Countdown to 2024 elections heating up about what to do about Social Security

Published in RINewsToday on November 27, 2023

The political clock is ticking. It’s 340 days before the upcoming presidential elections and control of Congress and the White House are up for grabs. As education, abortion, foreign policy, immigration, crime are emerging as upcoming campaign issues, fixing Social Security and Medicare are also on the voter’s radar screens, too.

As the Democrats call for expanding and shoring up the existing Social Security Program (by introducing H.R. 4583, Social Security 2100 Act and S. 393, Social Security Expansion Act and other legislative proposals), Republicans are calling for changes in the program including looking at raising the eligibility age for full-time retirement, possible means-testing, and adjusting benefits for higher income earners.

The Nov. 9th Republican debate was not reassuring for younger taxpayers who are counting on collecting the Social Security benefits they earn with every paycheck, says Max Richtman, President and CEO, National Committee to Preserve Social Security & Medicare. Two of the GOP presidential hopefuls promised, in effect, to cut Social Security for future beneficiaries,” he said.

However, former President Donald J. Trump, who didn’t participate in this debate, has warned the other candidates not to make cuts in Social Security and Medicare benefits. While he opposes raising payroll taxes to ensure the fiscal solvency of these programs, he doesn’t provide specific proposals as how to do this.

Presidential GOP candidates call for fixes to an unsustainable Social Security system

According to Richtman, Nikki Haley claimed that Social Security is going “bankrupt,” and she would raise the retirement age for workers who are now in their 20s, and also means-test benefits. Chris Christie also said he would raise the retirement age and eliminate benefits for higher earners, essentially converting Social Security into a safety net program, instead of an earned benefit.

“Governor Christie and Ambassador Haley fail to recognize that future generations of retirees will rely on their Social Security benefits even more than today’s seniors do — and that means testing would cut deep into the heart of the American middle class,” says Richtman. “Ron DeSantis — to his credit — promised not to cut Social Security, but demonstrated a fundamental misunderstanding of the program’s finances by perpetuating the myth that the government is ‘stealing’ from the trust fund,” he added.

On Oct. 25, the newly sworn in Republican House Speaker, Mike Johnson (R-LA) sent a message to his caucus calling for Social Security and Medicare reforms to be made by a debt commission to tackle changes being targeted for these programs. Richtman warns that this approach is “designed to give Congress political cover for cutting Americans’ earned benefits.” In response, the Biden Administration described such a commission as a “death panel” for Social Security.

Over six years ago, Congressman Johnson (now newly elected House Speaker) called for cuts to Social Security. According to Independent News Network, Meidas Touch Network, in a 2018 speech before the American Enterprise Institute, as incoming chair of the Republican Study Committee, he called for cuts in Social Security, Medicare and Medicaid. He viewed these programs as “essential threats” to the American way of life, even suggesting that the government might cease to exist if they continued to be fully funded the way they are now.

Slashing SSA benefits through a Debt Reform Commission

“That is why these commissions have been rightly described as ‘death panels’ for Social Security and Medicare. It is unfortunate and disappointing that one of the Speaker’s first priorities is creating a mechanism intended to slash programs that American workers pay for in every paycheck, fully expecting the benefits to be there when they need them,” says Richtman, charging that the House Speaker “clearly wishes to break this compact with the American people.”

“Congress should address Social Security in the sunlight, through regular order, as it always has,” said Nancy Altman, President of Social Security Works, and former top assistant to Alan Greenspan on the 1983 commission. “The only reason to create a fast-track, closed door commission is to overthrow the will of the American people by cutting their hard-earned benefits. Anyone who supports this commission is supporting benefit cuts.”

In a Nov. 13 correspondence to Congress, Jo Ann C. Jenkins of the Washington, DC-based AARP, also opposes the creation of s debt commission. She strongly disputes the GOP’s claim that Social Security is a driver of the annual deficits or national debt, stressing that the program is self-financed.

According to Jenkins, 90% of the retirement program is financed through payroll contributions from workers and their employers. Around 4% of its funding comes from federal income taxes on some Social Security benefits and 5.4% comes from interest earned on U.S. Treasury bonds held by the Social Security Trust Funds.

