LCAO Calls for Fourth Stimulus Bill to Protect the Health and Well-Being of Seniors

Published in the Wooonsocket Call on April 19, 2020

As part of the Economic Impact Payment provision in the recently enacted $ 2.2 trillion stimulus bill, at press time about 80 million Americans have already received their $ 1,200 stimulus check ($2,400 for joint filers) through direct deposit. But for those 70 million Americans waiting for this payment by paper check, this Congressional handout may not be delivered to their mail box by early May, predict a Democratic Senator.

While the U.S. Treasury Department denies that embossing President Donald Trump’s signature on the “memo” section of the check will delay the delivery of paper checks, Senate Finance Committee Ranking Member Ron Wyden, (D-Ore.) disagrees.

A Break in Protocol

In an April 15 statement, Wyden stated: “Donald Trump is further delaying cash payments to millions of Americans struggling to pay the rent and put food on the table to feed his ego. Only this president would try to make a pandemic and economic catastrophe all about him.”

According to an article published in the Washington Post on April 14, “It will be the first time a president’s name appears on an IRS disbursement, whether a routine refund or one of the handful of checks the government has issued to taxpayers in recent decades either to stimulate a down economy or share the dividends of a strong one.”

The Washington Post article, penned by Reporter Lisa Rein, reported that Trump had initially approached Treasury Secretary Steven Mnuchin, who oversees the Internal Revenue Service, to be allowed to sign the checks. “But the president is not an authorized signer for legal disbursements by the U.S. Treasury. It is standard practice for a civil servant to sign checks issued by the Treasury Department to ensure that government payments are nonpartisan,” says the article.

Political insiders say that we can expect to see a fourth stimulus package hammered out between the Democratic-controlled House, the GOP-led Senate and Trump, to pump billions to jumpstart the nation’s sputtering economy. A second round of cash payments may well be part of this economic stimulus package, they say.

“We could very well do a second round,” said President Donald Trump at a White House news conference held over a week ago. “It is absolutely under serious consideration,” he said.

Last week’s commentary publicized Max Richtman, president and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare, call to Congress to protect seniors in a fourth stimulus package (go to https://herbweiss.blog/2020/04/12/congress-must-protect-seniors-in-phase-four-stimulus-package/).

The continuing political battle over crafting the fourth stimulus bill has been put on hold for now with Democratic and WRepublican congressional leaders extending recess. After conferring with public health experts, the House and Senate will not come back into session until, Monday, May 4th.

Calling on Congress to Protect Seniors During the COVID-19 Pandemic

In an April 8 letter, the Washington, DC-based Leadership Council on Aging Organizations (LCAO), representing 69 national nonprofit organizations, urged Congressional lawmakers to ensure that a fourth stimulus package will protect the health and wellbeing of seniors and their families. LCAO’s 19-page communication provides over 50 recommendations (in the areas of housing services, income security and health and community resources) that are key to helping and providing the needed support to assist seniors cope with the raging COVID-19 pandemic.

Specially, LCAO calls on Congress to put funding for affordable housing in a fourth stimulus bill, by funding $ 1.4 billion for federally assisted housing supports to make up for vacancies along with decreased rents from HUD-and USDA-assisted older adult residents, and for emergency housing assistance. Investing $1 billion for new Section 202 Homes would result in short-and long-term jobs as well as 3,800 affordable homes becoming available with service coordinators, says LCAO. Congress was also requested to allocate $450 million in emergency assistance for HUD-assisted senior housing communities, too.

LCAO opposes any attempts to weaken the nation’s Social Security and Medicare programs. The aging group strongly resists any efforts to include a provision in the stimulus bill that would eliminate the payroll contributions to these programs and pushes for the expansion of Social Security and Supplemental (SSI) benefits to enhance the income security of America’s retirees.

Over 10 million workers and retirees have earned benefits under multiemployer pension plans, says LCAO, urging Congress in their letter to allocate sufficient funds to protect the “hard-earned benefits” of these retirees.

With a growing number of the nation’s seniors relying on the support of caregivers, LCAO calls for support of older adult caregivers and children through the expansion of the refundable tax credit for “other dependents.”

Within the next five years, 25 percent of the workforce will be age 55 and over, says LCAO, noting that it becomes crucial to provide adequate funding to the Senior Community Service Employee Program for workforce training.

It’s important to protect seniors from confusing and unfair billing hospitals and payment scams. This can be accomplished by establishing standards for billing that will help seniors manage the aftermath of health care costs due to the pandemic.

Each year, Medicare loses $60 billion to fraud and abuse. LCAO also requests $20 million for the Senior Medicare Patrol to educate Medicare beneficiaries on combating fraud and abuse scams.

