Aging Report is “Rhode Map” for Change

Published on June 27, 2016 in Pawtucket Times

Next year look for the policy debate in the Rhode Island General Assembly to heat with Governor Dan McKee’s Aging in Community Subcommittee of the Long Term Care Coordinating Council (LTCCC) release of a sixty page report in June documenting the sky rocketing growth of the state’s older population and identifying strategies to allow these individuals to age in place and stay in their communities.

The Aging in Community Subcommittee was mandated by the enactment of the Aging in Community Act of 2014, sponsored by Senate Majority Whip Mary Ellen Goodwin and Representatives Christopher Blazejewski and Eileen Naughton. The Subcommittee, chaired by Maureen Maigret, Vice Chair of the Long Term Care Coordinating Council, and former Director of the Division of Elderly Affairs, staff from Rhode Island College, Brown University and the University of Rhode Island, representatives from state agencies, members of the senior community, and senior service providers.

According to Maigret, it has taken almost 18 months to gather data, host focus groups and to write the “Aging in Community” report. The report provides demographic data snapshot on the state’s older population and also inventories current services and resources. It also identifies challenges faced by older Rhode Islanders and recommends strategies to promote successful aging in community in these nine issue areas.

Maigret believes that this report may take the most comprehensive look at what aging programs and services are available to assist older Rhode Islanders age in place in their communities and it identifies what programs and services are lacking. “The State Plan on Aging does have some data and actions planned but does not comprehensively cover all the domains covered in the “Aging in Community” report,” she says.

A Demographic Snap Shot

In 2010, the report notes that over 152,000 Rhode Islanders were age 65, predicting that this number will sky rocket to 247,000 in 2030. By 2025, Rhode Island will be considered to be a “Super Aging” state where 20 percent of its population will be over age 65. The report noted that two years ago the population of New Shoreham, Little Compton, North Smithfield, North Providence and Tiverton had already reached “Super Aging” status.

The report added that 42 percent of over age 65 household incomes amounted to less than $30,000. Only 49 percent of the retirees have non Social Security retirement income. Fifty two percent of the older renters and 39 percent of the home owners were financially burdened with covering housing costs. Poverty levels for older Rhode Islander vary, from 7 percent in Bristol County to 18 percent in Providence County.

The LTCCC report notes that even with lower incomes older Rhode Islanders have a major impact on the state’s economy. They bring in over $2.9 billion dollars from Social Security pensions and $281 million in taxes into the state’s economy. Older workers account for 33,750 jobs throughout all job sectors.

Rhode Island’s retirees provide an estimated $ 149 million by volunteering and an estimated $ 2 billion in providing caregiving services to family and friends.

A Spotlight on Priority Recommendations

The Subcommittee’s findings were the result of interviews held with aging service providers, an examination of age-friendly best practices in other states and ten focus groups conducted with older Rhode Islander from across the state.

The focus groups attendees gave the Subcommittee valuable information. They stressed that Senior Centers were “highly valued.” Many expressed financial concerns for their current situation and into the future. Attendees were very concerned about the lack of transportation and lack of affordable housing. State customer service employees were viewed by many as “unfriendly.”

Dozens of strategies were listed in the LTCCC report for state policy makers to consider to better assist older Rhode Islanders to successfully age in their community in these nine issue areas: Information and Communication, Community Engagement, Transportation, Economic Security, Food Security and Nutrition, Housing, Supports at Home, Healthcare Access and Open Spaces/Public Buildings

The LTCCC report identifies priority strategies including the restoring of senior center funding based on a population-based formula and continuing RIPTA’s no-fare bus pass program for low income seniors and persons with disabilities. It also calls for increase payments for homecare and for restoring state funding for Elder Respite.

Maigret says that creating a coalition of aging groups to “build an age-friendly Rhode Island” is the next step to take. Businesses can also become “age friendly” and better understand the economic value of older Rhode Islanders bring to the state and its educational institutions, she says.

Political Will Required to Implement LTCCC Report Strategies

There must be a political will to implement the strategies of the LTCCC report, says Maigret, starting with the state’s top elected official. “Governor Raimondo’s proposed budget had added $600,000 in funding for senior centers but the Rhode Island General Assembly removed it,” she said, noting that the decrease in funding got caught up in the negativity surrounding Community Service grants. “We were fortunate the 2017 budget will still have $400,000 in funding for senior centers,” she says.

