New Legislative Commission to work on improving programs, services to seniors 

Published in RINewsToday on June 19, 2023

During May, designated as Older Americans Month, the Rhode Island House of Representatives approved H 5224-SUB A, sponsored by House Deputy Majority Leader Lauren H. Carson (D-District 75, Newport), creating a legislative commission to study the services and programs for 240,000 older adults in Rhode Island – and to make recommendations for ways to improve and coordinate them. The number of seniors is expected to skyrocket to almost 265,000 by 2040, constituting an increase of nearly 75% since 2010.

On May 11, 2023, over three months since the resolution was dropped in the legislative hopper, it passed by a whopping bipartisan vote of 69 to 0 (with 6 members absent). There was no opposition to H 5224- SUB A from any organization. It seems that any House lawmaker or organization opposing this resolution would also oppose “motherhood and apple pie.”

With a number of House GOP concerns addressed in the state’s $14 billion budget, House Minority Leader Michael Chippendale directed his caucus to support passage. The House Republican Caucus also unanimously voted for H5224 – SUB A, and fully supported the mission of a legislative commission which is charged with collecting and analyzing the current state of affairs in regard to Rhode Island’s growing senior population.

Carson’s resolution calls for “a collaborative study of Rhode Island’s current services, and recommendations for potential initiatives that would help residents, agencies, providers, and the government to better assist the growing population of older adults in our state achieve well-being and maximum independence in ways that value, empower and engage them,” adding that such an effort is essential to the state’s future resilience and prosperity.

According to House Communications Director Larry Berman, 21 House legislative Commissions will be operational when Carson’s legislative commission becomes operational. The House Policy Office will staff the Commission.  The number of meetings (open to the public) has not yet been determined. The meeting agenda will be determined by its Chair, with input provided by the 16 Commission members, House lawmakers, members of the public, and aging advocates. 

Because H 5224 – SUB A only creates a House legislative commission, there is no need for a companion measure to be introduced in the Senate,” says Berman who notes that this Commission will begin in the Fall of 2023. It is charged to report its findings and recommendations to the House of Representatives no later than May 7, 2024. The Commission would then expire on August 7, 2024.

Providing a Road Map to Fix Systemic Policy Flaws

“This commission will provide valuable information to the House next year to provide a roadmap for providing service and programs for older Rhode Islanders, including funding options that will be strongly considered,” stated House Speaker K. Joseph Shekarchi  (D-Dist. 23, Warwick), after passage of the special legislative committee.

“We have had excellent results with other commissions that have studied housing and shoreline access that have led to legislation that the General Assembly has adopted.  Representative Carson is an extremely thoughtful and dedicated legislator who will work hard with commission members to develop great plans for the future,” says Shekarchi.

“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. Considering that nearly a quarter of our population is over 60, and Baby Boomers will continue to swell those ranks, now is the time,” said Carson. “This commission will take a look at the services we have, how we could improve and better coordinate them and offer them to more individuals, where the gaps and needs are, and what we need to do to better enable our population, as we grow older, to safely remain in the community and lead full lives,” she says.

The 16-member commission, all appointed by the House Speaker, will include three members of the House of Representatives, two Rhode Island residents over the age of 65, three directors from the Rhode Island Senior Center Director’s Association, a community action program director from the Rhode Island Association of Community Action Agencies, a member of the Long-Term Care Coordinating Council, and a member of a Rhode Island organization representing adults with disabilities.

In addition, the directors of the Office of Healthy Aging, the Department of Health, AARP Rhode Island, Age-Friendly RI and the Senior Agenda Coalition of RI or their designees will participate.

H 5224 – SUB A instructs the commission to study key statistics about services for older adults in Rhode Island, examining strengths, vulnerabilities, and demographic and financial statistics; assess the current state, federal and local services currently available, as well as any duplication of services; recommend ways to coordinate services within agencies and focus on better service delivery, including housing options and various living arrangements, health status and health care resources; provide recommendations for the creation of a portal to coordinate aging services in employment, education, independent living, accessibility and advocacy, as well as local older adult centers and services; provide recommendations on mental health, transportation, food access, and health care; provide recommendations for the funding of services through state, federal and private grants and for more efficient distribution and use of these dollars; and explore more regionalization of services.

Towards the Creation of a Strategic State Plan on Aging

“The newly established legislative commission to study the services and programs for our rapidly growing older population can become the launching pad for the state to move forward to create a multi-sector Strategic State Plan on Aging to coordinate Rhode Island’s programs and services for older Rhode Islanders, says Maureen Maigret chair of the Aging in Community Subcommittee of Rhode Island’s Long-Term Care Coordinating Council who also serves as a policy consultant and board member of the Senior Agenda Coalition of RI.  She notes that 10 states have already developed this “master plan” and she hopes Rhode Island will also join their ranks. 

