Tag Archives for Long-Term Care Coordinating Council

Governor’s Budget is Silent Regarding Many Senior Issues

Published in Pawtucket Times on March 24, 2003

Many of Gov. Don Carcieri’s policy initiatives can be found sprinkled throughout Fiscal Year 2004 Budget address.

While Carcieri’s 3,200-word speech identified his administration’s priorities – that is, maintaining human services, investing in education and creating jobs and fixing the state’s crumbling roads and bridges- it was silent on issues of interest to aging advocates and seniors.

At an AARP debate of gubernatorial candidates, Carcieri was asked if he would budget $15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing home residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million, for a total increase of $ 30 million.

At the debate, Carcieri acknowledged it would be difficult to find $15 million to fix the system because of the state’s looming budget deficit.

After a first read, Alfred Santos, executive director of the Rhode Island Health Care Association, found the recently released administration budget did not allocate the $ 15 million in new funding to allow nursing facilities to be reimbursed for the actual cost of care that they provide to frail residents.

Santos hopes to schedule a meeting with Gov. Carcieri and his policy staff to discuss Medicaid reimbursement and staffing issues.

“One of the biggest disappointments for seniors in the governor’s budget is his failure to include funding to allow more low-income persons to choose Medicaid waiver-funded assisted living,” noted Maureen Maigret, who serves as Lt. Governor Fogarty’s director of policy and executive director of the state’s Long-Term Care Coordinating Council.

“This has been a priority for the senior advocacy community, and the governor was supportive of this funding during his campaign,” says Maigret.

Maigret told All About Seniors that more than a year ago, the federal government had approved an additional 180 units in the state’s Medicaid assisted living waiver to respond to Rhode Islander consumer demands.

“Failure to fund these units is short-signed in terms of saving taxpayer dollars and denies low-income seniors the option to choose a less restrictive care setting,” said Maigret, who calls the state’s current assisted living waiver program a great success.

According to Maigret, in the last fiscal year, there was a decrease in state-funded nursing home use of about 50,000 days and an increase in Medicaid funded Assisted Living of about the same number of days. “We have reached the funding cap for these Medicaid-funded assisted-living units and have a waiting list of 35 persons,” she said, noting that some of these persons will now be forced to enter nursing facilities at twice the cost of the state.

Meanwhile, Maigret added that the governor’s budget does not address the dire need of more regulatory staff in the Health Department to monitor assisted living and enforce state standards.

On the other hand, the Rhode Island Pharmaceutical Assistance for the Elderly Program (RIPAE) is intact, Maigret said.

“With the costs of prescription drugs increasing at such alarming rates, RIPAE is a vital safety net for thousands of Rhode Island seniors.

Maigret noted that changes this year in Blue Chip and United Health senior plans may further impact many seniors’ accesses to prescription drugs, as these plans have new features which limit benefits for brand name drugs. Legislation proposed by Fogarty and introduced by Sen. Elizabeth Roberts and Rep. Peter Ginaitt will address this pharmaceutical issue, she said.

Finally, Maigret said senior advocates must watch other areas of the state budget that will ultimately impact seniors. Some community grants, such as those that support senior centers, are targeted for 10 percent cuts. While nursing homes are in line for an annual cost of living increase (COLA) in their Medicaid rates, no similar COLA is included for home and community care providers.

Maigret added the governor’s budget cuts about $ 10 million (state and federal funds) to continue its efforts of downsizing the Eleanor Slater Hospital Cranston campus, with a proposal to close two more wards. To offset these closures, the budget includes about $ 800,000 to fund about 20 more nursing home placements and new funds to increase capacity to serve persons with mental illness in community residential settings.

The push to get residents back into the community concerns Roberta Hawkins, state ombudsman and executive director of the Alliance for Better Long-Term Care. She opposes the closure of wards because there are persons in the community who require a higher level of care, a level that is only available at the Eleanor Slater Hospital.

Hawkins noted the administration budget does not include Medicaid funding to pay for dental services to seniors in the community and those residing in nursing facilities.

“The short-sidedness of this fiscal policy ultimately will increase care costs when the resident must be hospitalized for malnutrition, dehydration and bed sores, all caused by dental problems,” Hawkins said. “On a human level, who would want to constantly suffer from pain all night because of a toothache or gum problems?” she added.

Sandy Centazao, president and CEO of Meals on Wheels of Rhode Island, is still waiting to see if Carcieri will ultimately institutionalize her nonprofit group’s funding rather than continue to allocate it as a legislative grant. She expects this decision to be made before the enactment of the state’s FY 2004 budget on July 1.

With a looming recession and a nation at war, Carcieri and the General Assembly must ultimately make difficult decisions as to how to slice the state’s FY 2004 budget. The state’s final budget must  provide the funding and adequate resources to enable long-term care providers to take care of the state’s burgeoning older population. It’s the right thing to do, even n times of uncertainly.