“Rhode Island’s older adult population contributes a great deal socially, economically, and intellectually to our communities. Ensuring that those Rhode Islanders who desire to age-in-place are able to do so only enriches our society,” said Governor Raimondo. “I’m pleased that Director Fogarty, and members of his senior staff, serve and work with the Long Term Care Coordinating Council and the Subcommittee on Aging in Community. The insight they gain from service with these committees helps to shape State policy and programs related to services for seniors.

“I applaud the members of the Subcommittee for their dedication to creating a clear, comprehensive report on aging that can be a catalyst for change in our state. Their work recognizes that Rhode Island’s older population is growing dramatically and that we must direct public policy to help them remain active and in their homes,” said Lt. Governor McKee. I look forward to supporting the strategies detailed in the Subcommittee’s report to help build stronger, healthier communities for all Rhode Islanders.”

Finally, House Speaker Nicholas Mattiello, also says that the Subcommittee report’s recommendations will also be studied closely next legislative session. “I will be reviewing the findings of the report in greater detail and I will confer with Representatives Chris Blazejewski and Eileen Naughton, who sponsored and advocated for the Aging in Community Act of 2014. Our older population in Rhode Island is a growing one and it is important that we continue to listen to their needs and be responsive. I commend the work of the subcommittee, as well as all those who participated in the focus groups. I would anticipate that any policy and financial recommendations will be fully analyzed by the members of the General Assembly in the 2017 session.”

The LTCCC’s “Aging in Community” report gives our policy makers a road map in reconfiguring the state’s fragmented aging programs and services. With the Governor, House Speaker and Senate President on board, we might just see legislative changes in the next years that might just be what we need to keep people at home and active in their community. Lawmakers must not act penny-wise and pound foolish when considering legislative fixes.

Both the executive summary and the full Subcommittee “Aging in Community” report are available on the Lieutenant Governor’s website at: http://www.ltgov.ri.gov and the general assembly website at: http://www.rilin.state.ri.us/Pages/Reports.aspx.

Slater Mill Showcases Classic Rock ‘n’ Roll Flick  

Published in the Woonsocket Call on October 11, 2015

When planning the 2nd Annual S.A.M. Fest, in conjunction with this years Pawtucket Arts Festival, Slater Mill’s Executive Director, Lori Urso scheduled a showing of Jim Wolpaw’s “Complex World.” Urso, also a professional musician, knew featuring the film at her event in August was a great way to both promote a local Providence filmmaker and give homage to The Young Adults, a popular rock band playing at the nonprofit’s weekend festival, too.

Rediscovering a Classic Film at S.A.M. Fest

On Aug. 30, more than 80 people gathered early evening at Hodgson Rotary Park to watch on a big outdoor screen the 81-minute offbeat cult rock ‘n’ roll comedy filmed at Providence’s Lupo’s Heartbreak Hotel. While the film attracted the curious, many adoring and loyal fans of The Young Adults came to check out the flick, too, says Urso.

The Complex World captures one night at Lupo’s Heartbreak Hotel, with its zany plot involving terrorists, political conspiracy, 100 pounds of explosives in the bar’s basement and drugs, with music from iconic Providence bands such as the Young Adults, NRBQ and Roomful of Blues. The film had a brief two-month run in a Boston and one week in New York City, and it garnered good reviews. However, a distribution deal with Hemdale, a major film distributor that released “The Terminator” and the “Last Emperor,” fell through, ending up in a lawsuit. Even though Wolpaw won his case and a small settlement, the legal battle sealed the film’s fate. Over the years, the filmmaker’s DVDs have been sold on a website, and the last public showing was in 2010, for two days at the Providence-based Cable Car to raise money for a local charity.

Urso, 51, remembers being an extra during the 1987 film shoot, “a biker chick hanging out in the bar’s parking lot” at 79 Washington St.  “Quite a few people that I knew showed up to be extras that night. I’m glad I was able to be part of it,” she said.

Rudy Cheeks one of the founders of Young Adults and co-writer of the Phillip & Jorge column published in “Motiff Magazine,” was in attendance during the S.A.M. Fest screening, and he observed people of all ages in attendance, many of whom watched the film for the first time.

Even though the film was produced about 25 years ago, “it’s held up pretty well over the years,” says Cheeks. “The strongest part of the film was its ‘mise en scène,’ the capturing of the inside atmosphere of the bar.”