At the Senior Agenda Coalition  of RI’s August 2022 Gubernatorial Forum, she warned that the state’s aging and long-term services were fragmented, spread across a number of state agencies, charging that these agencies often lacked stable leadership and a coherent and overarching vision. Creating a Strategic Plan on Aging builds on work being done now by the Office of Healthy Aging and Subcommittees of the Long Term Care Coordinating Council, and would be a fix for this,” says Maigret. 

According to Maigret, at the August Forum Gov. Dan McKee stated he would issue an Executive Order for initiating a Master Plan on Aging, but that has not happened. Aging advocates are still waiting for this to happen.

“We look forward to joining with older-adult focused direct service, advocacy, non-profit, and state colleagues, and older adults themselves, to discuss how Rhode Islanders want to age and what we can build collectively to make that possible, says Director Maria Cimini, of the state’s Office of Health Aging (OHA).

“At the OHA we are thrilled there is interest and a commitment of time and resources to understand and plan for our state’s aging population, from where we sit, this opportunity will equip us to advocate for policies that empower and uplift our senior population, fostering dignity, purpose, and respect for all older adults,” adds Cimini.

Don’t Forget the Rhode Island’s Poor and Minority Elders

Susan Sweet, long-time advocate for poor and disadvantaged elders and the founder of The R. I. Minority Elder Task Force which provides limited financial assistance to low-income seniors in crisis reports: “We are seeing a large uptick in elders in crisis situations lacking basic needs such as food, utilities, housing, and personal items. Minority group members, immigrants, retirees as well as general population seniors are suffering more intensely since Covid, inflation, and lack of affordable housing matters have exacerbated the existing poverty among elders. In particular, homelessness among elders is at a peak we have not seen before.”

Sweet is hopeful that this new Legislative Commission will consider and react to the particularly difficult situations that confront the poor and minority elder populations. “I have seen many plans for services to elders that either ignore or do not implement agenda items addressing these populations and I hope that this commission will prioritize the severe privations that they face on a daily basis,” she says.

“With the lessons learned over the past 2 years and the devastating impact of COVID on our older adults, it’s critical that we reexamine our aging infrastructure, the needs for services, and the local service capabilities to this growing population,” Vin Marzullo, who served 31 years as a career federal civil rights & social justice administrator at the National Service agency.

“A serious, adult conversation is long overdue with the aging community, service providers and lawmakers about designing our plan for a more “Age-Friendly” RI, – which supports local senior centers as the local hub for the delivery of services,” suggests Marzullo.

The nursing home industry supports the mission of the newly enacted legislation committee. “Included in their charge is to, among other things, provide recommendations regarding available health care services.  Rhode Island’s nursing facilities play a vital role in health care for our older adults – providing care and services to over 18,500 seniors each year.  Many of these individuals are provided with short-term skilled nursing, physical, occupational and/or speech therapy following a hospitalization – enabling them to safely transition from the acute hospital level of care back home with continued services,” says John E. Gage, President and CEO of the Rhode Island Health Care Association.

“Of course, every Rhode Islander wants to remain independent, healthy and in their home for as long as possible.  When this is no longer viable, however, our state needs a strong spectrum of care, including home care, assisted living residences and skilled nursing facilities to support them as their care needs change.  Workforce is perhaps the most daunting challenge facing these health care providers, and this will need to be a focus for years to come,” notes Gage.

H 5224 A cosponsors are Representatives Samuel A. Azzinaro (D-District 37, Westerly), Thomas E. Noret (D-District 25, West Warwick), Susan R. Donovan (D-District 69, Bristol, Portsmouth), House Majority Whip Katherine S. Kazarian (D-District, East Providence), Karen Alzate (D-District 60, Central Falls, Pawtucket), Jason Knight (D-District 67, Barrington, Warren),  and Kathleen Fogarty (D-District 35, South Kingston.

A copy of H 5224 A may be accessed here: http://webserver.rilegislature.gov/BillText/BillText23/HouseText23/H5224A.pdf.

The House Floor vote (5/11/23) – 48 minute 48 second mark may be accessed here: https://ritv.devosvideo.com/show?video=d12583542bad&apg=84a99049.