“Any argument that claims that Social Security is a driver of the national debt – simply because it receives interest from the U.S. Treasury bonds- is disingenuous,” says Jenkins, noting that U.S. Treasury bonds are of the world’s safest investments.

Alex Lawson, Executive Director of the Washington, DC-based Social Security Works, agrees with Richtman’s assessment of House Speaker Johnson’s ongoing approach to Social Security and Medicare. “The Louisiana Congressman recently joined the vast majority of his caucus to vote for a commission designed to fast-track cuts to Social Security and Medicare behind closed doors”, notes Lawson.

“As Chair of the Republican Study Committee from 2019-2021, Johnson released budgets that included $2 trillion in cuts to Medicare and $750 billion in cuts to Social Security,” says Lawson. This includes raising the retirement age, decimating middle class benefits, making annual cost-of-living increases smaller and ultimately moving towards privation of Social Security and Medicare,” he notes.

With Johnson pushing for the creation of a debt commission, over 100 organizations have become co-signers on Nov. 8 correspondence to Congress opposing the legislative proposal.

Aging groups begin to mobilize

While the Social Security Trust Fund Report, released in April 2023, warned that Social Security funds will become depleted in 2033, making the program totally insolvent in 2034 when beneficiaries could only receive about 80 percent of their scheduled benefits, the cosigners say the program’s projected short falls are “manageable by size and still a decade away, are fully understood.”

“In this Congress alone, several legislative proposals that do just that have been introduced with numerous cosponsors. The only reason to make changes to Social Security via a closed-door commission is to cut already modest earned benefits — something the American people overwhelmingly oppose — while avoiding political accountability, say the co-signers.

“Congress already has a process to confront the federal debt. That process is known as reconciliation. Revealingly, Social Security cuts are excluded from the reconciliation procedure, because, as previously stated, the program is totally self-funded, cannot pay benefits or associated costs without the revenue to cover the costs, has no borrowing authority, and, therefore, does not add a penny to the deficit. Consequently, if a debt commission with jurisdiction over Social Security were to be formed, its purpose would be clear: to cut its modest benefits, while avoiding political accountability,” warn the cosponsors.

But the shortfall is real

In an article in Money magazine, the writer notes, “Taxpayer funds cover the bulk of Social Security payments, but if the program’s reserves run dry, beneficiaries would face immediate 20% cuts to their checks come 2034. Any decrease to Social Security payments would likely be extremely unpopular, considering they’re a major source of retirement income for tens of millions of people.” According to a new report from the American Academy of Actuaries, the longer the issue is put off, the harder it will be to address the looming shortfall.

The Third Rail of national politics

According to AARP research, “85% of older Americans, regardless of party, strongly oppose targeting Social Security and Medicare to reduce federal budget deficits. Specifically, the survey found that 88 percent of Republicans, 79 percent of Independents, and 87 percent of Democrats strongly oppose cutting Social Security. Similarly, 86 percent of Republicans, 80 percent of independents, and 88 percent of Democrats said they strongly oppose cutting Medicare.”

Washington insiders consider Social Security to be the “third rail of a nation’s politics”, a metaphor coming from the high-voltage third rail in some electric railway systems. Stepping on it usually results in electrocution and the use of the term in the political arena refers to “political death”.

Next November, can the GOP politically survive stepping on the third rail by targeting the nation’s most popular social welfare programs (Social Security and Medicare) for adjustments to reduce the federal budget deficit? When the dust settles after November, 2024 elections, we’ll see if younger voters, who have the most to economically lose, view Social Security and Medicare as a key issue influencing their vote and “untouchable.”

We’ll see.

Warning: Being lonely and isolated is hazardous to your health

Published in RINewsToday on May 8, 2023

Last Sunday, just days before releasing an advisory or “public statement” raising the alarm about the devastating impact of loneliness and isolation in the United States, U.S. Surgeon General Vivek Murthy published an essay in the New York Times announcing its planned release. In his essay he also talking about his own personal struggles with loneliness and called for enhancing social connections to be made a “top public health priority”.