Adds, Rick Bellaire, Chair and Archive Director of Pawtucket-based Rhode Island Music Hall of Fame, the Wolpaw’s Indie film produced outside of the major film studio system, is a great Rock and Roll documentary.  “It was a snap shot of what was happening in the Rhode Island music scene at the time the film was shot,” he says.

The Making of a Classic Film

While it took about two-and-a-half months to shoot the film in 1987, it took more than two years to bring “Complex World” to the screen of the Cable Car Theatre in 1990, says Wolpaw, noting that it ran for a record four months. The veteran filmmaker, who was nominated for an Academy Award for a 1985 documentary, was brought into this film project by Rich Lupo, the owner of Lupo’s Heartbreak Hotel, who just happened to be his roommate at Brown University and later a bartender and manager at the Providence bar.

In 1970, when both young men graduated from Brown University they shared their dreams. Lupo planned to open up a bar with music while Wolpaw wanted to become a filmmaker.  Wolpaw agreed to use Lupo’s bar in film if he opened on up.  “I never would have believed at that time we would both end up at that place,” says Lupo.

According to Wolpaw, the efforts to create and fund a film began a year before the bar was going to be torn down to make way for condos. The film was to use Lupo’s as a basis for the movie to “explain the spirit of the bar,” he said, noting that it would be shot like a documentary film.

Lupo invested the most to produce the film, but with increased costs, other friends chipped in, said Wolpaw. The unique film stood out among films that were produced in Hollywood, he said, “noting it was not the typical movie.”

Two years of editing and reshoots would later result in the final film, says Wolpaw, noting that over the years and even at the Slater Mill screening he “had trouble watching it.” Shooting the film like a documentary just did not work for the plot, he said, but it captured an early era of the Providence music scene.

Even after more than two decades since being released, orders for “Complex World” keep trickling in, says Wolpaw, who has worked as an adjunct film professor at Emerson College in Boston, the University of Rhode Island and the Rhode Island School of Design. He is pleasantly surprised that orders come in from such faraway places as British Columbia and France.

A Prolific Filmmaker  

Besides his Classic “Complex World,” Wolpaw is known for innovative approaches in considering artists and issues in the arts, and he has an impressive number of films under his belt:  “Cobra Snake for a Necktie” (Showtime 1980), a portrait of rock ‘n’ roll legend Bo Diddley; “Loaded Gun: Life, and Death, and Dickinson” (PBS 2003, INPUT 2004), a quirky look at poet Emily Dickinson that was chosen by “The Library Journal” for its list of Best Poetry Films; and “First Face: The Buck Starts Here” (PBS 2011), an accounting of the dollar bill portrait of George Washington.

Even at 67, Wolpaw, who has won awards at more than a dozen film festivals worldwide, has not slowed down. He is still working on three projects, a film about Cleveland poet and activist Daniel Thomson, one detailing the history of Rhode Island’s Ladd Center and a fictional narrative film about poet Dickinson. Hopefully, they will have a long shelf life and audience like “Complex World.”

“Complex Word” can capture viewers who wish to relive their experiences at Lupo’s, and purchases of the DVD benefit the Gloria Gemma Foundation and Advocates in Action. For details, go to www.complexworldthemovie.com.

 

H

 

 

Palliative Care Can Provide Comfort to Dying Residents

Published in Woonsocket Call on May 10, 2015

           A recently published study, by Brown University researchers, takes a look at end-of-life care in America’s nursing facilities, seeking to answer the question, is knowledge and access to information on palliative associated with a reduced likelihood of aggressive end-of-life treatment?

Brown researchers say when a nursing facility resident is dying, oftentimes aggressive interventions like inserting a feeding tube or sending the patient to the emergency room can futilely worsen, rather than relieve, their distress. While palliative care can pull resources together in a facility to provide comfort at the end of a resident’s life, the knowledge of it varies among nursing directors.  A new large national study found that the more nursing directors knew about palliative care, the lower the likelihood that their patients would experience aggressive end-of-life care.

Susan C. Miller, professor (research) of health services, policy and practice in the Brown University School of Public Health and lead author of the study in the Journal of Palliative Medicine, published March 16, 2015, worked with colleagues to survey nursing directors at more than 1,900 nursing facilities across the nation between July 2009 and June 2010.  The researchers hoped to learn more about their knowledge of palliative care and their facility’s implementation of key palliative care practices.

