Tag Archives for Brown University Researchers

Advocates call for Governor to reject budget cuts they say would harm older adults

Published in RINewsToday on Oct. 28, 2024

As the state’s Office of Management and Budget (OMB) holds its Revenue & Caseload Estimate Conference to discuss the economic and revenue outlook for the upcoming legislative session, the Senior Agenda Coalition of RI (SACRI) warns of “onerous budget cuts” proposed by state agencies overseeing programs and services for Rhode Islanders. At press time, the state’s Medicaid and the Office of Healthy Aging offices proposed 7.5 percent budget cuts to be included in the upcoming fiscal year 2026 budget. 

“It is unconscionable that at a time when our older population is growing – projected to reach one out of every four Rhode Islanders in a few years — to propose budget cuts for programs proven to keep them healthy and safe and that in the long term can save taxpayers money,” says SACRI Board Chair, Diane Santos.

According to Santos, the requests put forward by the Office of Healthy Aging (OHA) include a reduction in state funds for the Meals on Wheels home-delivered meals program projected to cause 13,000 fewer meals to be delivered to persons unable to shop and prepare meals; cuts in funding for local Senior Centers and programs for older adults; elimination of grants to provide security services in elderly housing; and decreased funding to support the Elderly Transportation program. 

Santos warns that proposed changes in Medicaid eligibility guidelines are projected to cause hundreds of vulnerable older adults and persons with disabilities to lose state Medicaid coverage for their nursing home care and cause nursing homes, many of which are already struggling financially and face critical worker shortages, to lose millions of dollars if implemented. In addition, changes in the Medicaid CNOM (Costs Not Otherwise Matchable) program could reduce federal dollars that match state funding and impact hundreds of persons receiving home care and adult day services that help keep them living at home, the proposed cuts could result in greater spending in other areas.

For example, says Maureen Maigret, SACRI Policy Advisor, “Brown University researchers have shown that funds spent on home-delivered meals can delay or even prevent costly nursing home care.”

Over the years, Maigret noted that SACRI has worked to boost state funding to communities to assist them to operate local senior centers and programs. These serve hundreds of older adults and families across the state with a wide range of programs that keep older adults healthy, informed and connected to their communities, she noted.

SACRI has called for the state’s budget to provide ten dollars for each person aged 65 and over to Rhode Island’s 39 cities and towns, says Maigret, calculating that this amounts to about $20 per older adult. “The proposed cuts now being considered fail to recognize the increased need for these services due to the significant growth of our older population,” says Maigret.

Drawing a line in the sand

At press time, SACRI and its partners delivered a letter to Gov. McKee urging him to not balance the state budget on the back of Rhode Island’s older adults, stressing that the “potential ripple impact on families will be significant.

“Nonprofits and those who will be impacted need to know that SACRI and its partners are closely watching this process and are ready to advocate to protect programs and services which may impact our varied constituencies,” says Carol Anne Costa, SACRI Executive Director.

Costa continued, “The fastest growing demographic in RI is people over the age of 65. That is an obstinate fact. And cuts to the budget must be re-prioritized.” The Office of the State Ombudsman agreed, “If anything, OHA should be getting an increase, as they manage to complete all of their obligations on a shoestring budget. And kudos to Maria Cimini and her team at OHA for the outstanding work they do,” says Kathleen Heren, the RI Ombudsman.

Costa noted that OHA is Rhode Island’s designated state unit on aging. It serves as the chief advocate for older Rhode Islanders, adults living with disabilities, and family caregivers. “Prioritizing reductions in spending in areas not directly tied to OHA’s core mission or that would not harm vulnerable older adults and persons with disabilities dependent on Medicaid to meet their long-term care needs is clearly a place to start [in determining budget cuts]. Administrative expenses and the millions of dollars being paid out to consultants could be heavily scrutinized for budget reductions,” she says. 

Adds Mirelle Sayaf, Executive Director of Ocean State Center for Independent Living (OSCIL), “The proposed budget cuts pose a serious threat to the mission of the OSCIL, which is dedicated to supporting individuals with disabilities. Reducing funding, along with changes to Medicaid eligibility and essential programs, will harm those we serve. These cuts jeopardize vital services such as home care, nutritional support, and community engagement initiatives that empower individuals to live independently and maintain their quality of life.”

“Cutting the budget for the OHA when its resources are already extremely stressed to fully meet the needs of a growing older population is unjustified,” charges SACRI’s Maigret, who is also a former Director of the Department of Elderly Affairs.”

Maigret also opposes changes to Medicaid eligibility after advocates have spent years to ensure persons in need of long term supports and services have access to a range of affordable options, and avoidance of long wait lists for service. She calls for increasing resources to the Rhode Island’s cities and towns to help them support local programs for older adults and increasing eligibility for the Medicare Savings Program so lower-income persons on Medicare can afford needed healthcare.  But, Maigret also says that housing needs of older adults must be considered when allocating housing funds.

