Watching over Nursing Homes once again – time for mandated Boosters

Published on December 20, 2021 in RINewsToday

Colder weather is keeping people more indoors now, and Thanksgiving and pre-Christmas gatherings are drawing people together in groups, small and large. Like other states across the country, Rhode Island is seeing a growing transmission of the COVID-19 Delta, and now Omicron variants. Some national sources say Rhode Island’s case rate is the highest.

According to WPRI’s COVID-19 tracking page, 73.7% of Rhode Island’s population, totaling 1,097,379 are fully vaccinated, 9.2 % are partially vaccinated, and 17 % have received no vaccination at all. “But some back-of-the-envelope math based on the state’s tally of daily doses shows nearly 251,000 people have received booster shots or third doses. And earlier this week, RI Gov. McKee publicly said the number is closer to 260,000 people,” says WPRI.

Taking a Snapshot of Vaccination Rates in Rhode Island’s Facilities

Just days ago, AARP Rhode Island called for increased boosters in the state’s nursing homes after releasing its new analysis of the latest data from AARP’s Nursing Home COVID-19 Dashboard.  The Dashboard revealed that only 54% of nursing home residents and 19% of staff in 79 Rhode Island nursing homes have received a COVID- 19 booster.

“With holiday gatherings on the horizon, these numbers are a cause for concern for state policy makers, as more than a year and a half into the pandemic, rates of COVID-19 cases in nursing homes are rising again nationally, along with increased community spread,” says AARP Rhode Island. While case rates declined slightly compared to the same time period last month, in AARP’s dashboard, looking week to week, the number of cases increased each week during the four weeks ending November 2, notes the state’s largest aging advocacy group serving more than 132,000 members aged 50 and older.

The Rhode Island-specific AARP Nursing Home Database says that resident cases grew from a rate of 0.64 per 100 residents in mid-October to 1.19 in mid-November. Staff cases decreased slightly from a rate of 0.96 to 0.82 during this same time period. Nursing home resident deaths from coronavirus rose slightly from a rate of 0.06 in mid-October to 0.11 in mid-November.

“COVID-19 continues to infiltrate America’s nursing homes with more than 1,500 new nursing home resident deaths nationally for the third consecutive month,” said AARP’s Rhode Island State Director Catherine Taylor. “Increasing vaccination rates—including boosters — among nursing home residents and staff is key to protecting our loved ones and getting the pandemic under control,” she says.

“AARP calls on nursing homes, state and federal authorities, and others to increase access to and receipt of COVID-19 boosters for both nursing home staff and residents,” Taylor added.

“As new variants emerge and vaccine immunity wanes, the low number of residents and staff who have received a booster creates an unacceptable level of risk since the disease spreads so easily in these environments,” says Tayler, urging Gov. Dan McKee “to prioritize the state’s most vulnerable population and take immediate action to addresses the relatively low percentage of nursing home residents and staff who have not received COVID-19 booster shots.”

According to AARP Rhode Island, while the percentage of residents and staff who have received boosters remain low, rates of those fully vaccinated—those who have received two COVID-19 shots—continue to slowly rise as of November 21. In Rhode Island, 99.10% of nursing home staff are fully vaccinated (the highest rate of any state in the nation) and 94.10% of nursing home residents.

The number of Rhode Island facilities reporting a shortage of nurses or aides rose sharply from 34.7% to 41.7% in the four weeks ending November 21, says the advocacy group. 

Rhode Island’s high vaccination rates can be tied to Rhode Island mandating all healthcare workers be vaccinated by Oct. 1, 2021, say John E. Gage, President and CEO of the Rhode Island Health Care Association. When the 30 day-compliance period ended, those who were unvaccinated were banned from entering the state’s healthcare facilities, he says, noting that termination resulted from failure to follow a reasonable policy set forth by their employer in compliance with Health Department’s emergency order. 

Yet, in at least one large nursing home facility, RINewsToday has learned, staff who refused to be vaccinated were either moved to non-patient-facing positions, or already worked in those positions, and allowed to keep working. An administrator said they are still working on encouraging 100% vaccination. Residents also have the right to refuse vaccination, and masks are required for patients outside of their rooms.