One day before the release of Murthy’s new advisory on May 2nd, White House Press Secretary Karine Jean-Pierre said Murthy’s new advisory is a component of the Biden administration’s bigger efforts to address the nation’s mental health. The releasing of this advisory was well-planned, being issued in May, designated as Mental Health Awareness Month in the US.

Sounding the alarm

The 81-page advisory report titled “Our Epidemic of Loneliness and Isolation,” finds that even before the COVID-19 pandemic, about half of U.S. adults reported experiencing measurable levels of loneliness.

While the advisory is “not an extensive review of the literature” the information was culled from electronic searches of research articles published in English and resources suggested by “subject experts,” with priority given to meta-analyses and systemic literature reviews.

As the nation’s chief advocate for public health, Murthy is using his office as a bully pulpit to issue an advisory calling for the nation’s immediate awareness and attention to the widespread epidemic of loneliness and isolation. He also provides a roadmap as to how it might be swiftly addressed.

According to the advisory, even before the onset of the COVID-19 pandemic, approximately half of U.S. adults reported experiencing measurable levels of loneliness. Disconnection fundamentally affects our mental, physical, and societal health. Loneliness and isolation increase the risk for individuals to develop mental health challenges in their lives, and lacking connection can increase the risk for premature death to levels comparable to smoking up to 15 cigarettes daily.

The advisory noted that the physical health consequences of poor or insufficient connection include a 29% increased risk of heart disease, a 32% increased risk of stroke, and a 50% increased risk of developing dementia for older adults. Additionally, lacking social connection increases risk of premature death by more than 60%.

While there are no new promises of federal dollars for tackling this societal problem, the Surgeon General’s advisory is tended to raise awareness and lays out a framework for a National Strategy to Advance Social Connection, which has never been implemented before in the United States. The advisory also provides suggestions about how specific groups – including governments, providers, researchers, health organizations, schools, high-tech companies, media, parents and caregivers, community-based and philanthropy organizations, workplaces and individuals – can take to increase connection in their lives, communities, and across the country and improve their health.

“Our epidemic of loneliness and isolation has been an underappreciated public health crisis that has harmed individual and societal health. Our relationships are a source of healing and well-being hiding in plain sight – one that can help us live healthier, more fulfilled, and more productive lives,” said Murthy, in a statement announcing the release of this advisory. “Given the significant health consequences of loneliness and isolation, we must prioritize building social connection the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders. Together, we can build a country that’s healthier, more resilient, less lonely, and more connected.,” he said.

Brigham Young University Professor of Psychology and Neuroscience, Julianne Holt-Lunstad agrees with the Surgeon General’s assessment of the national importance of recognizing that loneliness and isolation can be hazardous to your health and to society’s wellbeing. “The advisory shows that too many Americans lack social connection in one or more ways and the evidence of the severe consequences have been growing for decades. While the pandemic helped raise awareness, since this was problem well before the pandemic, getting back to normal is not enough,” she says.

“This advisory helps bring greater awareness to this important public health issue, and sets forth a framework for a national strategy –with detailed recommendations for various stakeholders—to begin to take action. The personal and societal costs of inaction are far too high,” says Holt-Lunstad.

Along with affecting a person’s physical health, loneliness and isolation can contribute substantially to mental health challenges, too, says the advisory. In adults, the risk of developing depression among people who report feeling lonely often is more than double that of people who rarely or never feel lonely.

Meanwhile, loneliness and social isolation in childhood increase the risk of depression and anxiety both immediately and well into the future. And with more than one in five adults and more than one in three young adults living with a mental illness in the U.S., addressing loneliness and isolation is crucial to fully addressing America’s mental health crisis, says the advisory.

The advisory notes that while the epidemic of loneliness and isolation is widespread and has profound consequences for our individual and collective health and well-being of the nation, there is a simple way to attack this societal problem: social connection.

Social connection is beneficial for individual health and also improves the resilience of the nation’s communities. Evidence shows that increased connection can help reduce the risk of serious health conditions such as heart disease, stroke, dementia, and depression. Communities where residents are more connected with one another fare better on several measures of population health, community safety, community resilience when natural disasters strike, prosperity, and civic engagement.

