Tag Archives for House Finance Committee

Bill would (re)create a RI Department of Healthy Aging

Published in Pawtucket Times on March 21, 2022

There are new efforts on Smith Hill to transform the state’s Office of Healthy Aging (OHA) into a department making it far more visible and effective as an advocate for the state’s growing senior population.  H. 7616, introduced by Rep. Lauren H. Carson (D-District 75, Newport), would expand the office in the Department of Human Services (DHS) into a full-fledged state department, expand its director’s authority, and appoint local senior centers as hubs for service delivery, with authority to bill Medicaid for transportation services.

The RI Department of Elderly Affairs (DEA) was created by law in 1977 and remained a department until 2011, when the legislature changed it to a division within the Department of Human Services (DHS). In 2019, the department was re-named the Office of Healthy Aging (OHA), shifting narratives and perceptions associated with growing older. At press time, the Office of Healthy Aging remains a division under the Department of Human Services. 

“Rhode Island should invest much more than we do in services that enable people to age in place and safely remain in their communities. Those services are far more cost-efficient overall, and encourage an active, more fulfilling lifestyle for people as they age”, says Carson in a statement announcing the introduction of the bill on March 2, 2022. “Considering that a quarter of our population consists of seniors, and that ratio is growing as the Baby Boomers join them, now is the time,” she adds.

At press time, the bill has been sent to the House Finance Committee, and its cost has not yet been determined and there is no companion measure introduced yet in the Senate.

“Working cooperatively with the senior centers operating around the state, we could make it much easier for people to access the support they need as they age, and really make the quality of life much better for the entire older population of our state,” says Carson expressing the importance of the state’s senior centers.

H. 7616 would authorize the new Department of Healthy Aging to protect and enable seniors to stay healthy and independent by providing meals, health programs, transportation, benefits counseling and more. Under the bill, the department would provide professional development to agencies and programs that provide services to seniors in the state and become a clearing house to help those agencies and businesses assist senior centers, which would serve as hubs for the delivery of services from the state.

In particular, H 7616 directs the new department to manage and develop a multi-tiered transportation system that works with the Department of Human Services, the Department of Transportation, senior centers and with all existing modes of public transportation to develop transportation plans that suit the elderly population of each municipality. The director would be enabled to authorize senior centers to bill Medicaid for transportation they provide.

The legislation also seeks to have the new department develop and submit to the General Assembly a funding formula to meet the requirements the new law sets forth, including input from seniors and the caregivers and allocating funding to each municipality based on its senior population, with restrictions that the funding be used only for senior programs.

Carson explains that this bill is intended to start important dialogue among state lawmakers, state officials and aging organizations about appropriately providing for Rhode Island’s aging population.

 “Whether or not we pass this bill this year, we have to address the needs of our growing older population. Leaving those needs unmet has a much greater price tag than decent locally administered basic programs would. Our whole state would be better served by investments that keep seniors safe with support in their community,” Carson said.

OHA and Aging Advocates Give Their Two Cents

Nicole Arias, a spokeswoman for OHA, says “we look forward to any future discussions and collaborations with community members, partners, and legislators.” When asked if the Rhode Island Advisory Commission on Aging, charged with advising the governor on aging policies and problems impacting older Rhode Islanders, Chair James Nyberg stated the commission also plans to review and discuss the bill at an upcoming meeting. 

“Our office looks forward to participating in dialogue that empowers and supports our aging residents and championing essential quality of life items such as healthy housing and reliable transportation. While our office is still unpacking H 7616, we appreciate Rep. Carson and the bill’s cosponsors for advocating on behalf of our senior residents,” says Lt. Gov. Sabina Matos, who over sees the state’s Long-Term Care Coordinating Council (LTCCC). The group works to preserve senior’s quality of life in all settings and coordinates state policy concerning all sectors of long-term care for seniors.

