Tag Archives for Bush Administration

Fed’s Proposal to Confronting Nursing Shortage is Not Enough

Published in Pawtucket Times on April 1, 2002

Responding to the nation’s serious nurse staffing shortage, a new Federal proposal gives states flexibility to allow nursing facilities to use paid feeding assistants to supplement the services of certified nurse aides (CNAs). The specialty trained staff would help residents eat and drink.

With a growing number of frail elderly resident in the nation’s nursing facilities, today’s nursing staff must take care of residents who require a higher level of medical care. This leaves less time to ensure that residents eat their meals and drink enough fluids on a daily basis.

Oftentimes, both physical and psychological changes will interfere with a resident’s ability to eat and consumer a meal. Some residents may only need encouragement or minimal assistance with eating.

On the other hand, frail residents may require staff assistance with feeding .  Assistance would be needed for residents with cognitive impairment, impaired swallowing due to muscular weakness or paralysis, a tendency to aspirate or choke, poor teeth, ill-fitting dentures or partial plates, poor muscular or neurological control of their arms or hands, as with Parkinson’s disease.

Under the Centers for Medicare & Medicaid Services (CMS) proposal, trained feeding assistants are allowed to help residents eat and drink, especially at meal times.

The workers would be required to complete a state-approved course to quality to be hired for the new position.  Currently nursing facilities rely primarily on CNAs, registered or licensed practical nurses to assist residents with eating and drinking.  However, volunteers and family members also may assist with these tasks.

At this time, there is no provision in federal regulations for the employment of nursing facility workers to perform only a single task without competing 75 hours of nurse aide training.

The proposed rule change published in the March 29 issue of the Federal Register would allow facilities to hire workers to perform a single task with training on feeding techniques and some basic information that is currently part of CNA training requirements.

“Meal times can often be the busiest time in nursing facilities,” says CMS Administrator Tom Scully.

“Feeding residents is often a slow process and competes with m ore complex tasks, such as bathing, toileting and dressing changes, as well as urgent medical care,” he added.

“Trained feeding assistants will free nurses and nurse aides to focus on residents’ other health care needs. The result will be that residents will receive better nutrition and care,” Scully noted.

The American Health Care Association (AHCA), a Washington, D.C.-based trade group, that represents both profit and non-profit nursing facilities, gives the new federal rules a thumbs up.

‘Simple common-sense dictates that when our nation’s health care system is being undermined by a chronic nursing staffing shortage, and the greater needs of increasing sicker patients, we should do everything conceivable to better the lives of our patients,” stated Dr. Charles H. Roadman II, president and CEO of AHCA. “The rule will also help the overextended nurses and nursing aides already on the job cope with competing important tasks.”

Hugh Hall, executive director of the Johnston-based Cherry Hall Manor Nursing and Rehabilitation Center, supports the federal government’s approval of the single task workers who feeds nursing facility residents.

“The prior regulation was not logical or practical when prohibiting other nursing home workers other than registered nurses, licensed practical nurses and CNAs from feeding, but allowing volunteers and families to participate in the feeding process with little training,” he said.

Hall, the former president of the Rhode Island chapter of AHCA, said the health care community would prefer that the federal government develop long-term care programs to recruit fully trained certified nursing assistants and to financially support those initiatives.

Roberta Hawkins, who serves as the state’s nursing facility ombudsman and executive director of the Alliance for Better Long-Term Care agrees.

“The federal proposal is only a Band-Aid fix.” Hawkins says, calling on the federal government to put more funds into the nursing facility reimbursement system to enable facilities to pay better wages to hire permanent full-time staff and to create career ladders.

“Even though you may teach an aide to just feed residents, they are not trained to spot medical changes in the resident, Hawkins told Everything About Seniors.  More important, she said, “they will not be familiar with the specific needs of the residents.”

Hawkins believes that the Bush administration’s proposal can become an obstacle in providing continuity of care in nursing facilities.

A state commission, chaired by Human Services Director Jane Haywood, is currently looking at Rhode Island’s staffing shortage and how the existing Medicaid reimbursement system can be improved.

Recommendations for a new and improved system coming from Haywood’s group might just fix a long-time systemic problem, enabling nursing facilities to better recruit and retain CNAs.

Hopefully, Haywood’s long-awaited proposals will be seriously considered by the administration and General Assembly and won’t end up on a dusty shelf or a circular file.

While allowing the use of single-tax workers, proposed by the Bush administration, it is a step in the right direction. Gov. Lincoln Almond, state lawmakers and state policymakers must not lose sight of the real issue – inadequate Medicaid payments- which fuels an ongoing CNA shortage in many of the state’s nursing facilities.