Six pillars to advance social connection

This Surgeon General’s Advisory lays out a broad framework for the United States to establish a National Strategy to Advance Social Connection based on six pillars.

Pillar one calls for strengthening social infrastructure (parks, libraries, and playground) and the programs and policies in place.

The second pillar urges government at all levels to create “Pro-Connection” public policies like accessible public transportation or paid family leave to foster more connections in the family and community.

Because loneliness and isolation are risk factors for patients with heart conditions, dementia and depression, the third pillar calls for utilizing heath care providers to assess and identify patients for risk of loneliness and intervene.

Pillar four calls for critically evaluating our relationship with technology to ensure that how we interact digitally with others doesn’t reduce meaning and healing personal connections with others.

More research is needed to study the impact of loneliness and isolation, beyond the evidence outlined in the advisory. Pillar five calls for the deepening of our knowledge to understand the causes and consequences of social disconnection, populations at risk, and effectiveness of efforts to boost connections.

Finally, pillar six notes the importance of cultivating a culture of connection to influence the relationships of people we have in our daily lives.

This week in an RINewsToday article on combined loneliness – and grief – Dr. Mari Nardolillo Dias noted the compounding risk for individuals. Dias says, “Grief and loneliness are common, albeit toxic, bedfellows,” and she suggests building in small activities to look forward to which she says gives us “hope” for the future. (https://rinewstoday.com/griefspeak-choose-hope-mari-nardolillo-dias/)

Social engagement can help maintain good brain health

For years, researchers involved in the publishing of 13 Global Council on Brain Health (GCBH) reports on various brain health topics including the impact of social isolation and loneliness. “We’re thrilled that the Surgeon General is focusing new attention and energy on this critical topic,” says Sarah Lenz Lock, senior vice president of policy and brain health at AARP, also serving as GCBH’s executive director.

Both the GCBH reports and the Surgeon General’s advisory talk about the importance of social connections to health, says Lock. “The GCBH focused on how critical social engagement was to maintaining good brain health as you aged beginning in 2016, while the Surgeon General report in 2023 talked about all ages and health conditions, and followed the extreme social isolation brought about the pandemic that occurred afterwards,” she notes.

According to Lock, the pandemic was a forced natural experiment that demonstrated the harm of loneliness and isolation which is what we had being saying long before. But now we can see it in even more stark terms [after the pandemic],” she adds.

Lock sees the Surgeon General’s efforts to create a National Strategy to Advance Social Connections to be an extremely important initiative. “People of all ages need to take steps to stay connected with others for their health and mental well-being. It’s not just a “nice to have’ this kind of project, it’s a critical need to have for the health and well-being of our nation,” she says.

While there is no federal funding allocated to fund implementation of the advisory’s recommendations, a divided Congress might just be able to come together to address the personal and societal problems caused by loneliness and isolation. “This is an issue that affects both parties and we hope that it is viewed as a bi-partisan issue. Further, the healing power of social connection goes beyond individual health. The more communities, society, and leaders, can feel connected the more we can trust and rely upon one another and tackle many of the issues that we face as a nation,” adds Holt-Lunstad.

During this session of Congress, the Surgeon General’s advisory should be put placed on its policy agenda to hammer out new laws to enhance the nation’s social connections. In concluding the advisory’s letter from the Surgeon General, Murthy warns: “If we fail to do so, we will pay an ever-increasing price in the form of our individual and collective well-being. And we will continue to splinter and divide until we can no longer stand as a community or country.”

For a copy of the Surgeon General’s advisory, go to: https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf

GCBH has published 13 reports on various brain health topics. All of them can be found here: https://www.aarp.org/health/brain-health/global-council-on-brain-health/resource-library/.

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Tips on Connecting with Others

Below are recommendations to optimize and promote social engagement from the GCBH report. The recommendations are ordered so that the first ones might be appropriate for people who have very few social connections. This is followed by suggestions for those who are relatively socially active. The final recommendations are for those people who are already socially active. The GCBH also recommends that these people consider increasing the diversity or variety of their engagement. It is recommended that people should generally maintain a variety of the suggested types of engagements.