LCAO’s letter also asked Congress for adequate funding of mass testing for COVID-19, data collection and accelerate Medicare enrollment to provide seniors and people with disabilities with access to needed medical treatment, two populations with the highest risk for being afflicted by the devastating virus. Congress must also ensure access and affordability to prescription drugs, says the Washington, DC-based aging advocacy group.

LCAO urged Congress to give states sufficient Medicaid funding to keep hundreds of thousands of Medicaid recipients from losing health coverage, which would increase the risk of these individuals spreading the COVID-19 virus.

The need to social distancing may force day care centers to close. LCAO says that a fourth stimulus bill package might add language within the Medicare and Medicaid Home and Community Based Service funding to authorize states to apply retainer payments to adult day care centers for the purpose of providing services to seniors outside the physical center.

LCAO also made a recommendation to prevent the unnecessary transfers of seniors to hospitals and nursing homes and support those recovering from COVID-19 by increasing beneficiary access to home health care by eliminating Medicare’s requirement that they be home bound to quality for this benefit.

LCAO’s letter supported the expanded access to hospice care by allowing physician assistants to certify need and to create a federal fund to identify and set up alternative care sites to nursing homes that meet the same minimum federal standards of care.

LCAO pushed for an additional $50 million to fund the Medicare State Health Insurance Program, a program providing unbiased, free and personalized information to assist seniors to chooses Medicare products, to help seniors understand their specific health care coverage needs under this COVID emergency.

The fourth stimulus bill, says LCAO, must also include funding to ensure providers in health care facilities and at community-based programs, be given personal protective equipment. These providers should be provided free child care and sick leaved during this crisis, too.

Considered “a frontline resource in the battling the pandemic,” LCAO calls for the adequate funding to Geriatric Workforce Enhancement Program, administered by the Health Resources Administration.

LCAO, noting the importance of federal programs that assist seniors to stay at home (including the Older Americans Act that directly serve seniors and caregivers, and the Supplemental Nutrition Assistance Program, the largest federal nutrition program), asks Congress to increase funding, benefits and streamline the application process to these programs to address healthcare and food needs during this pandemic.

With the COVID-19 virus spreading throughout the nation’s nursing homes and assisted living facilities, LCAO calls for more funding to the nation’s long-term care ombudsman program for remote online training and education of nursing facility staff and volunteers, and to the National Ombudsman Resource Center for training materials.

With elder abuse and neglect cases in the community reaching 63,000 in 2018 and an expected surge in incidences due to the pandemic, LCAO calls for funding of $ 120 million for the nation’s state and local Adult Protective Services programs in the next stimulus bill. Also, allocating $4.1 billion for the Social Service Block Grant Program can provide critical services to vulnerable seniors through adult protective services, adult day care and in-home support services, congregate and home delivered meals, case management programs.

Finally, in a fourth economic response package, LCAO calls on lawmakers to include $15 million for the Retired Senior Volunteer Program and $10 million for the Senior Companion program to provide volunteer opportunities for seniors in their communities during the pandemic crisis. Congress might also consider “easing or suspending the current age requirements for participation,” to allow younger seniors to participate.

Remember Your Older Constituents

With the Trump Administration and GOP lawmakers pushing to put billions of dollars into the fourth stimulus bill to support the nation’s large corporations and small businesses, during the COVID-19 pandemic, it is important for Congress to not forget the needs of the nation’s seniors. If you run into your Congressman or Senator, make sure you urge them to seriously consider the needs of their older constituents.

To get a copy of LCAO’s letter to Congress, go to https://www.lcao.org/files/2020/04/LCAO-April-2020-Letter-for-COVID-19-Package-4-FINAL.docx.pdf .

Courtesy of AARP: Long-Term Care Data at Your Finger Tips

Published in the Woonsocket Call on September 2, 2018

Across the States 2018: Profiles of Long-Term Services and Supports, by Ari Houser, Wendy Fox-Grage, Kathleen Ujvari, of AARP’s Public Policy Institute, was released days ago. The jampacked 84-page AARP reference report gives state and federal policy makers comparable state-level and national data culled from a large number of research studies and data sources, some of the data gleaned from original sources.

AARP considers the 10th edition of Across the States, published for the past 24 years, “the flagship publication” to assist policy makers make informed decisions as they create programs, and policies for long-term services and supports (LTSS). State-specific data “is easily found, “at your fingertips,” claims AARP.

Across the States, released August 27, 2018, includes a myriad of aging topics include: age demographics and projections; living arrangements, income, and poverty; disability rates; costs of care; private long-term care insurance; Medicaid long-term services and supports; family caregivers; home- and community-based services (HCBS); and nursing facilities. Each state profile is a four-page, user-friendly, print-ready document that provides each state’s data and rankings.