The Health & Human Services Committee heard this resolution on March 15, 2023.  See the 1hour and 50-minute hearing by going to https://ritv.devosvideo.com/show?video=e3ea82fcb949&apg=6aae3d42

Herb Weiss, LRI -12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 43 years.  To purchase his books, Taking Charge: Collected Stories on Aging Boldly and a sequel, compiling weekly published articles, go to herbweiss.com.

Path to an “age-friendlier” budget

Published in RINewsToday on June 5, 2023

After a 47:10 minute meeting on Friday night, the House Finance Committee approved a $14 billion budget for the 2024 fiscal year that commits funding toward addressing the housing crisis (top priority), supports business development and makes education funding more equitable while limiting the use of one-time revenue to one-time expenditures. 

The passed budget reflects the May revenue estimate that was $61.2 million lower than projected last November. 

On June 2, 2023, the budget passed on a partisan vote of 13-3, sending the budget bill (2023-H 5200A) to the full House of Representatives, which is slated to take it up June 9 at 2:30 p.m. Changes could be made.

Hammering Out a Compromised Budget 

At a news conference held on Friday at 3:30 p.m. before the vote, House Speaker K. Joseph Shekarchi  (D-Dist. 23, Warwick) compared the politics of hammering out the state budget proposal to Democratic and GOP leadership making a deal to avoid a national default earlier this week.  “Nobody, including me and everyone else here, got everything they wanted,” he said, noting that the state budget required “compromise.”  

“Our goal with this budget is to support Rhode Islanders’ needs while responsibly preparing for our future. Our top priority, of course, is addressing our housing crisis, and we have worked hard, in collaboration with Governor McKee and our colleagues in the Senate, to identify the most effective ways we can direct the funding we have toward solutions that will help create more affordable housing access. This budget also strengthens our efforts to provide educational opportunities in K-12 and higher education and supports businesses, working Rhode Islanders, retirees and those struggling to meet their families’ basic needs,” said Shekarchi, in a statement announcing the House Finance Committee’s passage of the budget.

“At the same time, we are being realistic. Given the end of the federal funding related to the pandemic, we need to plan not only for next year, but for the following years, when we are not going to have the level of revenue we’ve been fortunate enough to have for the past few years. We are spending our remaining federal COVID funding and our available revenue on one-time investments rather than creating long-term commitments that we can’t sustain,” he said.  

Adds Marvin L. Abney (D-Dist. 73, Newport, Middletown), chairman of the House Finance Committee: “This budget was carefully crafted so that our residents, particularly our most vulnerable, retain the supports and assistance that they and their families need, so that our businesses have the ability and opportunity to grow, and so that Rhode Island is situated to withstand a very possible financial downtown that will affect both our state and national economies.  Responsible, compassionate and thoughtful decisions were made to create a budget that will benefit all Rhode Islanders and this budget positions the state to be as competitive as possible into the future.”

Taking a Look at Aging Programs and Services 

“I am extremely pleased the budget passed by the House Finance Committee contains important funding that will benefit seniors as well as older adults with disabilities,” says Maureen Maigret, chair of the Aging in Community Subcommittee of Rhode Island’s Long-Term Care Coordinating Council and policy consultant and board member of the Senior Agenda Coalition of RI. “The Office of Healthy Aging (OHA) will receive an additional $250,000 in general revenue for the Aging and Disability Resource Center (ADRC). The ADRC provides counseling about services and benefits and assistance with the application process.  Advocating to strengthen the ADRC (called the POINT) was a high priority for the Senior Agenda Coalition of RI and the Aging in Community Subcommittee of the Long Term Care Coordinating Council,” says Maigret.

According to Maigret, this is the first time that ADRC will receive state funds. To date, it has operated with limited federal dollars and too many persons are not aware of the program. The state funding can be matched by federal Medicaid funds. “ADRC services are critically important for older adults, persons with disabilities and family caregivers, as they attempt to find appropriate services and navigate a sometimes-fragmented system of care, says Maigret.

Maigret says that the budget also adds funds to support two new staff positions for OHA’s protective services unit to deal with increasing reports of elder abuse and exploitation. OHA’s Adult Protective Services received over 6,000 calls last year. The additional funding for these positions will ensure that reports are investigated in a timely manner and protect older adults at risk of abuse and neglect. 

Other notable additions to the budget include an increase in the Personal Needs Allowance (PNA) for nursing home residents on Medicaid to $75/month (from $50.) This amount had not been adjusted since 1999, says Maigret noting that the additional funding will help thousands of nursing home residents pay for such items as haircuts, clothing and, telephone service.

