Tag Archives for Community-based Services

2025: A Year on the “Age Beat” in Rhode Island

Published in RINewsToday on December 29, 2025

Throughout 2025, this “Age Beat” columnist published a weekly commentary covering an extensive list of aging, healthcare, and medical issues. During this year, this columnist followed Congressional debates inside the Beltway involving Medicare, Medicaid, reauthorization of the Older Americans Act, and Social Security, reporting on how these federal policy proposals would affect older Rhode Islanders.  During the latest legislative session of the Rhode Island General Assembly, policy debates on Smith Hill were also covered in my weekly commentaries, examining how the proposed bills or enacted laws would impact state programs and services serving Rhode Island’s growing older population.

After reviewing the latest U.S. Census Data, it becomes very clear that the state’s aging population continues to grow.  For more than twenty-five years, I have tracked and continue to follow the graying of Rhode Island’s population.  Through more than 50 articles published in 2025 in Blackstone Valley Call & times and its sister publications, RINewstoday, Senior Digest and other statewide outlets, these stories have decoded complicated public policy debates, and demographic trends to shed light as to how they affect the daily lives of older adults, their caregivers, and nonprofit organizations that serve them.   

Some might interpret my weekly reporting as a way that specifically looks at older adults as one group of people.  However, others might see them on how aging impacts our own family members and our neighbors, and how we all deal with real-life challenges as we get older.

 Themes from Past Year’s Coverage

 Over the past year, several themes have become clear:  the economics of growing older and financially surviving retirement; staying safe from increasing sophisticated scams, public health issues surrounding loneliness and food insecurity; limited public transportation, finding a primary care physician, and managing multiple chronic illnesses.  Many of these commentaries also looked closely at state and federal policies that led to cuts in Medicare and Medicaid; the pressure points placed on Rhode Island’s safety net; and the ongoing policy questions the Rhode Island General Assembly is asking about how to help older adults stay independent at home—not just to live  longer, but live better.

You learn very quickly that national policy debates don’t go the same way here,, if you’ve lived in the Ocean State for a while.  A change in federal requirements of the Supplemental Nutrition Assistance Program (SNAP) or changing eligibility requirements and cuts to Medicaid funding are not distant Washington stories reported by the Washington Post or New York Times especially if they affect food, meal deliveries and health care provided in Providence, Pawtucket, Woonsocket, or Westerly. A change in Medicare drug pricing is not an abstract concept if it determines whether your older neighbor can fill a lifesaving prescription—or whether your spouse’s non-drug compliance stretches pills just to make them last.

 Many of these articles were tied to timely triggers—AARP reports detailing findings of national surveys and polls, a Senate Aging Committee or Congressional hearing putting a spotlight on an aging issue, a proposed legislative proposal being considered by Congress or the Rhode Island General Assembly. But the reporting doesn’t just give a concise summary of a policy issue. The point of these commentaries is to shed light on the issues by asking: “So what does this mean for older Rhode Islanders?” Where are the funding gaps?”  “Who is being left out?  “What can be done now while larger reforms slowly grind their way forward, only to be enacted years later?”

 Many of the commentaries published this year focused on out-of- pocket costs that increase with one’s aging —especially skyrocketing medical expenses. Even when Medicare covers a significant portion of one’s care, many older adults still face overwhelming costs, from premiums and co-pays to dental and vision needs, to uncovered services and especially costly prescription drugs and nursing home care.  The reporting also examined pending questions about Medicare’s financial future, including whether the program will be able to pay beneficiaries full benefits beyond 2033, or face potential benefit cuts.  Even the Washington, DC-based National Committee to Preserve Social Security and Medicare’s call for expanding the retirement program, along with raising the cap to enable Social Security to pay its bills made it into these commentaries.

 Another common theme in this year’s published commentaries is the recognition that aging affects not only our bodies and wallets, but also our emotions and relationships as well. The past year’s reporting on the role of loneliness and isolation serves as a reminder of how harmful they can be, especially when they lead to worse health outcomes.  In these writings, the goal is not to romanticize “community” but to show how social connection and networks in a “community” can be a good way to improve one’s health.