To promote meaningful social engagement:

1. Focus on the relationships or social activities you enjoy the most.

2. If you have no one around who can help you engage socially, turn to professionals who can assist. a. Examples: telephone hotlines, drop-in centers, a chat with a local religious leader, etc.

3. If you feel lonely, you can try to change this by making a new connection or by seeking different opportunities to engage with others.

4. If there are barriers to interacting with people (e.g., difficulty getting around, unsafe neighborhood), see if you can identify someone you could ask for help, and let someone assist you in making connections.

5. Try to keep a circle of friends, family or neighbors with whom you can exchange ideas, thoughts, concerns and practical matters, and who can also help or encourage you. It does not need to be a large group of people as long as those in it are important to you and you are important to them. Try to have at least one trustworthy and reliable confidante to communicate with routinely (e.g., weekly), someone you feel you can trust, and you can count on.

6. If you are married, this can benefit your cognitive health, but you should consider fostering other important relationships. Individuals who have never married or are divorced or widowed often have many other connections that provide support.

7. Try to speak every now and then (e.g., monthly) with relatives, friends and/or neighbors; communicate in person, or by phone, email or other means.

8. Help others, whether informally or through organizations or volunteer opportunities. For example, visit a lonely neighbor or friend, shop for/with them, or try cooking together.

9. Maintain social connections with people of different ages, including younger people. Keep in touch with grandchildren or volunteer to help people at a local school or community center. Think about the skills you have and that you use routinely that might be valuable to pass on to others. Offer to help teach a younger person skills you may already have, such as cooking, organizing an event, assembling furniture, saving for the future, investing in the stock market, etc.

10. Add a new relationship or social activity you didn’t try before. Place yourself in everyday contexts where you can meet and interact with others (e.g., stores or parks).

11. Be active and challenge yourself to try out organized clubs, courses, interest groups, political organizations, religious gatherings, or cooking classes.

12. If you are already socially active, diversify your activities. Consider joining or starting a group that doesn’t exist in your community and is centered around a common interest (e.g., a workout group).

Practical tips for those who have trouble engaging socially:

1. People can take small steps to connect with others. Share a smile a day with someone, show interest in someone by asking how they are, hold a door for someone, and practice a random act of kindness.

2. Reach out to neighbors or acquaintances whom you may not have spoken to in a long time: for example, call, send a card, email, or check social media.

3. Look at the list of additional resources that we provide in Appendix 1 and consider using them.

Source: AARP

CMS Moves to Strengthen Nursing Home Safety and Clarity of Consumer Info

Published in RINewsToday on January 23, 2023

To improve transparency of nursing home consumer information, the federal Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS), will now post Care Compare citations that are under dispute by nursing homes on its website. CMS will also take steps to protect nursing home residents from being inappropriately diagnosed with schizophrenia which oftentimes leads to improper use of anti-psychotic medications to sedate and chemically restrain residents.

“We have made significant progress in decreasing the inappropriate use of antipsychotic medications in nursing homes, but more needs to be done,” said CMS Administrator Chiquita Brooks-LaSure, announcing the new guidance this week. “People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medications,” she says.

CMS’s actions advance President Biden’s goal of reinforcing safeguards against unnecessary medication use and treatments that was outlined in his State of the Union address to create an Action Plan for “Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes.”

Tackling the inappropriate drugging of Nursing Home residents

Beginning this month, CMS will conduct targeted, off-site audits of nursing homes to determine whether facilities are accurately assessing and coding individuals with a schizophrenia diagnosis. Nursing home residents erroneously diagnosed with schizophrenia are at risk of receiving poor care and being prescribed inappropriate anti-psychotic medications. Anti-psychotic medications are especially dangerous to these residents due to their potential devastating side effects, including death.

According to the Washington, DC-based National Consumer Voice for Quality Long-Term Care, in 2008, CMS first introduced a quality measure in its Care Compare rating system that calculates the percentage of long-stay residents (over 100 days) that were receiving anti-psychotic medications. This quality measure was initially introduced to address the practice of some nursing homes of illegally using anti-psychotic medications to sedate residents with dementia or other increased patient care needs, rather than providing appropriate hands-on care interventions.