Families visiting had been restricted to the lobby, and at one time received a test in the parking lot prior to being able to enter. Today they are still screened for temperature, and they must wear a mask and complete a health symptom questionnaire. After a federal regulation went into effect several weeks ago easing access for families to visit, the screening also eased up and now tests are not required.

Any patient who is positive for COVID is moved to a quarantine area until fully recovered, and regular testing for patients and staff continues.

Some nursing homes are allowing families to take their loved one’s home for a Christmas holiday and then return after being with outside family and friends.

Gage notes that Rhode Island is ranked at No. 11 of states at a booster rate among residents of 54.1% compared to a national average of 38.4%.  Staff are boosted at 19.1% (#16) compared to a national average of 15.0%.  “Remember, individuals are not eligible for a booster until six months after their second dose of the vaccine series.  This will preclude some residents and staff, he says, stressing more credit should be given to the state’s health care facilities having the highest vaccine rates among staff and the second highest vaccination rate among residents.

According to Gage, the data released by the Centers for Medicare and Medicaid Services on Nov. 28, 2021 showed 99.38% of all workers in Rhode Island facilities are vaccinated – the highest (#1) vaccination rate for nursing homes in the country. Residents in Rhode Island nursing homes are 95.02% vaccinated – the second highest rate in the country.

To Booster or Not Booster, that is the Question

“With vaccines mandated in healthcare facilities and proof of vaccination being required to enter public places under the new Executive Order, it seems this would be a reasonable requirement for visitors to nursing homes,” says Gage, noting that this is not allowed according to the most recent guidance issued by the Centers for Med Centers for Medicare and Medicaid Services.

As to mandating booster shots for nursing facility staff, however, Gage warns, “staffing is at a crisis level already. We cannot afford to lose more staff with another mandate,” he says.

“The first rounds of vaccines were given most commonly by third-party sources such as CVS medical staff who came into the homes, similar as they do every year for flu shots”, said one nursing home administrator to RINewsToday – “For the boosters, we did them using our own staff, and ordering our supply from the RI Department of Health.”  Boosters were advised to be given 4-5 months from original vaccination completion – yet in the nursing homes most didn’t get them until 8 to 9 months – as late as the end of October.

However, Joseph Wendelken, Rhode Island’s Department of Health’s Public Information Officer, says that CVS and Walgreens are working to make COVID-19 vaccine booster doses available to all nursing facilities,. “If any facility is looking for additional support getting residents and workers vaccinated, we can provide that support,” he says.

Wendelken notes that there is a requirement for nursing home workers to complete a primary COVID-19 vaccine series, but there is no [federal or state] requirement for booster doses. “The data are becoming clearer and clearer that – especially with the Omicron variant – booster doses are absolutely critical,” says Wendelken.

“Residents [of nursing homes and assisted living facilities] were among the first to get vaccinated so that means their immunity has waned and boosters are needed to avert significant outbreaks and deaths,” says  Maureen Maigret, former director of the R.I. Department of Elderly Affairs and chair of the Aging in Community Subcommittee of the Long Term Care Coordinating Council. “It is critical that booster shots are offered to all nursing home and assisted living residents especially now that visitation has opened up and visitors do not have to show proof of vaccination,” she says.

As of December 15th, the RI Department of Health Department shows at least 114 new cases in nursing homes and assisted living facilities in the past seven days, says Maigret. “We must  remember that over 1,700 residents died as a result of COVID in these facilities and providing booster shots is our best defense against more fatalities for this vulnerable population.”  

Even though it is not a federal policy, a growing number of state officials across the country are calling for the definition for being fully vaccinated to now include the booster shot. With Rhode Island seeing a surge in COVID-19 cases and an increase in hospitalizations due to Delta and Omicron variants spreading throughout the state, many (including this writer) express it’s time for Governor Dan McKee to now mandate booster shots for nursing facility staff.  More important, it must become a priority for the Rhode Island Health Department to make sure that every consenting nursing facility resident receives a booster, too.

President Biden is set to address the country on Tuesday, at a time to be announced. There is speculation whether the term “fully vaccinated” will now include not just the two original vaccinations but the booster as well.