“The House Finance Committee also added $250,000 to increase funding for the Livable Home Modification grant program to $0.8 million,” says Maigret, noting that the program helps pay for costs of support home modifications and accessibility enhancements to allow individuals to remain in community settings. And of course, the funds dedicated to addressing housing affordability although not specific to the older population will benefit them,” adds Maigret. “Overall, these budget additions and the additional funds for community senior services and Meals on Wheels proposed by the Governor demonstrate a continued commitment on the part of our state leaders to address the needs of our growing older population,” she says.

The budget didn’t reinstate the retiree Cost of Living Adjustments (COLAs) eliminated in 2011.  “Once again, retired state workers, teachers, and municipal retirees who are part of the state retirement system have been shown how little they are valued by state legislators”, comments Susan Sweet, a former state associate director of elderly affairs and an advocate for low-income elders. “Although there were many bills in to restore the COLA or at least provide a token payment to these retirees, it appears that no funds at all are being directed towards that purpose.  This is a great disappointment to so many folks who faithfully performed their duties and were stripped of their promised pensions. No wonder that teachers and government workers are reluctant to spend their career lives in the public sector” she states.

Is Proposed House Budget “Age Friendly” ?

Maigret believes that the state has taken some positive steps toward becoming “age friendly” especially if we think of age-friendly with an intergenerational lens. Items that address children and youth such as expanded tuition assistance of Rhode Island colleges are important.  “However, we still have a long way to go in many of the domains for age friendliness,” she notes, “especially in the area of economic security for older adults as many live with income less than $25,000 relying mostly on fixed incomes.” 

Maigret calls on the Rhode Island General Assembly to fund mini-grants to communities to incentivize them to “look at their comprehensive plans with age-friendly lens.” 

Here is the link to the bill to establish the budget:

Here is the link to the entire budget and every article (as well as how it compares to the budget as submitted by the Governor in January):  https://www.rilegislature.gov/Budget/SitePages/FY24.aspx.

Here is a link to a press release which contains a summary of the highlights of the budget:

To watch the House Finance Committee meeting, go to https://ritv.devosvideo.com/show?video=defebab838c1&apg=52ab780b.

A close look on “Facts and Figures” about Alzheimer’s

Published in RINewsToday on April 3, 2023

For over five years, Janet Bryant, 65, has been a caregiver for her 67-year-old husband, Paul, who suffers from Alzheimer’s disease. Their daughter, Alison, and husband Ryan, living in the condo above her parents, step in to assist with caregiver duties when needed. 

“It’s often a long day when you’re caring for someone with dementia,” says Janet, who handles all financial, medical and household tasks. Even when Paul helps out with a few tasks he must be closely supervised, she says. And you must be watchful. “A few weeks ago, Paul was trying to make a cup of tea, and put the metal tea kettle in the microwave, causing the handle to burst into flames. I disabled the microwave and now I make him his tea. His wife of 47 years says he can’t be left alone, and gets lost in their small condo. 

Janet acknowledges that the long day often continues into night, as Paul has trouble finding the bathroom or tries to roam around. 

Janet’s experiences as a caregiver taking care of a loved one with Alzheimer’s disease is not uncommon. The newly released Alzheimer’s Disease Facts and Figures reports that 6.7 million people aged 65 and over, like Paul, are living with Alzheimer’s or other dementias in the United States — it’s one of the costliest conditions to society and is projected to reach $345 billion, a $24 billion increase from a year ago. By 2050 these costs could rise to nearly $1 trillion.

In 2022, like Janet, more than 11 million caregivers provided unpaid care for people with Alzheimer’s or other dementias, providing an estimated 18 billion hours of unpaid assistance — a contribution valued at $339.5 billion, noted Facts and Figures.

Taking a look at Facts and Figures

The Alzheimer’s Association’s 2023 Facts and Figures report (the first released in 2007) provides an in-depth look at the latest national and state-by-state statistics on Alzheimer’s disease prevalence, mortality, caregiving, dementia care workforce and costs of care. 

Alzheimer’s disease is not a normal part of aging; it’s a devastating cognitive disorder that will be the number 1 killer by 2050. This year’s Fact and Figures findings indicate that 1 in 3 seniors dies with Alzheimer’s or another dementia. This devastating disorder also kills more than breast cancer and prostate cancer, combined. Between 2000 and 2019, deaths from heart disease have decreased by 7.3% while deaths from Alzheimer’s disease have increased by 145%.  

Researchers found that while only 4 in 10 Americans talk to their physician right away when experiencing early memory or cognitive loss, 7 in 10 would want to know if they have Alzheimer’s disease if it could allow for earlier medical treatment. 