Lawmakers Consider Proposals to Reduce Costs of Prescription Drugs

Published in the Pawtucket Times on April 15, 2002

Amid the political bickering over the separation of powers bill and the controversy over allowing Rhode Islanders to vote next November on bringing gambling to the Ocean State, the Rhode Island General Assembly is getting around to considering three legislative proposals with broad public and bipartisan political support.

In the shadow of a huge state budget deficit, bills strongly endorsed by both senior and disabled advocates, would make pharmaceutical costs affordable while not costing the state one penny.

It was standing room only last Wednesday in Room 35 at a House Finance Committee hearing, chaired by Chairman Steven Costantino (D-Providence), of the subcommittee on human services. The legislative hearing, lasting almost four hours, drew the attention of the Rhode Island Commission on Aging, the Forum on Aging, the Gray Panthers, and Choices, to name a few.

Dozens of aging and disability advocacy groups, staffers of the Department of Elderly Affairs and the Department of Human Services, and lobbyists for the powerful pharmaceutical industry came to listen to testimony that would officially kick of the state’s debate on lowering pharmaceutical costs for seniors and persons with disabilities.

Under on legislative proposals (H 7291/S 2729), the state Department of Human Services would seek a waiver from the federal government allowing Rhode Island to use Medicaid funding to pay for prescription drugs for low-income seniors with incomes of up to $ 17,720 and couples with incomes up to  $ 23,880.

This bill, authored by Lt. Gov. Charles Fogarty and sponsored by Rep. Constantino and House Finance Chairman Gordon Fox, would enroll approximately 90 percent of the 37,500 seniors now enrolled in the Pharmaceutical Assistance for the Elderly Program (RIPAE) – the state’s pharmaceutical program. Because these seniors would now quality for prescription drug coverage under Medicaid, all Food and Drug Administration (FDA) drugs would be covered, not just those currently covered under RIPAE. Seniors would likely pay small co-payments, probably less than $ 10, rather than the 40 percent co-payments currently charged.

At this hearing, testimony was gathered on two other Fogarty legislative proposals that would make prescription drugs  more affordable to seniors and persons with disabilities who are not covered by the waiver. One bill (H 7290) would allow seniors enrolled in the RIPAE – approximately 5,000 seniors – to buy prescription drugs not currently covered by RIPAE at the discounted state price.

The second (H 7524) would allow 4,300 low-income persons on Social Security Disability Income (SSDI) who are between ages 55 and 65 to become members of RIPAE and purchase prescription medications at the state discounted rate.

Under both of these legislative proposals, the state would be able to obtain the manufacturer’s rebate available through RIPAE. Rebate funds gained from drug purchases by persons in the new SSDI part of RIPAE would accrue in a special fund to be used to subsidized the cost of these drugs in the future. This legislative initiative, like the other two, would be of no cost to the state.

There’s a very good reason why these proposals should be enacted, says Fogarty, who chairs the state’s Long-Term Care Coordinating Council. “Far too many of our seniors still face great burdens in paying for their medications. If your income is less than $ 10,000 per year – which is the median income for a person on RIPAE – having to pay $ 1,000 or more out of pocket for one’s prescription is a big problem.

“This year, in spite of our budget woes, we have a tremendous opportunity to greatly expand our prescription assistance program for seniors and persons with disabilities. By taking advantage of federal Medicaid dollars, we can save seniors millions and we can do these expansions with no added costs to the state,” Fogarty adds.

Susan Sweet, who represents CHOICES, a home and community advocacy agency and the Rhode Island Minority Elderly Task Force, says the expansion of RIPAE is critical, especially in light of the federal government’s failure to create a federal Medicare pharmaceutical benefit.

“Being able to pay for prescriptions avoids sickness, unnecessary hospitalizations and admissions to nursing homes, saving millions of dollars and many years of productive lives for seniors,” says Sweet. “Pharmaceutical products are the current and future medical miracles, and health insurance is inadequate without adequate drug cover, she says.

Shirley Kaiser, president of the Rhode Island Gray Panthers, whose group has battled years for putting the brakes on rising pharmaceutical costs, says seniors are giddy with the news that Rhode Island may finally move to addressing the problem.

The Gray Panthers strongly endorse the legislative proposals, and she believes this is the year for enactment of a legislative remedy.

At the Rhode Island General Assembly, some bills are enacted while many die during the legislative process, even those with great merit.

In light of the state’s fiscal uncertainties, lawmakers now have a rare opportunity to assist older Rhode Islanders and persons with disabilities in obtaining affordable prescription drugs at no cost to the state coffers.

With the widespread support and endorsement of these legislative proposals from state officials, aging and disability advocacy groups, and the pharmaceutical industry, for me it’s a no brainer – pass these bills and quickly sign them into law, says Kaiser.