 The commentaries on loneliness do not regard the negative emotional response as a personal deficiency but rather as a significant policy concern influenced by the persistent scarcity of affordable housing, inadequate public transportation, mobility limitations, the loss of spouses and friends, and communities designed around the use of cars rather than their pedestrian walkability or accessibility.  How we view this matters because it is the framing that shifts the discussion away from “Why don’t older adults get out more?” to “What community barriers make connections harder to make—and what public supports are needed to make community connections possible?”

 Taking a New Look at Being Age-Friendly

The commentary on “age-friendly” thinking shows how Rhode Island’s 39 cities and towns can change their programs, services, and public spaces to keep older adults engaged in their community instead of primarily isolated. The announcement that the City of Pawtucket had joined Newport, Cranston, Providence, Westerly, and Bristol to become one of Rhode Island’s Age-Friendly Network Communities is an example.  We hope to report on more communities doing the same.

Over the past year, coverage of food insecurity, and a profile on the Meals on Wheels of Rhode Island, have helped to answer bigger policy questions:  What happens when demand goes up but and payments don’t? How do people get on waiting lists?  “What does “service disruption” mean for someone living at home? And how much does it cost—both in money and in people, when these programs have to be cut back?

One of the most important things we’ve reported on this year is consumer protection, especially when it comes to scams that target older people, because they are often the ones that more easily fall for scams because they have savings and are concerned about them, aren’t as familiar with digital manipulation, or have cognitive impairment.  There are many reasons why this topic is important right now, especially with new technology being used to spread scams.  And the Rhode Island General Assembly has been quick to act.  One commentary informed readers that Rhode Island has passed a new law to crack down on Crypto ATM fraud, making it the 12th state to do so.

 The best reporting on scams doesn’t just explain the tricks and why people fall for them – it also keeps the reader updated as to how scams keep changing.  Plus, it gives you practical tips as to how to avoid them, like pausing before you respond, double-checking what you’re told, and turning to someone you trust if something feels off, verifying, and seeking trusted help before acting. I wrote about these tips in great detail.

These consumer protection commentaries didn’t blame the victims, rather by framing scams as a systemic program caused by new technology and weak verification standards. And it makes this point clear.  Scams are not just seen as financial crimes; they can also cause shame, isolation, and stress that can harm your health.

 Caregiving is also another common topic in this year’s published commentaries. Aging advocates will tell you that caregivers are the hidden backbone of providing care to those in need.  They will tell you that family members, friends, and neighbors help out in ways that would otherwise need paid services or institutional care.  An AARP report says that about 121,000 in Rhode Islanders provided unpaid care to others in 2021 – estimated to be valued monetarily at over $2.1 billion.

 These commentaries on caregiving don’t talk about it in terms of sentiment, but in terms of policy, taking a look at time costs, impact on jobs, burnout, and the lack of enough respite support. The reporting also helps to shed light on common caregiver stress, and that needing help is not a personal failure but a normal result of  demographics and underfunded state programs and services.

When National Policy Hits Close to Home

In Rhode Island, where community-based services are important  to “aging in place,” the weekly coverage has helped readers to understand the whole long-term care continuum—from home care to day care to senior centers to assisted living to nursing home care, if needed.

 At best, access to health care is uneven; transportation is a barrier to many; affordable, accessible housing is limited; and the Medicaid-funded workforce that helps people stay at home is overworked and underpaid.  Older adults are dealing with rising costs for food, utilities, and rent or home upkeep, as well as the effects of inflation.

 Although many of this year’s commentaries put the spotlight on policy issues that need to be fixed, they also provide state policy makers ideas to solve these issues.  These are advocacy groups age-friendly planning; stronger protections for consumers; smarter use of technology; and increased state funding that treats community-based supports as cost-effective interventions rather than optional add-ons.

AARP report: States’ care for seniors “painfully inadquate”. Major gaps in RI

Published in RINewsToday on October 2, 2023

Last week, the Washington, DC-based AARP released its latest Long-Term Services and Supports (LTSS) Scorecard, calling care provided to seniors and persons with disabilities during the last three years after the COVID-19 pandemic “painfully inadequate.”  This nine-page report detailed state specific data, finds major gaps in providing care in every state, including Rhode Island, especially in these categories:  “Housing for Older Adults”, “Home Care Costs” and “Home Health Aide Supply”. 

