, Ocean State Center for Independent Living, PACE, Progreso Latino, RI Assisted Living Association, RI Elder Info, RI Health Care Association, RI Organizing Project, RI Senior Centers Directors Association, SEIU Healthcare 1199, Senior Agenda Coalition of RI and Village Common of RI.

To watch the forum, go to https://www.youtube.com/watch?v=okQ5FguKMao.

For info about the Senior Agenda Coalition of Rhode Island, go to https://senioragendari.org/.

RI Gubernatorial Forum to ask, “what’s your Senior Agenda”

Published in RINewsToday on August 1, 2022

The Senior Agenda Coalition of RI (SACRI) has joined 17 organizations to bring you Rhode Island’s 2022 Gubernatorial Forum where candidates will talk about senior issues. The event is scheduled for Wednesday, August 3, 2022, at 10:00 a.m. at the East Providence High School’s new 900-seat capacity auditorium. Seating is limited to 450 people, leaving space for social distancing. Doors will open at 9:30 a.m. At press time, 350 seniors and aging advocates have registered to attend in person or virtually.    

“Senior issues must be viewed as a public policy priority because Rhode Island’s older population is growing dramatically,” says Bernard J. Beaudreau, SACRI’s Exec. Director, and one of the event’s organizers. According to Beaudreau, the U.S. Census Bureau estimates that the state’s total population of 65 years and older has grown by 20% from 152,183 in 2010 to 182,486 in 2020, adding 30,303 people in this age group. Rhode Island’s statewide planning projections also indicate that people sixty-five and older will grow to over 247,000 by 2030, an increase of 65,000 seniors over the 2020 census.

Gubernatorial candidates to delineate positions on key Senior Issues

“During the 90-minute forum, the gubernatorial candidates will share their positions on seven questions, hammered out by event cosponsors, as to how they would address a variety of policy issues impacting older Rhode Islanders,” says Beaudreau.  “Attendees will learn how candidates would rebuild and sustain a viable workforce for nursing homes and homecare providers. They will also be asked about their plans for Medicaid rebalancing and expansion to improve home and community-based care opportunities while ensuring the financial viability of nursing homes,” he says. 

Beaudreau says the forum also gives the gubernatorial candidates an opportunity to detail their strategies on how resources can be increased to significantly support healthy aging in the community. They will be asked by the moderator what type of assistance will be given to low-income seniors, and will they support a yearly cost-of-living adjustment to the state SSI payment and increase eligibility for the Medicare Savings Programs for seniors and people with disabilities to at least 185% FPL.

The attendees will also learn how the candidates, if elected governor, will ensure that an adequate amount of the $250 million in funding for affordable housing is allocated for seniors and how they will work to ensure equal access to high quality healthcare and information about available health care resources.

Finally, the gubernatorial candidates will be asked to make a pledge to address the needs of Rhode Island’s older population and provide the leadership and resources necessary to create and implement a Rhode Island Strategic Plan on Aging.

Recognizing the political clout of Seniors

“SACRI’s upcoming Gubernatorial Candidates’ Forum is important as older adults historically have high turnout in elections and the Forum provides an opportunity to hear the candidates’ views on issues important to seniors,” says Maureen Maigret, Chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee. “The Forum should cause candidates to take a serious look at the state’s demographics, to note how the older population is growing, and to reflect on how government can best support older adults’ desire to remain healthy and living in the community and provide quality facility care when needed,” says Maigret.

“The Forum allows us to set forth policy priorities and hold whoever is elected accountable for addressing them. An example of this is when former Governor Raimondo was elected. She had been presented with priorities for restoring budget cuts to senior services such as Meals on Wheels and some of the cuts were restored in her budgets,” Maigret noted.

SACRI’s Beaudreau says that the senior vote will influence the outcome of the upcoming primary and mid-term. “Rhode Island seniors 60 years of age and older represent 34% of all registered voters and accounted for 42% of the vote in the 2020 general election. Rhode Island seniors have higher voter participation rates than the rest of the population,” says Beaudreau, this being 77% compared to 57% for voters under 60 years of age. “We have a powerful voice to be exercised to impact public policy,” he says.

Political pundit Wendy J. Schiller sees seniors as a crucial voting bloc in American politics. “On average, 72% of voters over the age of 65 turn out to vote in presidential elections, as compared to about 48.6% of voters under the age of 30. Seniors are consistent and typically well-informed voters on issues concerning Social Security and Medicare,” says Schiller, Royce Family Professor of Teaching Excellence in Political Science and Director of the Taubman Center on American Politics and Policy, Brown University. 

According to Schiller, in the past 3 elections, “seniors have split about 55-56% for the Republicans, and 45-46% for Democrats. Seniors have been viewed as more conservative (Sun City AZ, the Villages FL) but the data do not really bear that out as you can see. There is a tilt, but not a full lean toward the GOP; this midterm season might be different though. If the 22 midterm elections were held tomorrow, you might expect to see even a bigger swing toward GOP candidates than usual because of inflation alone. Inflation is just one area where there is a gap in issue concerns between older and younger voters. Older voters worry a great deal about inflation eating into their savings and pensions that are not adjusted for inflation while younger voters may be as concerned with climate change and abortion rights as much or even more than they are worried about inflation,” she says.  