It is now time to put this longtime aging issue behind us and move forward to other pressing matters like creating and paying for a seamless long-term care system.

Ensure passage of the three bills by telling your representatives and senators how important these three proposals are for you, and request their passage.

Staffing Crisis Hits Nation’s Nursing Facilities

Published in the Pawtucket Times on February 25, 2002

A yet-to-be released federal report paints a very bleak picture about the quality of care provided in the nation’s nursing facilities.

According to an article published last week by The New York Times, a draft federal report finds that 90 percent of the nation’s nursing facilities do not have enough nursing staff to properly care for their residents.

Simply, put, the lack of staffing reduces the quality of care provided in nursing facilities, increasing the incidence of bedsores, falls, malnutrition, weight loss, urinary tract infections and blood-borne infections, the report notes.

According to the draft report, which was ordered by Congress, is expected to be officially released by the U.S. Department of Health and Human Services in April, reaching appropriate staffing in nursing facilities would cost the federal government big bucks.

With a $ 7.6 billion annual price tag, about an 8 percent increase over current expenditures – the report – entitled “Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes” – recommends cheaper ways to fix the staffing crunch in the nation’s facilities.

Rather than regulate minimum ratios of nursing staff to residents, the report calls for better management techniques and training of certified nursing aides CNAs) to increase staff productivity and to decrease CNA turnover. Additionally, market demand sparked by an informed public that has access to publicly reported nursing staff data may even increase nurse staffing levels in facilities, the report notes.

The New York Times article does not get to the root of the nation’s staffing problems in nursing facilities, charges Al Santos, executive director of the Rhode Island Health Care Association, the state’s largest trade group that represents nursing facility providers.

“While the article only focused on the inadequacies of staffing levels across the country, it failed to report on its cause – a lack of adequate government reimbursement for nursing facility care,” Santos said.

Santos stated the federal report, which is detailed in the New York Times, is correct in its assessment that the shortage is “likely to become worse.

It should come as no surprise to policymakers that in order to increase wages and to make frontline nursing jobs competitive. Medicaid can no longer pay roughly $ 4 per hour, per patient for shelter, meals, labor costs, special care, certain therapies and other items,” Santos adds. “Costs far outweigh government reimbursements for patient care, and chronic under-funding of Medicaid directly impacts staffing.”

There is no doubt in my mind that the lack of adequate staff in facilities create poor quality of care,” says Roberta Hawkins, executive director of the Alliance for Better Long-Term Care, who also serves as the state’s ombudsman on nursing facility issues. Hawkins said she fears that the continuing staff shortage in Rhode Island facilities will chip away the past 25 years of improved resident care that has resulted from state and federal nursing facility reforms.

Although inadequate pay and benefits are obstacles to retaining staff, Hawkins predicts that it will become even more difficult to recruit CNAs when more horror stories about poor care appear in local newspapers or on state or federal agency websites.

“As a society, all of us are responsible for the care not being provided to nursing facility residents. If we don’t provide that money to pay for the best of care, we are partially responsible for that care not being provided,” Hawkins said.

Hawkins sees as permanent fix to this ongoing staffing shortage found in Rhode Island facilities – tie the reimbursement rate to the level of resident care provided. For instance, facilities with heavy-care residents would receive a higher Medicaid reimbursement rate, which takes into account the increased staffing needs of those residents.

But adequate Medicaid funding is not the only solution to the continuing staff shortage dilemma facilities face, Hawkins warned.

“We need to create upward mobility in nursing jobs, improve training specialty care provided to Alzheimer’s residents, bedridden residents and to those requiring rehabilitation,” she said.

The new federal study doesn’t surprise Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council (LTCCC) and to those involved in providing or regulating nursing facility care in the Ocean State.

Just last year, a statewide LTCCC study found Rhode Island’s nursing facilities reported a shortage of certified nursing assistants, the staff who provide 90 percent of the direct care to residents.

“The report gives us useful information to look at the issue of staffing and quality in Rhode Island nursing facilities,” Fogarty said. “It also should serve as a clear signal to Congress that it must do a better job of planning and funding long-term care.”

A state commission chaired by Human Services Director Jane Haywood, is currently studying how the existing Medicaid reimbursement system can be improved.

Even with a mounting state budget deficit, it is now time for the governor, state lawmakers and state officials to put the energy and resources into tackling this ongoing staff shortage issue.

With major input from the nursing facility industry and from Hawkins and her resident advocates, Haywood’s final blueprint for changes in the state’s Medicaid program must be taken seriously. With a state election looming in November, candidates running for governor, the Rhode Island General Assembly and Congress must do their homework, study the staffing crisis in the state’s nursing facilities, and develop their positions to confront this pressing policy issue.

More than 10,000 nursing facility residents and their families pray that the report to be issued by the Department of Human Services will not end up in some back office on a dusty shelf.