Knowledge Is Power

According to the findings of the Brown study, the first nationally representative sample of palliative care familiarity at nursing homes, more than one in five of the surveyed directors had little or no basic palliative care knowledge, although 43 percent were fully versed.

“While the Institute of Medicine has called for greater access to skilled palliative care across settings, the fact that one in five U.S. nursing home directors of nursing had very limited palliative care knowledge demonstrates the magnitude of the challenge in many nursing homes,” Miller said. “Improvement is needed as are efforts to facilitate this improvement, including increased Medicare/Medicaid surveyor oversight of nursing home palliative care and quality indicators reflecting provision of high-quality palliative care,” she said, noting that besides quizzing the directors the researchers also analyzed Medicare data on the 58,876 residents who died during the period to identify the type of treatments they experienced when they were dying.

When researchers analyzed palliative care knowledge together with treatment at end of life, they found that the more directors knew about basic palliative care, the lower likelihood that nursing facility residents would experience feeding tube insertion, injections, restraints, suctioning, and emergency room or other hospital trips. Meanwhile, residents in higher-knowledge facilities also had a higher likelihood of having a documented six-month prognosis.

The study shows only an association between palliative care knowledge and less aggressive end-of-life care, the authors say, noting that knowledge leads to improved care, but it could also be that at nursing facilities with better care in general, there is also greater knowledge.  But if there is a causal relationship, then it could benefit thousands of nursing facilities residents every year for their nursing home caregivers to learn more about palliative care, the authors conclude.

Progress in Providing End-of-Life Care

Virginia M. Burke, J.D. President and CEO of the non-profit Rhode Island Health Care Association, said, “We were gratified that the authors found that most of the nursing directors who responded to their survey gave correct answers on all (43% of respondents) or most (36%of respondents) of the “knowledge” questions on palliative care.  We were also gratified to see that the number of hospitalizations during the last thirty days of life has declined significantly over the past ten years, as has the number of individuals who receive tube feedings during their last thirty days.  The need for continued progress is clear.”

Burke, representing three-quarters of Rhode Island’s skilled nursing and rehabilitation centers, adds, “It is not at all surprising that greater understanding of palliative care leads to better application of palliative care.”

The states’s nursing facilities are committed to providing person-centered end of life care, says Burke, noting that according to the National Palliative Care Research Center, Rhode Island’s hospitals are among the top performers for palliative care.  “We suspect that our state’s nursing facilities are as well.  We would be very interested in state specific results in order to see any areas where we can improve.”

Says spokesperson Director Michael Raia, of Rhode Island’s Health & Human Services Agency, “We need to provide the right care in the right place at the right time for all patients.”

When it comes to nursing facilities, Raia calls for reversing the payment incentives so that facilities are rewarded for providing better quality care and having better patient outcomes.  He notes that the Reinventing Medicaid Act of 2015 reinvests nursing home reimbursement rate savings into newly created incentive pools for nursing homes and long-term care providers that reward facilities for providing better quality care, including higher quality palliative care.

Bringing Resources to Families

With caregiving one of AARP’s most important issues, it’s no surprise that the organization provides a great deal of guidance on palliative care, stressing that “it involves organizations and professionals coming together to meet a person’s needs both in terms of pain management, along with emotional and spiritual perspectives,” said AARP State Director Kathleen Connell.

Connell says that “It’s is truly a team effort in which nursing home staff become key players. The resources are important to patient with chronic and terminal issues. Their families need help, too. So it is important any time we learn more about ways we can address this very important healthcare need.”

Adds Connell, “In Rhode Island, I’m confident that we have nursing homes that are dedicated to easing the difficulty of this particularly stressful stage of life. They give patients and their families enormous comfort. We certainly applaud their compassion and hope the report is helpful anywhere it identifies a need for improvement,” adds Connell.

AARP’s Caregiving Resource Center (http://www.aarp.org/home-family/caregiving/) includes an End of Life section. Check out a specific palliative care resource at  http://assets.aarp.org/external_sites/caregiving/multimedia/EG_PalliativeCare.html

To read the Brown Palliative Care Study go to http://online.liebertpub.com/doi/abs/10.1089/jpm.2014.0393.

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