Schiller says that seniors are like all other voters in that they are highly influenced by their political party affiliation, even in cases where the party proposes policies that run against their interests. “The GOP has proposed cutting Medicare ever since it was created, most recently under President Trump, but they are not careful to say that such cuts would not affect current recipients or even people aged 55 or over and the majority of seniors voted for Donald Trump in 2020. Democrats ran into some trouble with seniors when Bernie Sanders and others proposed Medicare for All because seniors thought it would dilute their own services through Medicare, and/or raise their premiums,” adds Schiller.      

Adds well-known Rhode Island Political Strategist, Rob Horowitz, “As a group, seniors vote more regularly than any other age group. In the 2020 presidential election, for example, more than 3-in-4 people eligible voters between the ages of 65 to 74 voted as compared to about 2-in-4 eligible voters between the ages of 18 to 24. Since Rhode Island has an older population, seniors are a key group in pretty much every state and local election.  Winning campaigns in Rhode Island and throughout the nation devote time and advertising dollars to reaching seniors.”

According to Bob Weiner, former chief of staff director of the House Select Committee on Aging under Florida Congressman Claude Pepper and former spokesman for both the Clinton and Bush White Houses, no one can forget the clout of older voters because they are the most motivated demographic group to vote. “They can’t be broken out by political parties as people expect,” observes Weiner, noting that it is a very close 50-50 split vote. “Older voters vote Democratic and Republican; the Democrats must do more to capture the senior vote.  It’s close. In 2020, while Joe Biden won the popular vote by 7 million, Donald Trump won the senior vote 52% to 47%. It’s not a matter of party. Seniors’ quality of life is not political,” he says.

“But on the issues, they will tear apart a candidate who doesn’t support Social Security, Medicare and the rights of seniors to have continued employment and privileges in society,” Weiner notes.

“So, anybody who thinks they can get away with some horrible position, such as cutting back Social Security or Medicare in five years or utilizing the myth that Social Security is in deficit crisis, they can’t  because it has a 2 trillion surplus resulting from Claude Pepper negotiations to keep the program fully solvent through 2034,” Weiner says, noting that it only needs a “little repair” to keep it going.    

“Anybody who thinks that they are going to use Social Security and seniors to fund other federal government operations is badly mistaken,” says Weiner. “When President Bush wanted to privatize Medicare and Social Security and made a campaign out of that he actually helped lose congressional seats in an off-year election,” said Weiner, warning political candidates to think twice when thinking about balancing the federal budget on the backs of the nation’s elderly. 

“Voting Gives You Power”

“In Rhode Island and across the country, the data clearly show that voters aged 50+ will be the deciders in the 2022 elections,” said AARP Rhode Island State Director Catherine Taylor. “We are working with dozens of advocacy volunteers who are fighting for voters 50+ to make their voices heard on the issues that matter – especially in Rhode Island where we are in the midst of a housing crisis, nursing homes are in jeopardy, the cost of long-term care is skyrocketing and where people want leaders who are committed to making local communities more livable.

“At the federal level, older voters want to know candidates’ positions on protecting and strengthening the Social Security benefits Americans have paid into and earned through years of hard work, protecting and improving Medicare benefits, lowering prescription drug prices, and supporting family caregivers who risk their careers and financial futures to care for parents, spouses, and other loved ones,” Taylor said.

“Voting gives you the power to decide what our future looks like,” she continued “But you have to be in the know to vote. AARP Rhode Island has collected the most up-to-date election information, including key dates and deadlines, to make sure that the voices of voters 50+ are heard. We are doing everything we can to make sure older Rhode Islanders are prepared to vote and know the safe and secure voting options included in the new, AARP Rhode Island-backed Let RI Vote Act. In mid-August, we will offer a Video Voter Guide posted along with all the latest election information at aarp.org/RIvotes,” Taylor said.

Co-sponsoring this event is a broad coalition of 18 service providers and advocates: 

A Community Together, Alzheimer’s Association of RI, Carelink, Community Partners Network of RI, Economic Progress Institute, Leading Age RI, NAACP Providence Branch, Ocean State Center for Independent Living, PACE, Progreso Latino, RI Assisted Living Association, RI Elder Info, RI Health Care Association, RI Organizing Project, RI Senior Centers Directors Association, SEIU Healthcare 1199, Senior Agenda Coalition of RI and Village Common of RI.

in the high school’s new 900-seat capacity auditorium. 

To read AARP web blog articles discussing the impact of senior voters at the polls, go to: 

www.aarp.org/politics-society/government-elections/info-2022/older-voters-midterm-issues.html

www.aarp.org/content/dam/aarp/research/surveys_statistics/politics/2022/aarp-targeted-congressional-districts-survey-voters-18-older.doi.10.26419-2Fres.00550.033.pdf

https://press.aarp.org/2022-4-6-Women-Voters-Age-50-Over-Will-Decide-Balance-Power-Next-Election

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/