Nursing Home Care in the Spotlight

Published in the Woonsocket Call on August 4, 2019

Following on the heels of its March 6 hearing, “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes,” the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,” on July 23, in 215 Dirksen, to study proposed reforms to reduce neglect and abuse in the nation’s nursing homes and to put a spotlight on the need to reauthorize key provisions of the Elder Justice Act.

During the two hour and twenty-minute morning hearing, Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Oregon) along 11 members of the Senate committee listened to the testimony of five panel witnesses.

In his opening statement, Grassley acknowledged that the work isn’t done yet to improving the care in the nation’s nursing homes and Congress must protect nursing home and assisted living residents and those in group living arrangements from harm. The Iowa Senator noted in the recently released U.S. Government Accountability Office (GAO) report the federal agency that provides auditing, evaluation, and investigative services for Congress, noted that while one-third of nursing home residents may experience harm while under the care of these facilities, in more than half of these cases, the harm was preventable.

Calls for Bipartisan Efforts to Improve Nursing Home Care

Grassley called on Congress to reauthorize programs, such as the Elder Justice Act, to put the brakes on the growing trend of elder an abuse fueled by social media.

Adds, Wyden, in his opening statement, there is now an opportunity for Congress to come together to hammer out bipartisan legislative reforms to fix the nation’s nursing home oversight efforts. He urged his fellow Senate committee members to work to reduce the instances of physical, sexual, mental and emotion abuse in nursing homes, that appears to be increasing. He also called for a redo to the federal nursing home rating system because it does not reflect the increased prevalence of abuse.

During the first panel, Megan H. Tucker, Senior Advisor for Legal Review, of the HHS Office of Inspector General (OIG), stated that abuse and neglect oftentimes are not properly identified, reported or even addressed. While most providers are delivering good care, Tucker warned that Health and Human Service safeguards are lacking.

Tucker testified that the Centers for Medicare and Medicaid Services (CMS) should use data more effectively and close the gaps in their reporting process to ensure that abuse and neglect are identified and the deficiencies corrected.

Concluding the first panel, John E. Dicken, Director, Health Care, of the U.S. Government Accounting Office (GAO), discussed a newly released GAO report, released at the hearing, that detailed a growing trend of abuse and neglect of residents. According to one GAO report findings, abuse deficiencies more than doubled between 2013 (430) and 2017 (875), with the greatest increase in actual harm and immediate jeopardy deficiencies, and that abuse is still under-reported, he said. The GAO report also expressed concern over “significant gaps” with CMS’s oversight.

Leading the second panel, Robert Blancato, Coordinator of the Elder Justice Coalition, called on Congress to reauthorize, the Elder Justice Act. With elder abuse becoming a “national emergency,” he urged lawmakers to dedicate funding for Adult Protective Services at the local and state levels. Blancato also stressed the importance of strengthening the long-term care ombudsman program, continuing the Elder Justice Coordinating Council, authorizing an Advisory Board on Elder Abuse, Neglect, and Exploitation, and finally funding for elder abuse forensic centers.

President and CEO, Mark Parkinson, of the Washington, DC-based American Health Care Association (AHCA), representing nearly 10,000 of the 15,000 plus nursing homes in the country who provide care to nearly four million individuals each year, stated he was not at the hearing to defend poor care but to provide solutions to Congress to prevent such incidents from happening again.

Fixing the Problem

Parkinson testified that over the past seven years, facilities participating in AHCA’s quality initiative, have shown improvement in 18 of 24 quality measures. Specifically, there are less hospital readmissions, fewer antipsychotic medications being prescribed, staff are spending more time than ever before with residents and today’s nursing homes are more person-centered care today than ever before.

Parkinson called on lawmakers to improve employee background check systems, add patient satisfaction data to CMS’s nursing home rating system, address the severe staffing shortage and to adequate fund Medicaid.

Finally, Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care, ended the second panel discussions, by warning that more must be done to protect nursing home residents from abuse.

Smetanka urged Congress to take steps to enforce minimum requirements for sufficient staffing, establish standards and oversight for nursing home ownership and operations, prevent rollback of nursing home regulatory standards, increase the transparency of information and to strengthen and adequately fund elder justice provisions.