Bernard J. Beaudreau, Executive Director of the Senior Agenda Coalition of Rhode Island, says his group strongly supports any and all efforts that increase the state’s programs and services to address the growing needs of our aging population, especially those with low and moderate incomes.  The state-wide coalition calls for the reinstatement of OHA to a full department, but not without the commensurate expansion of funding and services that are needed for this important state government function.   

“When the Department of Elderly Affairs was reorganized to be a division of the Department of Human Services, we were concerned that it signified a diminishing of the importance of senior needs in the state budget.  While from a management perspective, the division within the larger Department of Human Services could streamline the delivery of services, there would still be the need to increase staffing and programs to meet the growing needs,” says Beaudreau. This did not happen in the ensuing years.

“Restoring the OHA to a department status will strengthen its position at the budget table and elevate the importance of programs supporting older residents of our state. We hope that will make a difference,” says Beaudreau.

“The legislation proposed by Rep. Carson elevates the conversation about the importance of age-friendly policies that enable Rhode Islanders to choose how we live as we age,” said AARP Rhode Island State Director Catherine Taylor. “AARP Rhode Island looks forward to being part of this conversation and continuing to advocate fiercely at both the state and local levels for enhanced home and community-based supportive services, accessible and affordable housing and transportation options, and full inclusion of people of all ages and abilities in community life,” she said. 

According to Maureen Maigret, policy consultant and chair of the Aging in Community Sub-committee of Rhode Island’s Long-Term Care Coordinating Council, H 7616 is a very significant bill that will help to stimulate a long due discussion as to how the state should fund senior programs and services in light of the state’s growing age 65 and older population. This age group is projected to represent at least one in five of  the state’s residents by 2040.

Maigret recalls that the state’s Department of Elderly Affairs was created by law in 1977 and remained a cabinet level department until 2011 when the Rhode Island General Assembly changed it to a division within the Department of Human Services as part of the enacted budget bill.  Eight years later, lawmakers would change the agency’s name from the division of elderly affairss the OHA. The enacted law placed OHA in the Department of Human Services for administrative purposes and called for the OHA Director to be appointed by and to report to the Governor with advice and consent of the Senate.

When Maigret left her position of Director of Elderly Affairs (serving from 1991 to 1994), its budget for FY1995 was $13.9 million (state funds) and it had at least 60 full-time employees. The state’s  FY2022  budget for OHA stands at $12 million (state funds) with 31 authorized employees, she said.

Maigret warns that the existing OHA is under-resourced both in state funding and human resources. She calculates that Rode Island spends about fifty dollars per older person (age 65 and older) when taking into account state funding for senior services and its population age 65 and over.

“We could do so much more to support our older adults by addressing service gaps especially for those not poor enough to meet our strict Medicaid income eligibility rules which require older adults to have income less than $13,600 and assets less than $4,000 single and $6,000 for a couple,” Maigret says. Funding for local senior centers and programs in Rhode Island municipalities should be calculated by at least $10 per person aged 65. 

Maigret urges state lawmakers to support local transit assistance efforts, to increase funding for caregiver support programs, and to expand information services to provide assistance to seniors to assist them to find subsidized home maintenance and chore service programs.  Better funding should be allocated to support volunteer programs that provide companionship and other services to reduce social isolation,“ she says.

“I suggest reverting the OHA to a full department as called for in H 7616 only if there is a concomitant increase funding and resources, says Maigret, noting that one source of funding could be available from  the Perry/Sullivan law (that the Governor’s budget proposes to defer for FY2023.),  These state funds could be used to allow OHA to truly provide the needed supports and services to older adults to live full and healthy lives as intended in the department’s creation,” she says.

“Older adults suffered greatly during the COVID pandemic – 90% of the deaths were individuals 60 and over, claims Vin Marzullo, a well-known aging advocate who served as a federal civil rights and and national service administrator. “We must provide greater attention and care for this vulnerable population,” he says. 

