Published in Pawtucket Times on July 16, 2001

As the dust settles with the aftermath of the 2001 General Assembly session, senior advocates and providers held their ground with the state legislature allocating small funding increases in some existing programs, but no major expansions or new programs were implemented.

More than 2,500 bills were introduced during the 2001 General Assembly session, with lawmakers considering a small handful of proposals that specifically targeted senior programs and services.

Pawtucket Rep. Antonio J. Pires, who heads the House Finance Committee, gives his take to The Times on the session as it related to older Rhode Islanders.

During this year’s legislative session senior advocates called on the General Assembly to consider increased funding for Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE).

Recognizing the high cost of prescription drugs and its adverse impact on the elderly, lawmakers ratcheted up the $10.3 million RIPAE program by $ 2 million. With the passage of the state’s Fiscal Year 2002 budget, the size of a large phone book, lawmakers appropriated a 20 percent increase to support the RIPAE program, stated Pires.

The General Assembly expanded the drug formulary lists of drugs to include prescription drugs to treat osteoporosis,” Rep. Pires noted. Additionally, he added that the state’s budget now provides 100 percent of covered drug costs incurred once the program’s poorest clients spend more than $ 1,500 in coo-payments in a year.

While senior advocates had pushed for more drugs to be covered by RIPAE drug formulary, Pires stated, “We can’t afford to pay for an o pen formulary program yet because of budgetary limitations.” In next year’s legislative session, when more state monies are available, coverage for gastrointestinal drugs will seriously be considered, he added.

“It’s a trade-off,” Pires said, in explaining why lawmakers choose not to add drugs to the RIPAE formulary list but rather to increase the eligibility income limits to allow an estimated 3,l50 seniors and disabled persons to participate in the state’s Medical Assistance Program. This program pays for nursing home care for low-income eligible seniors. The enacted state budget included $ 1.8 million from all sources of funds, including $ 857,485 in general revenues to increase the eligibility income for those who are 65 years old or disabled. Now individual income limits increased from $ 576 to $  686 per month, he said, noting that income limits for couples also increased from $ 889 to $ 921 per month.

According to Pires, the Fiscal 2002 State budget also includes $ 85,000 to continue funding the state’s elder guardianship program enacted last year. “The program brings volunteer guardians to assist frail elderly who are cognitively impaired and without families or friends in decision making,” he said. This year’s funding would allow a full-tie coordinator to be hired who will recruit and train the volunteer guardians. Ultimately, the funding would also allow the program to be phased in statewide over a three-year period, he said.

“We also continue to fund the state’s Elder Information Network Program,” Pires added, noting that the FY 2002 budget includes $ 425,000, a $ 12,300 increase over last year’s budget. Funding for this program provides grants to 15 community-based agencies to employe specialists to link information and services across the state.

This session Rhode Island lawmakers also moved to soften the blow of federal cutbacks to RIPTA by providing an additional $ 2.5 million to the state’s transportation agency. “RIPTA found itself in need of cutting routes to balance it’s budget,” Pires stated, noting that the General Assembly responded to the federal cuts by appropriating one-half cent of the state’s gasoline tax to help the agency keep its exiting bus routes.

“RIPTA may have to make some adjustments to their bus routs but not to the extent that they had fared,” Pires said. Ensuring that buses continue to run throughout the state are important because this mode of transportation provides older riders their mobility and independence, he said.

Finally, on the heel of calls by the nursing home industry and senior advocates, Pires noted that the General Assembly allocated $ 4.5 million with a $ 4.5 million federal match, to provide higher salaries for certified nursing assistants to keep them in their profession.

While nursing home providers did not get the $ 14.1 million, they requested, the 2002 state budget called for a funded study to develop a new plan on how nursing homes would be funded, Pires said. “We anticipate that the modern payment principles that will be developed will ensure continued quality of care for the elders in facilities,” he added.

But the funding allocated by the General Assembly to alleviate the direct care staff shortage and a study to develop a new payment methodology still leaves many nursing home providers and senior advocates seriously concerned about the direction of quality care with the inadequate paid to a shrinking work force.

Based on an independent study, providers found that last year health care worker turnover approached 92 percent in Rhode Island facilities due to low wages in relation to the work performed, stated Hugh Hall, chair of the  Direct Care Staffing Coalition and administrator of Cherry Hill Manor.

Hall noted that certified nursing assistants must complete 125 hours of training followed by a state licensing exam, both written and practical, to perform this type of work. These workers have found they can make as much or more working in local retail establishments than in nursing facilities, he says.

While nursing home providers appreciate the funding that the legislature has approved, it doesn’t go far enough, says Hugh, to address the inadequate wages that the state is funding for direct care workers. “The state continues to cut the same size of the pie for an ever-increasing aging population,” he noted.

In response to those seeking better funded programs this year, Pires stated, “We had limited resources to expend so there wasn’t a lot of new programming this year but quality of life and independence remains my top priority as chairman of the House Finance Committee.” The eight-term Democrat noted that this year’s focus was to ensure that the existing level of senior services would not be cut but maintained with some incremental expansion.