The AARP Nursing Home COVID-19 Dashboard analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard. For more information on how coronavirus is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes. Medicare.gov’s Care Compare website now offers information about vaccination rates within nursing homes and how they compare to state and national averages.

RI Nursing Homes with new cases (more than 5) in the past 14 days:

Berkshire Place, Providence – 10 to 15

Jeanne Juga Residence, Pawtucket – 5 to 9

Oak Hill Health Center, Pawtucket – 20 to 24

Pawtucket Falls Healthcare, Pawtucket – 10 to 14

Summit Commons, Providence – 5 to 9

West View Nursing, West Warwick – 10 to 14

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard. For more information on how coronavirus is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes. Medicare.gov’s Care Compare website now offers information about vaccination rates within nursing homes and how they compare to state and national averages.

Time to resolve RI’s ongoing Nursing Home staffing crisis

Published in RINewsToday on April 18, 2021

The latest release of AARP’s Nursing Home COVID-19 Dashboard shows that both cases and deaths in nursing homes declined in the four weeks ending March 21. Although these rates are improving, chronic staffing problems in nursing homes—revealed during the COVID-19 pandemic—continue. In Rhode Island, 30% of nursing homes reported a shortage of nurses or aides, which is only fractionally better than the previous reporting period. 

AARP has come out swinging to fight for enhancing the quality of care in Rhode Island’s 104 nursing homes.

AARP Rhode Island, representing 131 members, calls for the General Assembly to ensure the quality of care for the state’s nursing home through minimum staffing standards, oversight, and access to in-person formal advocates, called long-term care Ombudsmen. The state’s the largest aging advocacy group has urged lawmakers to create a state task force on nursing home quality and safety and has pushed for rejecting immunity and holding facilities accountable when they fail to provide adequate care to residents.  It’s also crucial that Rhode Island ensures that increases in nursing homes’ reimbursement rates are spent on staff pay and to improve protections for residents, says AARP Rhode Island. 

Last December, AARP Rhode Island called on Governor Gina Raimondo to scrap Executive Order 20-21 and its subsequent reauthorizations to grant civil immunity related to COVID-19 for nursing homes and other long-term care facilities. The aging advocacy group warned that these facilities should be held responsible for providing the level of quality care that is required of them for which they are being compensated.

Rhode Island Lawmakers Attack Nursing Home Staffing Crisis

During the legislative session, the state’s nursing home staffing crisis caught the eye of Senate Majority Whip Maryellen Goodwin is a policy issue that needs to be addressed. They knew that Rhode Island ranked 41st in the nation in the number of the average hours of care nursing home residents receive, according to data from the Centers for Medicare and Medicaid Services.  The state also has the lowest average resident-care hours per day of any New England state.

On Feb. 2, the Rode Island Senate approved S 0002, “Nursing Home Staffing and Quality Care Act” sponsored by Goodwin and nine Democratic cosponsors to address an ongoing crisis in staffing nursing homes that has been exacerbated by the COVID-19 pandemic.  The bill had passed unanimously in the Health and Human Services Committee, and ultimately, the full Senate gave its thumbs up to the legislative proposal by a vote of 34 to 4.  Only one Republican senator crossed the aisle and voted with the Democratic senators.

“There is a resident care crisis in our state. Staffing shortages and low wages lead to seniors and people with disabilities not receiving the care they desperately need. The pandemic, of course, has exponentially increased the demands of the job and exacerbated patients’ needs. We must confront this problem head-on before our nursing home system collapses,” said Sponsor Senator Goodwin (D-Dist. 1, Providence).

The legislation would establish a minimum standard of 4.1 hours of resident care per day, the federal recommendation for quality care long endorsed by health care experts including the American Nurses Association, the Coalition of Geriatric Nursing Organizations, and the National Consumer Voice for Quality Long-Term Care. The bill, which the Senate also approved last year, has been backed by Raise the Bar on Resident Care, a coalition of advocates for patient care, and the Rhode Island’s Department of Health (RIDOH).