The LTSS Scorecard, consisting of 50 indicators, focused on: affordability and access; choice of setting and provider; safety and quality; support for family caregivers; and community integration, using data from a variety of publicly available sources, such as the Centers for Medicare and Medicaid Services, American Community Survey, and Bureau of Labor Statistics.

Many benefits of accessing the data

According to AARP, this Scorecard can be a roadmap for improving the LTSS systems and the lives of those who rely on assistance.  Many others will benefit by reviewing this data, too. Federal, state, and local policy makers can identify priorities and ensure resources are allocated equitably. Aging advocates can glean public data and hold government officials accountable. Family caregivers can identify needed resources and become actively involved in policy discussions and advocacy. Seniors relying on long-term care programs and services can learn to inspire culture change and demand available tools. Finally, employers can improve workplace policies and practices to assist caregivers and healthcare groups so they can explore public-private partnerships and alliances. 

Like the findings reported in AARP’s LTSS Scorecard in 2020, Rhode Island ranked 12th in the country in 2023, but this year’s Scorecard reveals that the state has made some progress in improving care options for older Rhode Islanders, specifically the enrollment in the Program of All-Inclusive Care for the Elderly (PACE), as well as the availability of Adult Day Services.

“The pandemic reinforced the need to strengthen long-term care for countless loved ones across the country, including here in Rhode Island,” said AARP Rhode Island State Director Catherine Taylor in a Sept. 28th statement announcing the release of the 2023 LTSS Scorecard. 

“AARP’s Scorecard shows that there are many roads to meet the needs of all Rhode Islanders who deserve the very best care, including the 121,000 family caregivers in our state. The overwhelming majority — 87% — of Rhode Islanders age 45+ would prefer to receive care for themselves or loved ones at home with caregiver assistance. Yet, our low rankings in Housing for Older Adults (51st), Home Care Costs (43rd) and Home Health Aide Supply (41st) underscore how difficult it is for them to age the way they choose. It’s time to accelerate our efforts, for the sake of saving more lives,” she says.  

RI is dead last in housing

“In particular, Rhode Island’s dismal ranking for Housing for Older Adults – dead last – points to the urgent need to increase the supply of affordable, accessible housing. We can do that by passing legislation early in 2024 to strengthen homeowners’ ability to build an accessory dwelling unit (ADU) to allow them to age in place, support a family member, or house a caregiver,” Taylor said.

A national snapshot of the LTSS Scorecard’s 2023 Data

According to Scorecard, 12 states, including Rhode Island, have enacted paid family leave laws and 18 states have paid sick day laws, which can be used to assist caregivers. AARP’s latest Scorecard also reported that only 6 states provide a tax credit for family caregivers’ out-of-pocket expenses. Rhode Island does not provide a tax credit – nor is it among the 7 states that have statewide laws protecting caregivers from discrimination in the workplace that ensure they are not unfairly treated due to caregiving duties outside of work.

Meanwhile, it was reported that dozens of states experienced declines in the number of care choices that help support family caregivers. For instance, 16 states, including Rhode Island, had declines of 10% or more in access to home health aides since 2019. 

Regarding Home and Community-Based Services (HCBS), the LTSS Scorecard reported that 11 states, including Rhode Island, had state policies that improve presumptive eligibility for Medicaid HCBS at the time of data collection, making it possible for people to go home to receive care after being in the hospital – rather than having to be admitted to a nursing home while their eligibility for Medicaid payments is being determined.

The research indicated that many states also have large numbers of people with low care needs living in nursing homes, indicating a lack of HCBS access and services. More than 20% of nursing home residents in Rhode Island have low needs – compared to 9% nationally.

Data confirms Major Workforce Crisis in nursing facilities across US

As to nursing homes and institutional care, the AARP’s 2023 Scorecard confirmed that a  major workforce crisis exists in facilities across the country. Across all states, wages for direct care workers are lower than wages for comparable occupations, with shortfalls ranging from $1.56 to $5.03 per hour. In Rhode Island, wages are $1.79 lower than other entry level jobs.   