Now, with the Congress putting poor nursing home care on its policy radar screen, both Democratic and Republic congressional leadership must work closely together to come up with bipartisan solutions. Fix this problem once and for all.

Senate Finance Committee members — Senators Lankford, Stabenow, Daines, Menendez, Carper, Cardin, Warner, Casey, Brown, Cortez Masto, and Hassan – attended the July 23 hearing

To listen to this Senate Finance Committee hearing, go to http://www.c-span.org/video/?462733-1/finance.

For a copy of the GAO report, http://www.gao.gov/assets/710/700418.pdf.

AARP Pushes for Higher Standards When it Comes to Financial Advisors

Published in Woonsocket Call on June 28, 2015

AARP continues its efforts to push for a proposed U.S. Department of Labor (DOL) Fiduciary Rule that would require financial advisors to put their client’s interests first when giving retirement advice.  In advance of last weeks hearing, before the House Education and Workforce Committee, the nation’s largest aging advocacy group delivered nearly 60,000 petitions containing the signatures from every state to support a higher standard in financial advising to prevent conflicts of interest.    .

In a June 16 release, the Washington, D.C.-based AARP stated that the June 27th Congressional hearing only showcased financial firms and their concerns, but did not provide much of an opportunity to hear directly from consumers about how the new proposed rule would benefit them.  But, AARP’s petitions drive should send a powerful message to Congress, that the nonprofit group, representing 37 million older Americans, and 60,000 voters identified on those petitions want to have their voices heard by Congress on this very pressing retirement issue.

When Advising, Do No Harm

“While a number of investment advisers also support a rule requiring advice to be in the best interest of clients, some opponents have recently weighed in with comments that offer time worn code words for harming consumers,” said Nancy LeaMond, Chief Advocacy and Engagement Officer, AARP.  She says that the delivered petitions would ensure “that all, not just some, financial advisers put their clients’ interests first.”

“Many opponents of the proposed new rule, who are asking for delays or say the regulatory costs are too high, are simply looking to protect high fees at the expense of consumers.  But consumers deserve advice in their best interest, not advice that benefits the adviser,” says LeaMond.

In addition to forwarding petitions to the Department of Labor, AARP volunteers continue their efforts to call on Congress to prevent legislation that seeks to stop or slow an updated “best interest” standard.  According to the AARP, “each year hidden fees, unfair risk and bad investment advice rob Americans of $17 billion of retirement income.”

LeaMond says that AARP plans to submit comments to the DOL on the proposed rule in the weeks ahead. The nonprofit group’s petition delivery included over 33,000 signatures and follows an initial petition delivery last month that included over 26,000 signatures that support eliminating conflicts of interest in retirement advice.  “It is important that the Department hear from individuals who are negatively impacted by the current standard, not just financial firms who benefit from it,” she said.

AARP’s petition drive efforts followed President Obama’s February visit to AARP Headquarters where he used the opportunity to publicly support the proposed DOL rule, endorsed by a coalition of aging, labor and consumer groups that limits conflicts of interest, increases accountability, and strengthens protection for Americans receiving retirement investment advice.

At the AARP press event, Obama called for the updating of DOL rules and requirements that would mandate higher standards for financial advisors, requiring them to act solely in their client’s best interest when giving financial advice.

Obama noted that the existing rules governing retirement investments written over 40 years ago “outdated,” filled with “legal loopholes,” and just “fine print,” to be in need of an overhaul.  The existing rules governing retirement investments were written “at a time when most workers with a retirement plan had traditional pensions, and IRAs were brand new, and 401ks didn’t even exist,” said the President.

According to Megan Leonhardt, senior editor for WealthManagement.com, in a June 15th article, “New Coalition Pushes for DOL Fiduciary Rule,” DOL’s proposed rule has “been delayed multiple times since the agency first rolled it out in 2010.  It was expected to be released in August according to the agency’s regulatory agenda, but an update in May pushed back the date to January.”

“Industry lobbyists have mounted significant pushback. The Securities Industry and Financial Markets Association and the Financial Services Institute have argued a rule similar to the DOL’s initial proposal could limit the public’s access to quality financial advice,” says Leonhardt.