The bill would also secure funding to raise wages for caregivers to recruit and retain a stable and qualified workforce. Short staffing drives high turnover in nursing homes. Not only does high turnover create undue stress and burnout for remaining staff, but it also diverts valuable resources to recruit, orient, and train new employees and increases reliance on overtime and agency staff.  Low wages are a significant driver of the staffing crisis. The median wage for a CNA in Rhode Island is less than $15, and $1/hour lower than the median wage in both Massachusetts and Connecticut.

The legislation would also invest in needed training and skills enhancement for caregivers to provide care for patients with increasing acuity and complex health care needs.

At press time, the companion bill (2021-H-5012), sponsored by Reps. Scott A. Slater (D-Dist.10, Providence) and William W. O’Brien (D-Dist. 54) was considered by House Finance Committee and recommended for further study.

RIDOH’s Director Nicole Alexander-Scott, MD, MPH says the state agency “supports the thoughtfulness of the provisions included in the legislation and welcomes dialogue with its sponsors, advocates, and the nursing home facility industry regarding methods to sustain the necessary conditions associated with the intent of the bill.”

Alexander-Scott states that “RIDOH takes its charge seriously to keep nursing home residents and is supportive of efforts to update standards of care to better serve Rhode Islanders in nursing facilities, as well as increase resident and staff satisfaction within nursing facilities.”

Scott Fraser, President and CEO of the Rhode Island Health Care Association (RIHCA), a nonprofit group representing 80 percent of Rhode Island’s nursing homes, says that “staffing shortages are directly traceable to the chronic lack of Medicaid funding from past governors. Period.” 

According to Fraser, state law requires Medicaid to be funded at a national inflation index, usually averaging around 3%. “Up until this year, previous governors have slashed this amount resulting in millions of dollars in losses to our homes.  Thankfully, Governor McKee is proposing to fully fund the Medicaid Inflation Index this year,” he says.

RIHCA opposes the mandatory minimum staffing the legislation now being considered by the Rhode Island General Assembly, says Fraser, warning that its passage would result in facilities closing throughout the state. “No other state has adopted such a high standard,” he says, noting that the Washington, DC-based American Health Care Association estimates that this legislation would cost Rhode Island facilities at least $75 million to meet this standard and the need to hire more than 800 employees. 

Fraser calls for the “Nursing Home Staffing and Quality Care Act” to be defeated, noting that the legislation does not contain any provisions for funding.  “Medically, there is no proof that mandating a certain number of hours of direct care results in any better health outcomes.  This is an unfunded legislative mandate. If homes are forced to close, not only would residents be forced to find a new place for their care, but hundreds of workers would also be forced out of work,” he says.

Goodwin does not believe that mandating minimum staffing requirements in nursing homes will force nursing homes to close. She noted that the legislation is aimed at ensuring nursing home residents receive adequate care and that Rhode Island is the only state in the northeast without such a standard.

“There is an un-level playing field in nursing home staffing in Rhode Island,” charges Goodwin, noting that many facilities staff 4.1 hours per day, or close to it, while others only provide two hours of care per day. “In either case, the overwhelming majority of well-staffed and poorly-staffed nursing homes remain highly profitable,” she says. 

According to Goodwin, the lack of staffing and certified nursing assistants (CNAs) is due to unreasonable workloads and low pay. “RIDOH’s CAN registry makes it clear that retention of these workers is a big issue. This is in part because they can make as much money – or more – in a minimum wage profession with much less stress,” she adds, stressing that “The Nursing Home Staffing and Quality Care Act” directly addresses these staffing challenges.

One quick policy fix is to provide nursing home operators with adequate Medicaid reimbursement to pay for increased staffing.  Lawmakers must keep McKee’s proposed increase of nursing home rates pursuant to statute, requiring a market-based increase on Oct. 2021, in the state’s FY 2020 budget. The cost is estimated to be $9.6 million.

With the House panel recommending that Slater’s companion measure ((2021-H-5012) to be held for further study, Goodwin’s chances of seeing her legislation becoming law dwindles as the Rhode Island Assembly’s summer adjournment begins to loom ever closer. There’s probably no reason to insist that a bill be passed in order to have a study commission, so this could be appointed right away if there is serious intent to solve this problem.