Nationally, more than 50% of nursing staff in nursing facilities leave their job within a year (53.9% turnover rate). However, in Rhode Island, the rate is slightly better than the average, at 49.3% – with Montana, Vermont, and New Mexico experiencing the highest averages in staffing turnover.  

Staffing disparities are also a significant challenge, say researchers, noting that residents of nursing facilities with high admissions of Black residents receive almost 200 fewer hours of care per year compared to residents of facilities with high admissions of white residents. 

According to the LTSS Scorecard, only 22% of nursing facility residents live in a facility with a 5-star rating in the US – with less than the national average, about 20.2%, of Rhode Island residents living in a 5-star facility. Gaps in workforce and equity result in persistent problems in care, say the researchers. One measure, pressure sores, can be life-threatening as they can lead to bone or joint infections, cancer, and sepsis. In this measure, 10% of facility residents nationwide experienced a pressure sore.

Finally, this year’s Scorecard announced that there is progress being made to create innovative and effective alternatives to traditional nursing facility models. Specifically, the researchers say that 10 states, including Rhode Island, made strides in nursing home innovations, such as by utilizing Green House® Nursing Home availability and policies, which includes small facilities, private rooms, and other best practices.

AARP’s 2023 LTSS Scorecard identified recommendations that can fix the nation’s delivery of long-term care programs and services to enable seniors to age in place in their communities. It called for increasing support to the nation’s 48 million family caregivers, “who are the backbone of the long-term care system, providing over $600 billion in unpaid care, such as with paid leave, tax credits, and other mechanisms to address health and financial needs.”

AARP Rhode Island continues to call on the Rhode Island General Assembly to support the state’s 121,000 family caregivers by advocating for enhancements to the state’s Temporary Caregivers Insurance program.

Recommendations on enhancing Long-Term Services and Supports

The Scorecard’s recommendations also called for investing in states’ Home and Community-based Care Infrastructure, by increasing support and training for home health aides and home visits, supporting the ability to access and use medical devices and equipment, and updating key Medicaid regulations and payment models.  

To tackle the workforce crisis, a recommendation suggests that it is crucial to support both nursing facility and in-home workforce by improving recruitment and training, increasing pay, and expanding the ability of trained nurses, aides, community health workers and other paraprofessionals to take on some aspects of care. States can choose to enact and enforce staffing and related care standards.

A recommendation also calls on States to expand the use of innovative, effective models for nursing homes can improve both quality of care and quality of life, such as with smaller facilities and private rooms and to address inequities by investing to close the staggering gaps in access to quality care and facilities and staffing shortages.

(Editor’s Note:  During the pandemic, then Governor Gina Raimondo allocated $5 million towards 2 changes in nursing homes – making all rooms private and providing non-shared, private bathrooms – for all residents – efforts to follow up on this effort have not resulted in what happened to that initiative according to the RI Department of Health).

Another recommendation urges states to create multisector plans for aging and building of coalitions and age-friendly health systems, to help seniors to age in place at home by having affordable and accessible housing and transportation, improved community design, and comprehensive emergency preparedness plans.

Researchers also suggested the advancing innovation in cities, counties, and states by supporting comprehensive state- and community-wide aging plans and piloting new approaches and programs, like Green House® Nursing Homes and presumptive eligibility, that can then be scaled.

Finally, Climate Change is increasing national disasters, and the LTSS Scorecard recommends that every state have a sound emergency preparedness plan to support nursing home residents, in particular, in times of crisis – including natural disaster.

“AARP’s LTSS Scorecard shows some progress and innovation, but there’s still a long way to go before we have systems that allow people to age well, and independently, for as long as possible and support the nation’s 48 million family caregivers. It’s also clear some emerging issues deserve more attention – from whether nursing homes are prepared to confront natural disasters, to whether they have plans in place to maintain and grow their workforces,” says Susan Reinhard, Senior Vice President, AARP Public Policy Institute.