Acting in the Client’s Best Interest

“Rhode Island has been part of the national effort to move the Labor Department rule forward,” said AARP Rhode Island State Director Kathleen Connell. “We’ve talked to people who have been quite surprised to know that their savings could be at risk by having an adviser fail to act in their client’s best interest. The response to the petition campaign is a measure of the concern. Retirement planning is daunting for the vast majority of Rhode Islanders. There’s plenty to worry about. Having confidence that your financial adviser is working in your best interest would relieve some of the anxiety.  That’s why there seems to be overwhelming support for the rule change.”

Along with AARP, Rhode Island federal lawmakers are weighing in on this key retirement issue, seeing its importance to older Rhode Islanders.

Rep. David N. Cicilline (D-RI) says, “Protecting the financial well-being of our seniors is a top priority for me, and ensuring that they have access to complete and accurate information before making investment decisions is an essential component of that effort.  President Obama and Labor Secretary Perez are leading a good faith effort to protect consumers, including seniors and I look forward to evaluating the final rule after the public comment period ends and I have had the benefit of considering these comments.”

Adds, U.S. Senator Sheldon Whitehouse (D) “Investors should have the security of knowing that the advice they receive is in their best interest.  I applaud the Obama Administration for updating regulations on retirement investments and for working with a wide range of stakeholders to ensure the new rules help Americans save more for retirement.”

For this writer, hiring a financial advisor is like purchasing a used care, that is you always feel that you might have made the wrong decision.   New DOL requires that call for higher standards for financial advisors, who would be required to act solely in their client’s best interest when giving advice, just might give me peace of mind, when planning my retirement…and probably to millions of older Americans, too.

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

Poll Calls Upon Congress to do “the people’s work”

Published in the Pawtucket Times, January 10, 2014

Four months ago, public anger reached a boiling point when the Republican-led House, controlled by its minority faction of Tea Party members, and the Democratic majority in the Senate failed to agree to an appropriations continuing resolution.
As a result of this budget impasse, a 16 day federal shutdown forced the furlough of 800,000 federal employees and another 1.3 million were required to report to work without known payment dates.

Public polls at that time blamed the GOP for turning its back on the nation by putting partisan politics first rather than doing the People’s business.” The popularity of Congress sank to a new historic low with heated partisan conflict echoing throughout the hallways of Congress.

Hammering Out an 11th Hour Deal

Senator Ted Cruz (R-Texas) with the blessings of conservative groups, including the Heritage Action, the Club for Growth, Freedom Works, and the Senate Conservatives Fund, forcefully pushed House Speaker John Boehner (R-Ohio) to offer continuing resolutions not acceptable to President Obama and Congressional Democrats to politically force a delay or to defund the Patient Protection and Affordable Care Act (called “Obamacare”). Strong GOP opposition, spearheaded by Tea Party lawmakers, to raising the nation’s debt ceiling almost forced the government to run out of money to pay its bills.

After weeks of intense political bickering, Congress finally hammered out a political compromise, one that would open the doors of government, but also raise the debt ceiling to keep the nation from free-falling off the fiscal cliff. A failure to raise the debt ceiling could have resulted in the nation’s credit rating being downgraded. If this occurred, average Americans might have seen higher interest rates for mortgages, car loans, student loans and even credit cards. Higher business expenses, due to expensive borrowing rates, might have forced businesses to stop hiring or even to lay off employees. Housing prices might have drop and retail sales slow. The 11th hour compromise kept the American tax payer and business community from taking a huge hit in their pocketbook.

Although Cruz and Tea Party lawmakers in both chambers viewed shutting down the federal government and not raising the debt ceiling as a way to put excess government spending on the chopping block economy, there was economic damage. According to the economists at Standard & Poors, the total cost of the political gridlock to the nation’s economy that occurred before Christmas was estimated to be $24 billion.
Americans Lack Confidence in Congress

With the new Congressional session beginning this month, a new national poll released last week by AP-NORC Center for Public Affairs reveals that few Americans have faith in the current political status with Congress receiving low marks on its performance of upholding the views of most Americans while only 9 percent say it is doing a good job.

According to the poll that comes months after the first government shutdown in 17 years, 70 percent lack confidence in the federal government’s ability “to make progress on important issues facing the nation in 2014.”

However, the poll findings indicate that the respondents have a little bit more faith in their local and state governments, with 45 percent saying that they are at least moderately confident in their state government and 54 percent having at least moderate confidence with elected officials at the local level.