The measure, excluding residents with certain diagnoses, including schizophrenia, Huntington’s disease, and Tourette’s syndrome, resulted in some nursing homes improperly diagnosing residents with schizophrenia, observed the Consumer Voice, a national organization representing consumers in issues related to long-term care, helping to ensure consumers are empowered to advocate for themselves.

CMS’s new guidance acknowledges that there has been a steady rise in schizophrenia diagnoses since the quality measure was first introduced, charges the Consumer Voice, noting that it comes on the heels of a report issued by the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) which found that from 2015-2019 there was a 194% increase in the number of residents diagnosed with schizophrenia who did not have that diagnosis prior to admission to the nursing home.

“It is important to note that it is extremely rare for schizophrenia to suddenly occur in older people,” says the Consumer Voice, stating that the onset of schizophrenia generally occurs in someone’s late teens through their twenties.

CMS announced that it will begin to conduct audits of nursing homes with high rates of schizophrenia diagnoses and “examine the facility’s evidence for appropriately documenting, assessing, and coding a diagnosis of schizophrenia.” Facilities that have “inaccuracies” will have their Five-Star Quality Measure Rating adjusted. CMS will downgrade the facility’s Quality Measure ratings to one star, which would drop their Overall Star Rating as well. CMS will monitor each facility’s data to determine whether they have addressed the identified issues. After that, CMS will decide whether any downgrades should be reversed.

While Consumer Voice has expressed significant concern with the accuracy of CMS’s Quality Measure, it supports these actions. The Quality Measure rating often inflates a facility’s overall 5-Star rating on Care Compare. This action will help incentivize compliance and make sure the public is aware of these illegal practices in nursing homes, says the consumer advocacy group.

Increased transparency

Separately, CMS announced it plans to take a new step to increase the transparency of nursing home information provided to consumers by publicly displaying survey citations that facilities are disputing. Currently, when a facility disputes a survey deficiency, that deficiency is not posted to Care Compare until the dispute process is complete. This process usually takes approximately 60 days; however, some cases can take longer.

Although the number of actual deficiencies under dispute is relatively small, they can include severe instances of non-compliance such as Immediate Jeopardy (IJ) citations. This level of citation occurs when the health and safety of residents could be at risk for serious injury, serious harm, serious impairment, or death. Displaying this information while it is under dispute can help consumers make more informed choices when it comes to evaluating and choosing a facility. This new information will begin appearing on Care Compare on January 25th. While citations will be publicly displayed, they will not be included in the Five-Star Quality Rating calculation until the dispute is complete.

“We support anything that CMS can reasonably do to improve the health and safety of seniors in long-term care, especially those with cognitive impairment. When it comes to the nursing home industry’s concerns about new CMS rules, we think it’s best to err on the side of transparency. Seniors and their families need as much information as possible to make informed decisions about long-term care,” says a spokesperson for the Washington, DC-based National Committee to Preserve Social Security and Medicare, an advocacy group whose mission is to protect Social Security and Medicare.

Local reaction: “You cannot un-ring a bell”

RI Health Care Association

“We fully support improving nursing home transparency, safety and quality, and accountability regarding our members’ service to the residents and patients entrusted to their care,” says John E. Gage, President and CEO of Rhode Island’s Health Care Association, representing 64 of the 80 nursing facilities in the state. “Eliminating any inappropriate use of psychotropic medications and ensuring the highest quality of care is a shared focus of both CMS and RIHCA,” notes Gage.

“We strongly disagree with CMS’ decision to post of deficiencies that are in the process of being disputed through established CMS policies, regardless of their scope and severity, says Gage. “Posting deficiencies that, in many instances, are incorrect, inaccurately cited or cited at an inappropriate level of scope and severity, during an approved appeals process is unfair and could damage a facility’s reputation unfairly,” he adds.

According to Gage, doing this is akin to convicting someone before their full trial, (prosecution and defense alike) before the verdict is announced. “You cannot “un-ring a bell,” he says.