Almond and the General Assembly are currently at odds over subsidized gambling in the Ocean State.

During this year’s budget debates, overshadowed by a projected $70 million plus budget deficit, let us not forget about Rhode Island’s 10,000 nursing facility residents or the growing elderly population who may ultimately require that level of care or community-based long-term care services.

If the General Assembly can easily find $ 15 million next year to keep the greyhound racing industry afloat, lawmakers might dedicate some time and a little energy and effort in finding state dollars to increase funding to Rhode Island’s long-term care delivery system.

For older constituents and the state’s aging baby boomers it is the right thing to do.

Social Security funds could be up for grabs

Published in Pawtucket Times on September 10, 2001

Don’t expect quick government action to provide prescription drug benefits to seniors or immediate meaningful Social Security or Medicare reforms soon.  With the backdrop of a $1.35 trillion Bush White House tax cut, a shrinking budget surplus combined with an ailing economy and dwindling consumer confidence, Congress may be forced to take from “Peter to pay Paul.”

But let me give you the political translation…According to a recent released Congression Budget Office (CBO) August 2001 report, the federal government will need to use $9 billion of the tax receipts used to buy bonds invested in the Social Security trust fund in the fiscal year that ends September 30 to made ends meet, increasing the likelihood that heated bipartisan bickering and congressional gridlock will occur when lawmakers being their efforts to pass next year’s 13 spending bills.

Don’t look for things to get better soon, says the nonpartisan CBO, because by 2003 it’s estimated that $18 billion in Social Security reserves will be needed to keep the government in operation.  By 2005, CBO notes that if current tax and spending policies are followed, and the economy performs as the agency estimates, on budget surpluses will emerge.

Senior groups have expressed concern about the federal government having the dip into the cash generated from Social Security payroll taxes, calling it a tragedy that will block passage of any meaningful prescription drug benefit proposals or Medicare and Social Security reforms.  “The loss of tax revenue due to the present’s tax cuts and the slowing economy will lead to new federal debt and $600 billion in additional interest payments over the next ten years,”  predicted Max Richtman, executive director of the Washington D.C. based National Committee to preserve Social Security and Medicare.

“It’s enough to pat for a generous prescription drug benefit under Medicare,” Richtman says.

“Now it looks like the federal government will have to pay bondholders instead of providing seniors with the help they need on prescription drugs, Richtman added, noting that it’s a case of misplaced priorities.

“The $600 billion (in additional interest payments) could fund a prescription drug program with co-payments and deductible at a level that is more affordable for all seniors,”  Richtman says.  Meanwhile, any funds not used could help pay for repair of glasses, refitting dentures and new batteries for hearing aids, all costs not covered by Medicare. 

Adds Ed Zesk, president of Aging 2000, a nonprofit consumer organization focused on improving health care for seniors, “Its is unfortunate that the Bush administration got caught up in tax cut rhetoric to the point where they are focused into a corner and gave a tax cut without accessing its impact on the future of Medicare and Social Security.  While Americans certainly appreciate a few bucks back from Uncle Sam it is a shame that a nation we are potentially mortgaging our future health care and Social Security for a short term tax rebate.

“Clearly the tax cut has made it virtually impossible to develop any kind of meaningful prescription drug proposal for Medicare,”  Zesk told All About Seniors.  “This is just one example of the long-term benefit being sacrificed for the short-term gains,” he says.

Kathleen S. Connell, executive director of AARP Rhode Island, states that  AARP also opposes a federal government raid on the Social Security funds to finance other government programs.  However, the nation’s largest senior advocacy group was pleased that earlier this year both Congress and President Bush had agreed to protect Social Security by using surplus funds in the program for only debt reduction.  “To use the surplus funds other than for debt reduction would undermine that consensus and signal a trend that we believe would not be good economic policy,” Connell said.

According to AARP research, the overall balances for the program funds would not be affected and full benefits could be paid up until 2038, Connell said.  “The key thing that needs to be understood as long as the surplus is used for debt reduction, it would reduce the obligation of future generations and free up money to help the economy.”

With Congress going back into session, lawmakers must now begin the task of passing 13 appropriation bills for the fiscal year beginning October 1.  With the CBO report raising the issue of spending the Social Security receipts, it is now time for Congress to quit finger-pointing and charging each other of raiding the  Social Security and Medicare program.

With the graying of America, Congress must be aside its political differences and work toward long-range bipartisan solutions to ensure the solvency of the Social Security and Medicare programs.  No longer should seniors accept quick political fixes from either political party.