The federal government receives low marks on its performance. For instance, 55 percent believe the government is doing a poor job of representing the views of most Americans while only 9 percent say it’s doing a good job.

Meanwhile, the poll’s results find Americans are more pessimistic than optimistic on matters such as the nation’s ability to produce strong leaders, America’s role as a global leader, and the opportunity to achieve the American dream.

The People’s preferred agenda for the government in 2014 includes a diverse set of policy issues that range from economic problems to social policies to foreign affairs, notes the poll. Health care reform tops their list of priorities, mentioned by 52 percent of respondents as one of the top ten problems, followed by unemployment (42 percent), the economy in general (39 percent), and the federal deficit (31 percent).

“While it is very easy to ask people to choose a single ‘most important problem’ and to build a list for the answers, the reality is that government has to address many issues at the same time,” said Trevor Tompson, director of the AP-NORC Center. “This survey, with data about the public’s priorities on a range of policy issues, provides policy makers with rigorous data as they seek to understand the public’s outlook on where the country is now and what the action agenda should be for the year ahead.”

Wendy Schiller, Associate Professor of Political Science and Public Policy at Brown University, notes that the AP-NORC poll reveals “broader concerns expressed in national opinion polls, and by the average Rhode Islander “that our country seems to be slipping on lots of levels.”

Schiller, a frequent guest on Rhode Island PBS’s “A Lively Experiment,” notes that aging baby boomers and seniors worry about issues facing the younger generations, personal debt resulting from student loans to national debt. On the other hand, “Younger folks worry about how they will take care of their parents and grandparents, as well as providing for their own retirement,” she says.

“In a state like Rhode Island, which has such a strong family centered culture, these issues weigh heavily on almost everyone’s minds,” observes Schiller.

One of the poll’s positive findings was that the respondents did not cite healthcare for seniors as a pressing issue even though they did express concern over Social Security and health care reform, adds Schiller. “Preserving Medicare is as important, if not more, to the physical and financial well-being of seniors, so I found it striking that it was not as large a concern [as other issues].”

The polls negative findings of a distrust of government, rather than just a disappointment, concerns Schiller, noting that “Democracies do not fare well when the people lose faith in their government.”

As indicated by the poll, Schiller believes that Rhode Island state elected officials are viewed more positively by voters than those serving in Congress. But, 2014 will be a challenging year for them, especially with issues like the 38 Studios debacle, pension reform issues, and Rhode Island job growth. Schiller believes that “If the General Assembly can increase the trend towards greater transparency and accountability, than they might be able to reverse the downward slide of public faith in government.”

As noted in the poll, “public opinion about Congress is at an all-time low,” says Darrell M. West, Ph.D., Vice President and Director of Governance Studies at the Brookings Institution. “People are disenchanted with the hyper-partisanship in Washington, D.C., and the inability of congressional leaders to address major policy problems, he says, noting that the government shutdown was very disturbing to mainstream and people now worry about Congress getting anything done.

West, a former Brown University professor and a prominent Rhode Island political commentator, does not see a major resurgence of bipartisanship in this Congress.
“The parties have incentives to highlight their differences rather than compromise their principles. That will make it difficult for the parties to work together, he says.

But West sees an indicator that the GOP might move away from its ties to the Tea Party that put a damper on reaching across the aisle to get the people’s work done. “The only promising sign is Speaker Boehner’s declaration of independence from the right-wing. A month ago, Boehner criticized outside conservative groups and said they had lost all credibility. If he really believes that, it may embolden him to work on immigration reform and pass needed legislation”, says West.

Because of the complexity of today’s domestic and foreign policy, the People want and need their elected officials to quit this partisan bickering and join together to solve the enormous problems that face the nation, warns well-know Rhode Island activist, Susan Sweet, a keen watcher of state, national, and global politics. “Without the political will to stand together and strengthen the People of America, this great experiment in democracy could decline and fall,” she says.

The AP-NORC national poll was conducted by The Associated Press-NORC Center for Public Affairs Research from Dec. 12-16, 2013, with 1,141 adults. Additional information about how the survey was conducted, including the survey report and the survey’s complete topline findings can be found on the AP-NORC Center’s website at http://www.apnorc.org.

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