“As mentioned by CMS, we are just talking about a relatively small number of deficiencies,” states Gage. Rather than potentially posting erroneous deficiencies, he calls on CMS to speed up the process of conducting Informal Dispute Resolutions (IDRs) or Independent Dispute Resolutions (IIDRs) to no more than forty-five (45) days to ensure that accurate information is posted timely. IDRs and IIDRs are two different options from CMS that nursing homes can choose to appeal of cited deficiencies.

“As to the changes to the public reporting and the Five-Star Quality Rating System, we are disappointed that the Biden Administration and CMS have apparently made this determination administratively, without any comment period to allow for an opportunity for nursing homes and the public to provide feedback,” says Gage.

LeadingAge RI

“I appreciate CMS’s goal of increasing oversight of unnecessary antipsychotic medication use, although it should be noted that there has been a National Partnership to reduce the unnecessary use of antipsychotic drugs for years, so the industry has been very engaged in these efforts already,” notes James Nyberg, Executive Director of LeadingAge RI, a not-for-profit membership organization comprised of not-for-profit providers of aging services.

Nyberg expresses concern about CMS posting deficiencies that are under dispute publicly. “That is taking a guilty before proven innocent approach, which is unfair and detrimental to providers. There is an existing process to resolve disputes over deficiencies, and this seems to short-circuit it, especially when deficiencies can be/and are overturned during the process. One more blow to a beleaguered industry,” he says.

Long-Term Care Ombudsman

“The inappropriate use of antipsychotic medications in nursing homes has been an on ongoing issue for many years,” observes Kathleen Heren, Rhode Island’s Long-Term Care Ombudsman. “It takes a skilled practitioner who gives a battery of tests to diagnose someone with schizophrenia. This shouldn’t be determined by a hospital intern who spends 20 minutes with an agitated resident in a hospital emergency room,” she says.

According to Heren, schizophrenia has an early onset [about 4% of schizophrenia arise before the age of 15, and about 1% before the age of 10]. A 78-year -old resident does not become schizophrenic all of a sudden because he or she is agitated. “I can say that I have not seen many deficiencies given to Rhode Island nursing homes for overusing anti-psychotic medications,” she says, because of the efforts of Health Care Centrics, Rhode Island’s Quality Assurance organization, that has provided in-depth staff training on the use of these drugs. The surveyors from the Rhode Island Department of Health (RIDoH) are very quick to cite facilities for not following guidelines in the inappropriate use of these drugs.

Heren says that there have been cases where RIDOH has rescinded a deficiency based on the input received by the survey team during the Informal Dispute Resolution process. “There are some facilities that are continually receiving deficiencies and that families should be able to see why a deficiency was given and a facilities response as to why it was considered unfair,” she says.

CMS Actions promote quality of care

RI Department of Health

“At the Rhode Island Department of Health (RIDoH), one of our major focus areas is monitoring and ensuring that nursing homes and other healthcare facilities provide the highest quality of care and services in a clean and safe environment, says Joseph Wendelken, RIDoH’s Public Information Officer.

“We will continue to do everything we can to protect patients and residents, which includes following any new CMS protocols and partnering with CMS on new initiatives,” Wendelken says.

Senior Agenda Coalition of RI

Adds Maureen Maigret, Policy Advisor for the Senior Agenda Coalition of RI, “Rhode Island nursing homes have generally provided good quality of care over the years,” acknowledging that improvements can always be made. “Both of these changes are intended to promote better quality care,” she says. “If people are erroneously coded as having schizophrenia, they may be subject to poorer care and harmed by being prescribed inappropriate medication. Posting inspection citations under dispute on Nursing Home Compare with a notation they are under dispute is important in that resolution of the dispute could take 60 days or longer and in the meantime the public remains unaware of what could be significant deficiencies which could impact their decisions,” states Maigret says.

The QSO memo — Updates to the Nursing Home Care Compare website and Five-Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute — is available here for review:

https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-states/updates-nursing-home-care-compare-website-and-five-star-quality-rating-system-adjusting-quality

Herb Weiss

Aging Issues

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