“Since the proposed legislation to elevate the OHA to department status was initiated by the Rhode Island House, I would hope that former House legislator, Marie Cimini, would welcome and embrace this legislation to become a premiere agency for the Governor, quips the West Warwick resident. He notes that Cimini was recently nominated by Gov. Dan McKee for the position of Director of the state’s Office of Healthy Aging.  This nomination requires Senate confirmation.

The other cosponsors of the H 7616 include Rep. Deborah Ruggiero (D-Dist. 74, Jamestown, Middletown), Rep. James N. McLaughlin (D-Dist. 57, Cumberland, Central Falls), Rep. Terri Cortvriend (D-Dist. 72, Portsmouth, Middletown), Rep. June S. Speakman (D-Dist. 68, Warren, Bristol), Rep. Edith H. Ajello (D-Dist. 1, Providence) and Rep. Brandon Potter (D-Dist. 16, Cranston).

Hopefully the upper chamber will see the wisdom in considering a companion measure to  H. 7616.  Let the debate begin. 

For more details about OHA, go to https://oha.ri.gov/

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. 

Rhode Island Lawmakers Poised to Give Retirees Financial Tax Relief

Published in Woonsocket Call on May 31, 2015

During the 2014 legislation session, Rep. Robert E. Craven, (District 32) introduced and successfully pushed for passage in the General Assembly. This legislative proposal would ultimately being signed into law by the Governor. Little did the North Kingston law maker realize that door knocking to get reelected in last November’s election would give him an issue to tackle on Smith Hill this year.

At hundreds of homes, he heard the same issue from his older constituents. One such comment was etched sharply in Craven’s memory: “You’re a nice guy, buy I am not going to vote for you because I am leaving the state, the older voter told him. The puzzled lawmaker asked “why?” The response, “We decided the state is so expensive to live in because of taxes we’re going to sell our house and move to Florida. Wanting the specifics, Craven asked, what specific tax bothers you? “We are only of a few states that tax social security benefits, that’s the straw that broke the camel’s back,” said the older voter.

Craven’s legislative proposal, H 5000, was heard Wednesday night before the House Finance Committee. Strongly supported by House leadership, he says, the legislation would ease the tax burdens on Rhode Island retirees by exempting them from paying state income tax all Social Security benefits as well as income received from federal, state and local government retirement plans, disability benefits, military pensions and private pension plans and deferred-compensation plans.

Among its more than 40 co-sponsors are Rep. Stephen M. Casey (D-Dist. 50, Woonsocket), Rep. Michael A. Morin (D-Dist. 49, Woonsocket), Rep. Samuel A. Azzinaro (D-Dist. 37, Westerly) and Rep. Cale P. Keable (D-Dist. 47, Burrillville, Glocester).

If enacted, Rhode Island would join 27 other states – including Massachusetts and Maine – and the District of Columbia that specifically exempt Social Security income from taxation. (Although Rhode Island does not specifically tax Social Security benefits, that income is identified on federal tax returns. Since Rhode Island’s income tax is based on the federal adjusted gross income of federal tax form filers, the end result is that Rhode Island generates a portion of its income tax collections from Social Security benefits.)

According to Craven, his legislative proposal would financially benefit Rhode Island seniors who receive retirement benefits. ”After paying into the Social Security system their entire working lives, or putting a little money away into private pension plans, or working at jobs that provide them with a pension, it doesn’t seem right that retirees are having taxes eat away at benefits they depend on for their very livelihood,” he says.

“Retirees living on a fixed income are probably more severely impacted by taxes and tax increases than other population groups,” observes Craven. “If we are committed to helping retirees have a safe and secure life in their later years, and if we want to help seniors afford to stay in Rhode Island rather than moving to more tax-friendly locations, we need to ease their financial burdens. Exempting retirement income from the state income tax is one step we should take,” he adds.