Food & Shelter important, too

Gerontologist Deb Burton, Executive Director of RI Elder Info also has some thoughts about the state’s proposed budget cuts.

“Cuts to Meals on Wheels that cause our most vulnerable, at-risk, elders to go hungry are simply unconscionable. Taking meals away from our elders cannot happen,” says Burton.

“We must bring back the housing stabilization unit for older adults. Older adult homelessness has increased more than 400% since COVID hit and rents skyrocketed. Rising housing costs, fixed incomes, and wait lists of 2-8 years for affordable elderly housing have all contributed to this crisis. In addition to these challenges, the application process for getting an apartment is onerous and nearly impossible if one does not have access to the internet,” adds Burton.

Eviction prevention is critical in addressing the elder homelessness issue, says Burton, noting that private sector partnerships and philanthropic donations can support a housing stability unit for older adults, ensuring sustainable funding for eviction prevention programs.

“We must find the strength and compassion to provide the funding necessary for food and shelter for our most vulnerable friends and neighbors. If we don’t, what does the future hold for ourselves?” asks Burton.  

A Final Call

“The November Revenue and Caseload Estimating Conferences will provide updated projections to inform budget development which will help set priorities. However, RI’s most vulnerable and fastest growing demographic must be prioritized in finalizing the FY2026 budget,” urges Costa.

The Best of…Research Confronts Nursing Homes’ Pain-Management Problems

Published December 10, 2001, Pawtucket Times

         Nobody says that old age is easy, especially for those who ultimately end up being admitted into a nursing  facility.  And for those residing in facilities, there is a very high probability of being in pain, Brown University researchers say.  One of the first nationwide research studies reported in the Journal of the American Medical Association last April that pain is “prevalent, persistent and poorly treated in nursing facilities.”    

         According to the JAMA study, nursing facilities across the country provided “woe-fully inadequate pain management” with a large majority of the residents ultimately experiencing excruciating severe pain just months after admission.  Furthermore, the researchers acknowledged that the study results may even “underestimate the actual pain burden.

        The study noted that for those able to report on their pain, the rate of persistent pain in Rhode Island facilities was 46.4 percent. Nationally, the rate is 46.7 percent.  For those in pain, persistent pain left untreated experience impaired mobility, depression, and a reduced quality of life, the researchers say.
 
        The Rhode Island Quality Partners, Inc., Brown University Researchers and 18 Rhode  Island nursing facilities came together last year to confront this issue by improving  how nursing facility residents are assessed for pain and how pain is managed.   At a press conference held last month, it was reported that all facilities participating had put into place pain policies and procedures, which included both the use of medication management and non-drug interventions like massage, music and aroma therapies and heating packs.

        During the 15 month study, the participating nursing facilities attended two-hour educational seminars each month.   The seminars were conducted by the project partners and, with the assistance of nurse facilitators, each facility began to develop pain policies and procedures, and worked with the project partners to implement the treatment protocols.

       Preliminary findings show a nearly 10-fold increase in the rate of comprehensive assessment of pain among the 18 nursing facilities, as well as a five-fold increase in the use of pain intensity scales to monitor the resident’s pain.  Translation.  Nursing facility residents benefited from the facility’s efforts to confront this care issue.

       “Some Rhode Island facilities watch previously inactive residents begin to participate in a variety of activities.  Others found that residents could cut back on some of their medications once their pain was well controlled,” stated Dr. David R. Gifford, principal clinical coordinator with Rhode Island Quality Partners.

       “Nursing facilities were able to get together, share and work closely with each other to try to improve pain management, despite the staffing shortages, inadequate Medicaid reimbursement despite all the other regulations they are trying to comply,” Gifford told All About Seniors.  “The participating facilities deserve credit for putting the time and resources into the project to improve an area of care that every one is concerned about, that is inadequate pain management.”

       “Both scientific and professional literature clearly tell us that pain management has been an area that can be controlled but it has not been,” states Wayne Farrington, Chief, Facilities Regulation, at the State’s Health Department.  “Sadly nursing facility residents have been living with unnecessary pain and implementing the best practices that were determined by this research project will greatly enhance the quality of life in 103 Rhode Island facilities.” 

        Hopefully, the states nursing home industry will disseminate the methods and practices identified as being successful by this research project to every facility in the state.  At least in Rhode Island, nursing facility residents should not be suffering from unnecessary pain.

        Herb Weiss is a Pawtucket, Rhode Island-based writer covering aging, health care and medical issues.  This article appeared in December 10, 2001 in the Pawtucket Times. He can be reached at hweissri@aol.com.