The LTSS Scorecard is a charitable project made possible by a grant from AARP Foundation, with support from The SCAN Foundation, The Commonwealth Fund, and The John A. Hartford Foundation, and has been updated every three years since 2011.

To view the full Scorecard and state-by-state information visit https://ltsschoices.aarp.org/ 

To view the Scorecard for specifically Rhode Island, go to:  https://ltsschoices.aarp.org/scorecard-report/2023/states/rhode-island.

To view Previous Scorecards (2011, 2014, 2017 and 2020) go to https://ltsschoices.aarp.org/scorecard-report/report-archive/

Confronting the Long-Term Care Dilemma in Uncertain Times

Published in the Pawtucket Times on January 14, 2002

 Aging advocates are about to find out how many slides you can cut the Rhode Island budgetary pie, especially when lawmakers are predicting that the state’s deficit could soar to hundreds of millions.

With the backdrop of a recession, pushing to keep funding at current levels for existing programs and services this legislative session may be their only hope as advocates for affordable health care and housing, education, disabled persons, seniors, and low-income families call for their fair share, too.

Meanwhile, CHOICES, a broad-based coalition of provider organizations and advocate organizations, will push this legislative session for more funding to keep Rhode Island seniors in their homes.

The coalition representing home care agencies, assisted-living facilities, adult day care, housing, senior center, disabled and senior advocates and Meals on Wheels, will continue its efforts to urge the General Assembly for reforms to Rhode Island’s long-term care system, said Paula Parker, Executive Director of Rhode Island Partnership of Home Care and a CHOICES member.

“Consumers must have options to choose programs and services that can provide them with greater independence in familiar surroundings,” Park told ALL About Seniors, adding that this is an underlying principle of CHOICE’S philosophy.

During the state’s prosperous years, Rhode Island’s allocation for home and community-based services slowly inched up from seven to eight percent of the state’s total long-term care budget.  Parker noted, however, that General Assembly funding for long-term care services continued to be heavily weighted toward funding institutional facility care.

“The challenge today is to continue the momentum of increasing state support for home and community-based services in less prosperous times,” Parker said, because the start’s rising elderly population creates a need to expand options in long-term care.

Susan Sweet, a consultant, long-time consumer advocate and CHOICES member, added that the seven-year-old coalition plans to continue its education efforts to inform legislators and the public about the cost savings of home and community care for elders as opposed to institutional care.

For example, Sweet stated that full-time adult day care five days a week may cost up to $ 10,000 annually as compared to an average $38,000 bill for nursing facility care.

Options in the state’s continuum of care include assistance with the costs of pharmaceutical drugs, community-based programs, rehabilitation facilities and nursing facility care. Sweet said, “A menu of available choices allows seniors and their families to seek out and receive the most appropriate and cost-effective care for their current situation. That’s what CHOICES is all about.”

Can long-term care options assist lawmakers in controlling the state budget while providing needed services for seniors?

Yes, said Sweet. “Not only is the quality of life greatly enhanced for elders and their families when institutionalization is delayed or eliminated, but also individual assets and state contributions to care through the Medicaid program are greatly reduced or eliminated,” she said.

Recognizing that lawmakers must work within severe budgetary constraints. Sweet said she believes it should be fiscally short-sided not to recognize the significant budgetary savings that home and community-based care- and preventative care- bring to situations that, without intervention, would lead to costly health care such as hospitalization and protracted institutional stays.

“The challenge for Rhode Island is to continue progress on creating less restrictive and less expensive community services while continuing funding for needed acute and long-term care,” Sweet said, stressing that in a tie of decreasing revenues, this will not be an easy task.

Lawmakers must either conform the long-term care crisis now for today’s seniors in the shadow of the state’s current budget deficit or in later years, when the state’s demographic time bomb I ready to explode. For today’s seniors and for the aging baby boomers who follow in their footsteps, lawmakers, state agencies, providers and seniors  must cooperate in crafting a seamless long-term care system with options that enhance quality of life and provide independence. This may take years.

But until then, amid competing interests for limited state dollars, advocates for better long-term care will have to roll up their shelves with the support of senior and disabled constituents to get this year’s slice of the state budget pie.