Aging in Place in Your Rhode Island Community

Published in RINewsToday on May 2, 2022

As the graying of the nation’s population continues, older persons are choosing to live out their remaining years remaining in their communities in their homes, whenever possible. A new just-released study of adults age 50 and older from the AP-NORC Center for Public Research and the SCAN Foundation, finds a majority of older persons would like to age in place and are confident they can access needed services that will allow them to stay at home in their community for as long as possible.  

Gathering Thoughts About Aging in Place

According to this new national study released last week, two-thirds of the respondents think their communities meet their needs for accessing services like health care, grocery stores and social opportunities. The researchers found that all types of health care services are widely perceived as easy to access in their communities, and most feel that local health care understand their needs (79%) and take their concerns seriously (79%).

But, a closer examination of the small proportion of older Americans (Blacks and Hispanics) who feel less prepared and less supported in their community raises concerns about equity in access to the resources necessary to age in place.

However, the study reported that a few respondents say they had a hard time accessing needed services because of communication obstacles like a language barrier (11%), cultural barrier (8%) or age gap (8%); issues with affordability (15%); or issues of respect for their religious (4%) or cultural (3%) background. 

Those in urban areas—and suburban areas especially—describe their communities as having more supports for aging in place than those in rural areas. Older adults in suburban areas see their communities as doing the best job with meeting needs for healthy food, internet access, and the kinds of foods they want to eat. Suburban areas are also seen as better than rural areas in particular at meeting needs for health care and social activities. Older rural Americans are less likely than those living elsewhere to use a range of services simply because they aren’t available in their area. They are less likely to feel that community services are easy to get and designed for people their age than those in urban or suburban communities as well. And they are less likely to think a variety of health care services would be easy for them to access.

Income disparities are also associated with access to critical aging services. Those with incomes of $50,000 and below are less likely than those earning more to have access to services that are in their language (73% vs. 82%), close by or easy to get to (58% vs. 65%), respectful of their religious beliefs (57% vs. 65%), or designed for people their age (53% vs. 63%). When it comes to medical services, they are also less likely to have easy access to dental care, physical therapy, pharmacies, nursing homes, and urgent care than those earning more.

Additionally, those age 65 and older generally feel more prepared and report better access to important community services than those ages 50-64.

Aging in Place in the Ocean State 

For older adults aging in place, in their own homes, is by far the preferred model, says Mary Lou Moran, Director, Pawtucket Division of Senior Services at the Leon Mathieu Senior Center. “In fact, the theme of this year’s federal observance of Older Americans Month “Age My Way” focuses specifically on this very topic. The coordination, accessibility, and connection to services and programs is critical to the successful delivery of services and is where much work needs to be done,” she says. 

Moran says that senior centers located in communities throughout the state deliver needed information and assistance to older adults on accessing the needed  services to age in place.  Social isolation, access to transportation, food and housing insecurity, economic stability, and connectivity to services, are obstacles to enabling a person to stay in the community in their homes, adds Moran.

Over the years, Rhode Island’s inadequate Medicaid rates have become major obstacles to allowing a person to stay at home. However, recent state legislation, H 7616, to recreate a Department of Healthy Aging, spearheaded by Reps Carson, Ruggiero, McLaughlin, Contvriend, Speakman, Ajello and Potter, addresses some of the challenges that service providers are facing when trying to assist individuals to age in place. Moran adds, as the number of older adults continues to grow exponentially, the time has come to fully put the needs of our elders in the fore front to enable them to age with choice, dignity and respect.

According to Maureen Maigret, policy consultant and Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, “Rhode Island is fortunate to have a number of government-funded programs that help older adults to age in place.” These programs include Meals on Wheels home-delivered meals program; Medicaid home and community services including home care, adult day services; assisted living and self-directed programs; Caregiver respite and support services; Home Modification grants to help make homes accessible; and elder transportation assistance for those age 60+ for medical trips, to get to adult day.  She also mentioned the Office of Healthy Aging’s Home Cost Share program for persons age 65+ and persons underage 65 with dementia who are not Medicaid eligible with income up to 250% of the federal poverty level and the wonderful programs offered at the state’s senior centers.