Tax Exemption in House Budget

Weaving its way through the legislative process Craven ultimately expects his legislative proposal to be modified to not give older tax payers a complete exemption on paying taxes for their social security income. Specifically, the revised language would say, “If your house hold income is under $100,000 or less than your Social Security is tax exempt from state income taxation.”

While a Senate companion measure has been introduced by Senator Walter S. Felag, Jr., representing Bristol, Tiverton and Warren, an amended H 5000 will be placed in the House Budget because of its cost, says Craven.

The price tag could be between $30 and $35 million, Craven says, noting that better than expected revenues enable it to be funded. “It’s a priority to the state’s economic recovery, he says.

Older retirees, making from $35,000 to $100,000, from Social security and their pensions, will just put their dollars in the local economy, adds Craven. “It’s a good investment and we owe it to them. These retirees have been here all their lives, he says, noting that they ask very little for benefits from municipalities. “They have a lot of time on their hands to volunteer [in their communities] and are very philanthropically included in offering money and services to charities.”

Says House Speaker Nicholas Mattiello, “Representative Craven’s bill to exempt the state tax on Social Security will be included as part of the budget that the House Finance Committee will be considering within the next few weeks. Governor Raimondo included this exemption for low-wage earners in her original budget proposal, but the House will be broadening it to assist the middle-class retirees as well. The House budget exempts retirees, age 65 and over, who have income thresholds of up to $80,000 for individuals and $100,000 for joint tax filers.”

“We believe that by incorporating Rep. Craven’s bill into the budget, this will begin to stop the exodus of retirees leaving Rhode Island for many other states where there is no state tax on Social Security benefits,” adds Mattiello.

Gov. Gina M. Raimondo sees Social Security is a key source of income for older Rhode Islanders, noting that her submitted March budget proposal eliminates state taxes on Social Security benefits for low and middle income seniors “to help them make ends meet and stimulate our economy.”
With Rhode Island unions hit hard by the state’s recent pension reform, Craven’s proposal has received thumbs up from some.

James Parisi, field representative and lobbyist for the Rhode Island Federation of Teachers and Health Professionals, says his union supports Craven’s legislative proposal. “Unlike some other tax cut proposals introduced this session, his bill includes state and local government pension benefits. About half of the state’s teachers were never eligible to participate in social security so any tax cut proposal that is limited exclusively to social security benefits would be unfair to thousands of retired public school teachers,” he says.

Jim Cenerini, a lobbyist for Council 94, AFSCME also says his union is squarely behind H 5000. “Council 94 believes that legislation deserves careful consideration and support because: many other states provide some type of income tax exemption to retirement benefits/Social Security; in 2014 Kiplinger ranked Rhode Island as one the least tax friendly states for retirees; and since a significant majority of public employees remain in Rhode Island, and contribute to our local economy by spending on goods and services, it’s important to provide an incentive to remain in-state.”

A Final Note…
Other legislation proposals have also been thrown into the legislative hopper this session to protect older taxpayers. H 5446, introduced by Woonsocket law maker Rep. Stephen M. Casey, would protect the pocket books of retired teachers who are receiving a pension from Massachusetts. “These retirees, whose pension are overseen by Massachusetts Teachers Retirement System, are essentially double taxed because of the state’s tax code,” he says.

On Friday, May 29, the Rhode Island Public Expenditure Council (RIPEC) issued a report noting that the state may have significantly more funds available in fiscal 2015 and 2016 than anticipated when Gov. Raimondo submitted her budget in March. Specifically, state revenues are expected to be up by $106.8 million this year and $36.6 million next year, with additional funds available from expenditure reductions.

For this writer, its sound public policy to use some of the anticipated surplus identified in RIPEC’s report to enact H 5000 and H 5446 to lessen the tax burdens of Rhode Island’s retirees. As mentioned earlier, older taxpayers pull less resources from their cities and towns. But, most important, these retirees have greatly contributed to the quality of life in their communities throughout their working years.

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