Slater’s legislation may well be resurrected in the final days of the Rhode Island General Assembly, behind the closed doors when “horse-trading” takes place between House and Senate leadership.  If this doesn’t occur, either the House or Senate might consider creating a Task Force, bringing together nursing home operators, health care professionals and staff officials, to resolve the state’s nursing home staffing crisis. 

RI Senate Tackles High Cost of Prescription Drugs – Herb Weiss

Published in RINewsToday.com on March 15, 2021

In the shadow of the COVID-19 pandemic, as Governor Dan McKee and the Rhode Island General Assembly move to hammer out their Fiscal Year 2022 budget, Senate lawmakers push a package of eight legislative proposals to put the brakes on skyrocketing cost of prescription drugs.

The Senate resolution (2021-S 0560) sponsored by Senate Majority Whip Maryellen Goodwin (D-District 1, Providence), has already been passed and complements the prescription drug affordability package that will be considered next week that would require health insurers to provide coverage, without cost sharing, for colorectal screenings and follow-up colonoscopies when necessary.

The package of legislation aims to protect Rhode Islanders by limiting copays for insulin, capping out-of-pocket expenses for high deductible plans, requiring health insurers to cover preventive colorectal cancer screening, eliminating clauses hidden in pharmacy contracts that prevent a pharmacist from talking about more affordable options, requiring transparent pricing information, importing wholesale prescription drugs from Canada, and creating a board responsible for evaluating and ensuring drug prices are affordable. 

According to Greg Paré, the state Senate director of communications, this package of legislative proposals was developed in conjunction with AARP during the off session before the 2020 Senate session and first submitted last year, but legislation considered last session was limited due to the pandemic and so it did not pass. The legislation has been resubmitted this year with some small modifications and remains a Senate priority.

Last year, AARP along with 14 groups including, the Alzheimer’s Association, the American Cancer Society Action Network, and Aging in Community, urged lawmakers to pass the package of legislative proposals.  Expect to see some of these groups again call for passage of either the total package or specific bills at a Senate Health and Human Services Committee’s virtual hearing, chaired by Sen. Joshua Miller, on Thursday, at 5:00 p.m. For the hearing’s agenda, go to: For hearing details go to: https://bit.ly/3ezofmJ.

Passage of this legislative package would require action by both the Senate and House. At press time, not all of the Senate bills have companion measures in the House.   

Controlling the Skyrocketing Increase of Prescription Drugs

Here are specifics about the Senate’s prescription drug affordability legislative package that will be considered next week by the Rhode Island’s Senate Health and Human Services Committee:  

Legislation (2021-S-0170 sponsored by Sen. Melissa A. Murray (D–Dist. 24, Woonsocket, North Smithfield), would limit the copay for prescription insulin to $50 for a 30-day supply for health plans that provide coverage for insulin. Additionally, the bill mandates that coverage for prescription insulin would not be subject to a deductible.  

Legislation (2021-S 0381)sponsored by Senate Majority Leader Michael J. McCaffrey (D–Dist. 29, Warwick), would cap out-of-pocket expenses for prescription drugs at the federal minimum dollar amount for high-deductible health plans, currently $1,400 for individual plans and $2,800 for family plans.    

The bill (2021-S-0383), sponsored by Senator Goodwin (D–Dist. 1, Providence), would save lives by requiring health insurers cover preventive colorectal cancer screening in accordance with American Cancer Society (ACA) guidelines. This coverage must be provided without cost-sharing and includes an initial screening and follow-up colonoscopy if screening results are abnormal. The ACA recommends people at average risk of colorectal cancer start regular screening at age 45.  

A bill (2021-S -497) sponsored by Sen. Walter S. Felag Jr. (D–Dist. 10, Warren, Bristol, Tiverton) would allow consumers to pay less for their prescription drugs by banning gag clauses sometimes found in pharmacy contracts that prevent a pharmacist from talking to a customer about more affordable options.   