Looking at Trends

AARP Public Policy Institute researchers have identified four trends in reviewing state data. Of most importance to Congress and state legislatures, Across the States gives a warning that America’s population is aging. The nation’s age 85 and over population, those most in need of aging programs and services, is projected to triple between 2015 and 2050, a whopping 208 percent increase.

But, by comparison, the population younger than age 65 is expected to increase by only 12 percent. The under age 65 population, currently, 85 percent of the total population, is projected to be 78 percent in 2050. Bad news for propping up the Social Security system with the worker-to – beneficiary ratio declining.

Across the States researchers say that the demographic shift of an increasing older population will have an impact on family caregiving. “The caregiver support ratio compares the number of people ages 45–64 (peak caregiver age) to the number ages 80+ (peak care need),” notes the report. Today, there are about 7 people ages 45–64 for every person age 80. By 2050, that ratio will drop to 3 to 1.

America’s older population is also becoming more diverse, reflecting overall trends in the general population. Across the States researchers note that the Hispanic population age 65 and over is projected to quadruple between 2015 and 2050.

Finally, Across the States report notes that State Medicaid LTSS systems are becoming more balanced due to the increase of state dollars going to fund home and community-based services (specifically to care for older people and adults with disabilities). But, this trend varies in level of balance, say the researchers, noting that: “The percentage of LTSS spending for older people and adults with disabilities going to HCBS ranged from 13 percent to 73 percent in 2016. While 40 states became more balanced, 11 states became less balanced for older adults and people with physical disabilities in 2016 compared with 2011.”

Taking a Closer Look

Across the States notes that the age 85 and over population is projected to significantly outpace all other age groups when the aging baby boomers begin turning age 85 in 2031. In 2015, people ages 85 and older made up 2 percent of the US population. By 2050, they are projected to represent 5 percent. By contrast, in the Ocean State the age 85 and over population was 2.7 percent of the state’s population. By 2050, look for the oldest-old population to inch up to 5.4 percent.

Throughout the nation the cost for private pay nursing facility care is well out of reach of most middle-income families. Across the States notes that in 2017 the annual median cost for nursing facilities is $97,455 for a private room and $87,600 for a shared room. But, in Rhode Island the annual cost is higher, with a private room costing $ 104,025 and $ 101,835 for a shared room. The researchers say that for the cost of residing in a nursing facility for one year, a person could pay for three years of home care or five years of adult day services.

Because of the high costs, most people go through their life savings paying for costly care and ultimately have to rely on the state’s Medicaid program. Nationally, the percent of Medicaid as primary payer in 2016 was 62 percent (61 percent in Rhode Island).

According to Across the States, family caregivers provided $470 billion worth of unpaid care in 2013, more than six times the Medicaid spending on home and community-based services. In Rhode Island, 134,000 provided 124 million hours of care annually with an economic value $ 1.78 billion. But, AARP’s report warns federal and state policy makers about the stark demographics in America’s future that will for the nation’s “Oldest Old” to scramble to find a caregiver, due to a shortage. Will state’s have the financial resources to fund programs and services to make up for this demographic reality.

For a copy of Across the States report and Rhode Island specifics, go to: http://www.aarp.org/content/dam/aarp/ppi/2018/08/across-the-states-profiles-of-long-term-services-and-supports-full-report.pdf.

Rethinking Rhode Island’s LTC Delivery System

Published in the Woonsocket Call on April 12, 2015

AARP Rhode Island releases a state-specific analysis, of the 2014 edition of “Raising Expectations: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People with Physical Disabilities, and Family Caregivers” that just might give state officials cause for concern, a low rating on its long-term care delivery system, when compared to other states.

The 2011 Scorecard was the first multidimensional assessment of state performance of LTSS. Like this earlier version, the release of the 109 page 2014 report, referred to as the LTSS Scorecard, and its state-specific analysis (prepared by policy consultant Maureen Maigret), measuring how well the nation and each of the states is doing in providing long-term care services, does not bode well for the nation’s littlest state. It finds the Ocean State ranks 38th nationally on 26 performance indicators, with it achieving the lowest rank of all New England States.

“Our analysis provides a closer look at where Rhode Island is keeping pace and where we fall short,” said AARP State Director Kathleen Connell. “The report indicates that, as the state with the highest percentage of persons 85 and older, we face exceptional challenges. It is our hope that the General Assembly and state policymakers find the analysis to be a valuable tool,” she says.

Failing Grades

The 2014 LTTS Scorecard indicates that Rhode Island:

• Ranks 4th highest among states in nursing home residents per 1,000 persons age 65 and over

• Has a high percent of low-care nursing home residents and spends a far higher percent of its LTSS dollars than the national average on nursing home care as opposed to home and community-based services.