However, Maigret says that for some of these services such as home care there may be wait lists due to worker shortages. (People can find out about these programs or to find out what benefits they may be entitled to by calling the POINT at 401-462-4444).

There are also private services available for almost any service needed to help people age in place if they have the financial means to pay for them,” says Maigret.  

The National Village to Village Movement Comes to Rhode Island

While some of these volunteer programs in RI may offer some type of services such as transportation, a relatively new initiative has come to Rhode Island. “The Village Common of Rhode Island (TVC) provides a variety of supports through the efforts of almost 200 trained and vetted volunteers,” says Maigret. 

Maigret says that the goal of TVC is to help older persons to stay in their own homes and connected and engaged with their community. “This “neighbor helping neighbor” model started 20 years ago in Beacon Hill Boston and now there are 300 nonprofit “villages” operating across the country. TVC supports include transportation, running errands, home visits and telephone assurance, minor home repairs and light yard work, assistance with technology, and a virtual caregiver support program. A robust weekly calendar offers virtual events, and a monthly newsletter keeps members and guests informed. All this is done with a lean 1.5 person staff, a working board of directors and almost 200 volunteers,” she notes. 

“I had heard about the “village” model some years back and supported efforts to start a “village” in Rhode Island, she says. “It amazes me that a small band of committed volunteers were able to put all the pieces in place to operationalize a “village” and to see what has been accomplished. There are now active “villages” in Providence, Barrington, Edgewood/Cranston and Westerly with almost 300 members and more “villages” are under development. One of the priority goals of the Board is to reach out to underserved neighborhoods in our urban and rural areas to listen to people and find out what is important to them and what type of “village” program might work in their area,” she says. 

“We know that transportation is a huge issue for folks living in our rural areas and that is a huge concern. And, based on findings of the 2021 RI Life Index: Older Adults in Rhode Island(from RI Blue Cross Blue Shield//Brown University School of Public Health), we know that older persons of color living in our core cities have lower perceptions of community life, access to healthcare and experience lower food security and access to technology,” adds Maigret.  

“Research on the fairly new “village” programs shows promise in fostering feelings of being connected to others and suggest older women living alone with some disability most likely to experience improved health, mobility and quality of life (https://pubmed.ncbi.nlm.nih.gov/28509628/.),” says Maigret, noting that this is an important finding as Rhode Island has such a high portion of older adults living alone.

TVC President Anne Connor (74) says she has been a member and volunteer since 2015. “That we are volunteer supported is noteworthy and having an Executive Director, Caroline Gangji, (formerly acting Executive Director at Age Friendly RI), improves our ability to serve our members”, says the retired librarian and paralegal.

As TVC founder Cy O’Neil once said, ” …you don’t create a fire house when the house is burning.”  TVC is more than services – it is the relationships we build that are key to our success, says Connor.  

For details about The Village Common Rhode Island, go to https://www.villagecommonri.org/.

For specifics programs and services offered by the Rhode Island Office of Healthy, go to  https://oha.ri.gov/.  

New efforts on Smith Hill to increase Medicaid reimbursement rates

Published in RINewsToday on April 18, 2022

On March 8th, a press conference on Smith Hill put the legislative spotlight on introduced rate setting legislation intended to fix Rhode Island’s long-time problem of paying insufficient reimbursement rates to human-service agencies delivering social, human and clinical services to Medicaid recipients. 

Over 80 human service providers, clients, and aging advocates, came to support Sen. Louis DiPalma and Rep. Julie Casimiro’s two pieces of legislation to fix a broken Medicaid payment reimbursement system. These bills would provide for periodic rate review/setting processes to ensure accurate and adequate reimbursement of social, human and clinical services.

“Senate President Dominick J. Ruggerio came, giving his blessings, too. “It is critical that we undertake a review of reimbursement rates so that we have a thorough understanding of the data and we can make informed decisions,” said the top Senate lawmaker. “These bills will help bridge the gap and bring reimbursement rates where they need to be,” he said.