This bill (2021-S-0494) would require pharmaceutical drug manufacturers, pharmacy benefit managers, health insurers, and hospitals to disclose certain drug pricing information. Such transparency would help payers determine whether high prescription costs are justified. This bill is sponsored by Senate President Dominick J. Ruggerio (D – Dist. 4, North Providence, Providence).  

This bill (2021-S-0499), sponsored by Sen. Louis P. DiPalma (D–Dist. 12, Middletown, Little Compton, Newport, Tiverton), would create a state-administered program to import wholesale prescription drugs from Canada, which has drug safety regulations similar to those of the United States. Such programs are allowed under federal rules, with approval from the U.S. Department of Health and Human Services. 

This legislation (2021-S0498) would create a prescription drug affordability board tasked with investigating and comprehensively evaluating drug prices for Rhode Islanders and possible ways to reduce them to make them more affordable. The bill is sponsored by Sen. Cynthia A. Coyne (D–Dist. 32, Barrington, Bristol, East Providence). 

The bill (2021-S 0496) introduced by Sen. Felag (D-District 12, Bristol, Tiverton, Warren) aims to protect consumers from unexpected changes in their health plan’s formularies (list of covered drugs). Under the legislation, formulary changes can only be made at the time of health plan renewal, if the formulary change is made uniformly across all identical or substantially identical health plans, and if written notice is provided 60 days or more before the change. 

Seniors Hit Hard by High Price of Prescriptions

“The high price of prescriptions is having a severe impact on Rhode Islanders, particularly older residents,” said Ruggerio, noting the state’s population is one of the oldest in the nation.  “Many older Rhode Islanders have limited means, and the high cost of prescriptions means people are 

Ruggerio warns that the pharmaceutical industry is not going to address this on its own, so it’s up to the state and federal governments to take action.”

Maureen Maigret, Co-Chair, Long Term Care Coordinating Council, observes that with Medicare paying the tab for costly pharmaceuticals, controlling rising drug costs is a federal issue.  “But this is a big issue to address for those with low and moderate incomes under-insured for prescription drugs,” she says. “I applaud the Senate legislative package aimed at controlling the cost of prescription drugs for Rhode Islanders, says Maigret, who cites the findings of a Kaiser Family Foundation survey that shows one out of four persons take four or more prescription drugs and more than one-third say that have difficulty taking their medication properly due to cost.  “Seniors may fail to get prescriptions filled, resort to pill splitting or skipping doses. Some may end up with costly hospital Emergency Rooms or inpatient visits as health conditions worsen due to the inability to afford their medications, notes Maigret, calling for lawmakers to make necessary prescription drugs affordable for all who need them. Maigret says, “It is time to make necessary prescription drugs available for all who need them.”

“AARP Rhode Island is eager to work with both the Senate and the House of Representatives to pass this important legislation designed to lower prescription drug costs,” said AARP State Director Kathleen Connell. “The high cost of drugs leads families – and particularly older Rhode Islanders on fixed and limited incomes — to often make impossible decisions. No one should have to choose between paying rent, providing food for themselves or their family and vital prescription medications that keep them healthy,” she says.

We look forward to working with legislators from across the state to help improve the health and financial stability of everyone by lowering the cost of prescription drugs. We thank Senate President Ruggerio for once again bringing forth this very important legislation,” adds Connell.

It’s mid-March. Lawmakers turn their attention now to passing the state budget.  Even if the Senate passes every bill in the prescription drug affordability package, the lower chamber must pass companion measures for these bills.  When passed, Governor Dan McKee must sign the legislation to become law.  Right now, it’s an uphill battle and Rhode Islanders must call on their state lawmakers to get on board to support bills to reduce the high cost of pharmaceuticals.  It’s the right thing to do. 

Things that You Should Know 

This meeting will be streamed live online through Capitol TV:

http://www.rilegislature.gov/CapTV/Pages/default.aspx

Written testimony is encouraged and can be submitted prior to 2:00 PM on Thursday, March 18, 2021, in order for it to be provided to the members of the committee at the hearing and to be included in the meeting records. Finally, if you are interested in providing verbal testimony to the committee at this hearing, please go to the following link and make your request by 4:00 p.m., on Wednesday, March 17, 2021:  https://bit.ly/3bIJAs2