• Has some of the highest long-term care cost burdens in the country making private pay long-term services unaffordable for the vast majority of older households.
But, on a positive note, the state-specific analysis noted that Rhode Island’s best progress was made in the Legal and System Supports dimension largely due to the 2013 passage of the Temporary Caregiver Insurance program and Caregiver Assessment requirements for Medicaid Home and Community Based Services (HCBS).

In addition, to revisiting the 19 recommendations made following the release of AARP’s 2011 Scorecard, the more recent 2014 analysis recommends five new major policy initiates to improve the littlest state’s LTSS. Among the recommendations: funding of an Aging and Disability Resource Center; the developing an online benefits screening tool to allow access to income-assistance benefits and conducting outreach programs to increase participation; reviewing the Rhode Island’s Nurse Practice Act to allow nurse delegation of certain health maintenance and nursing tasks to direct care workers; requiring hospitals to provide education and instruction to family caregivers regarding nursing care needs when a patient is being discharged; and exploring emerging medical technologies to better serve home and community based clients.

The current analysis finds that only four recommendations out of the 2011 recommendations have been implemented, most notably those to promote coordination of primary, acute and long-term care and to strengthen family caregiver supports.

Meanwhile, only six recommendations were partially implemented, including the expansion of the home and community co-pay program and authority (but not implementation) under the 1115 Medicaid waiver renewal to provide expedited eligibility for Medicaid HCBS and for a limited increase in the monthly maintenance allowance for persons on Medicaid HCBS who transition out of nursing homes. Finally, nine recommendations, although still relevant, have not been implemented.

Response and Comments

Responding to the release of AARP’s 2014 Scorecard and state-wide analysis, Governor Gina Raimondo says, “we need to ensure that we have a strong system of nursing home care for those who truly need those services, but we must invest our Medicaid dollars more wisely to support better outcomes. We cannot continue to have the fourth highest costs for nursing home care (as a percent of median income of older households) and also rank near the bottom of all states in investments in home and community-based care.”

According to Raimondo, the state’s Working Group to Reinvent Medicaid is looking closely at AARP’s Scorecard and state-specific analysis and Rhode Island’s spending on nursing home and long-term care. Health & Human Services Secretary Elizabeth Roberts has directed her staff to look directly at the proposals recommended by AARP Rhode Island.

“I expect the Working Group will include specific proposals stemming from these findings in their April budget recommendations and their long-term strategic report they will complete in July,” says the Governor.

AARP Rhode Island Executive Director Connell, representing over 130,000 Rhode Island members, was not at all surprised by the findings of the recently released 2014 Scorecard. “Based on benchmarks set in the 2011 Scorecard, it was apparent that there was much work to do,” she says, recognizing that there are “limited quick fixes.”

“Some steps in the right direction will not lead to an immediate shift in the data. This is a big ship we’re trying to steer on a better course. We were encouraged, however, by ‘improving’ grades for lower home-care costs and the percentage of adults with disabilities ‘usually or always’ getting needed support rising from 64 percent to 73 percent,” adds Connell.

Connell says that the Rhode Island General Assembly is considering legislation to improve the delivery of care, which might just improve the state’s future AARP ‘report’ cards.” “In this session, there is an opportunity to improve long-term supports and services with passage of several bills, including one that would provide population-based funding for senior centers,” she says, stressing that it’s a “responsible investment that will help cities and towns provide better services.”

Connell adds, “The proposed CARE Act gives caregivers better instruction and guidance when patients are discharged and returned to their homes. This can be a cost saver because it can reduce the number of patients returned for treatment or care.”

The larger mission for state leaders is the so-called ‘re-balancing’ of costs from nursing care to home to community-based care. That’s where real savings can occur and home is where most people would prefer to be anyway.”

Finally, Virginia Burke, Executive Director of the Rhode Island Health Care Association, a nursing facility advocacy groups, supports the implementation of the policy initiatives recommended by AARP’s state-specific analysis. But, “The primary driver of our state’s nursing facility use is the extremely advanced age of our elders,” Burke says, noting that the need for nursing facility care is more than triple for those aged 85 and older than for seniors just a decade younger. Due to the state’s demographics you probably won’t see a change of use even if you put more funding into community based home services, she adds.

Governor Gina Raimondo and the General Assembly leadership will most certainly find it challenging to show more improvement by the time the next Scorecard ranks the states. Older Rhode Islanders deserve to have access to a seamless system, taking care of your specific needs. Creative thinking, cutting waste and beefing up programs to keeping people in their homes as long as can happen might just be the first steps to be taken. But, the state must not turn its back on nursing facility care, especially for those who need that level of service.

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