The Reimbursement Fix…

DiPalma and Casimiro’s bills do not specify dollar amounts for adequate hourly wages but would hammer out the “periodic rate review and setting process.”

The first bill (2022-S 2311 / 2022-H 7180) establishes a process which would require the Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of social service programs licensed by state departments, agencies and Medicaid. 

The second one (2022-S 2200 / 2022-H 7489) establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.

At press time, legislation has been referred to the Senate and House Finance committees for review. 

“Years of stagnation in our state’s Medicaid reimbursement rates have negatively affected hundreds of thousands of Rhode Islanders who rely on a wide range of services,” claims DiPalma, (D-District 12, Middletown, Little Compton, Newport and Tiverton), a long-time advocate at the Rhode Island General Assembly for human services providers and disabled Rhode Islanders.  

DiPalma says a comprehensive rather than a piece meal approach is now needed to address this reimbursement issue. Stressing that the two bills would fix the continuing reimbursement issue. “For our providers, the people they serve, and the future of our state, it is imperative we act now,” he warns. 

Rhode Island’s healthcare system is suffering a crisis of care that’s only worsened due to the pandemic, charges Casimiro (D-Dist. 31, North Kingston and Exeter), noting that the state’s human health agencies are understaffed and under-supported and it is hurting the state’s most vulnerable residents.  

“Our reimbursement rates have remained too-low and unchanged for many years and the residents of our state cannot access the crucial services they need if there is no one there to provide the care,” said Casimiro, urging Rhode Island lawmakers to stop the exodus of human services workers for their jobs.  Proper oversight of the rate setting process and appropriate reimbursement rate increases will ensure a high-level of care provided, sorely needed now, she says.    

Providers call for ratcheting up RI’s Medicaid payment rates

Long-time aging advocate and former Representative, Maureen Maigret, translated the rate payment issue into a “dollar and cents” example. Maigret, a policy consultant who previously chaired the Long-Term Care Coordinating Council’s Aging in Community Subcommittee, noted that the Bureau of Labor Statistics show in 2020 in Rhode Island the average wage for a home health aide was less than $15 per hour and nursing assistants slightly $16. “These low wages do not come close to meeting one’s basic needs, forcing workers to work more than one job or, as more are doing, just abandoning this type of work altogether for better pay, she added, stressing that this was before these workers faced 7% inflation and gas prices reaching over $5 per gallon,” she said.

“High workforce turnover rates are especially troubling for patients receiving homecare, who value building a long-term relationship with someone coming into their home frequently, says Bernie Beaudreau, Executive Director, the Senior Agenda Coalition of Rhode Island, “Seniors cannot age with independence and dignity if homecare workers are not treated with respect in wages and working condition,” he says.

This legislation is a step in the right direction and provides the state an opportunity to move toward the realignment of reimbursement rates that accurately reflect the actual cost of the delivery of behavioral health treatment and services,” says Susan Storti, President and CEO of The Substance Use and Mental Health Leadership Council of Rhode Island.

“These bills ask our state a clear, direct question: do we, or do we not, support inclusive lives in our communities? We must reply with an equally clear answer: ‘Yes, we do’ and pass S-2311 and H-7180, says Tina Spears, Executive Director, Community Provider Network of Rhode Island, noting that for CPNRI and its members it is all about inclusion of children and adults with disabilities and behavioral health conditions in our society. 

Time to pay providers adequately  

With all 38 Senators co-sponsoring both his Senate bills, DiPalma is pleased with the positive reception his legislation has received in the upper chamber. “We cannot delay any longer. The time to act is now,” he says, stressing that it’s important for lawmakers to get these bills over the “goal-line. “There are hundreds of thousands of Rhode Islanders counting on us to get this done,” he adds.

DiPalma says that a Senate hearing is being planned  to consider S 2311 and S 2200 on Thursday, April 28 at the Rise of the Senate in the Senate Lounge. All are encouraged to attend the hearing and voice their support. 

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

Published on March 21, 2022 in RINewsToday

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/