This year’s report also examines the capacity of the medical specialty workforce essential for diagnosis, treatment and ongoing care for people living with Alzheimer’s and all other types of dementia. The shortage of dementia care specialists could soon become a crisis for Alzheimer’s disease care, warn the researchers, especially with the recent FDA accelerated approval of new treatments targeting the underlying biology of Alzheimer’s disease, which is reframing the health care landscape for people with early-stage Alzheimer’s or MCI due to Alzheimer’s disease.

Caring for those living with Alzheimer’s or other dementias poses special challenges, the report noted. As dementia symptoms worsen, caregivers can experience increased emotional stress (59%), depression, anxiety, chronic stress, and new or exacerbated health problems. Additionally, caregivers often experience depleted income and finances due to disruptions in employment, and paying for health care or other services for both themselves and those with dementia.

While recent advancements in treatment of early-stage Alzheimer’s, including mild cognitive impairment (MCI) due to Alzheimer’s disease, are providing hope to millions living with memory loss and early cognitive decline, the latest Fact and Figures finds too often individuals with memory concerns, and their doctors, are not discussing the issue, missing a critical first step toward diagnosis and potential treatment.

“Providing the best possible care for Alzheimer’s disease requires conversations about memory at the earliest point of concern and a knowledgeable, accessible care team that includes physician specialists to diagnose, monitor disease progression, and treat when appropriate,” said Maria C. Carrillo, Ph.D., chief science officer of the Alzheimer’s Association, in a statement announcing the release of the 128-page report.

“For the first time in nearly two decades, there is a class of treatments emerging to treat early-stage Alzheimer’s disease. It’s more important than ever for individuals to act quickly if they have memory concerns or experience symptoms.”

An accompanying special report, The Patient Journey in an Era of New Treatments, offers new insights from patients and primary care physicians (PCPs) on current barriers that impede earlier discussion of cognitive concerns. Focus groups reveal many people with subjective cognitive decline (self-reported memory concerns) do not discuss cognitive symptoms with their health care providers. Previous special reports have indicated many people believe their experiences are related to normal aging, rather than a potential diagnosable medical condition.

Taking a close look at Rhode Island

The number of people aged 65 and over with Alzheimer’s and other dementia continues to increase in Rhode Island, from 24,000 in 2020, and expected to climb to 27,000 by 2025.  That’s an estimated 12.5% increase.  Fifty-two percent of Rhode Island caregivers report having one chronic condition, 41% say they are depressed and 11% rate their health as poor. 

Currently there are 36,000 unpaid caregivers in the Ocean State providing about 51 million total hours of uncompensated care (valued at over $1.29 million).  

The cost of health care continues to skyrocket to care for those with Alzheimer’s and other dementias.  The state’s Medicaid program spends over $470 million, with the projected cost to increase by 20.1% by 2025. 

Two years ago, there were 33 practicing Geriatricians in Rhode Island. By 2050, a 48.5% increase of this medical specialty will be needed to meet the patient care demands. Three years ago, there were 7,410 Health and Personal Care Aides providing care. By 2030, an increase of direct care workers by 27.5% will be needed to provide personal care. 

Implications for Rhode Island lawmakers, state officials

Donna McGowan Executive Director of the RI Chapter of the Alzheimer’s Association expects the release of the latest Alzheimer’s Disease Facts and Figures to educate state policy makers about the impact of Alzheimer’s on their own communities and districts, specifically the number of Rhode Islanders living with Alzheimer’s or related dementia, and the number of caregivers who provide for them. 

“Further, along with personal discussions, the report will help them to understand the reality that many of their constituents are hesitant to seek a medical diagnosis, or even support it. And the report will highlight for policy makers the crisis that is the shortage of workers in the Alzheimer’s and related dementia professional caregiving field,” notes McGowan.

As the 2023 Alzheimer’s Disease Facts and Figures indicates, a growing number of caregivers have approached the Rhode Island chapter to access programs and services, says McGowan. Last fiscal year, approximately 4,600 individuals contacted the Rhode Island chapter to access programs and services which equated to an “8% overall increase over the previous fiscal year,” she said.  

According to McGowan, this year they are tracking approximately a 16% increase in individuals contacting their helpline, totaling approximately 5,336 individuals accessing programs and services. 

“With the report showing we may not have sufficient specialist capacity to deal with the projected increase in Rhode Islanders with ADRD, there is a critical need to provide Rhode Island primary care practices with the training needed to care for persons with dementia and their caregivers,” says Maureen Maigret, Policy Advisor for Senior Agenda Coalition of RI (SACRI), who also serves on the state’s Advisory Council on Alzheimer’s Disease and Care and a member of The Care Transformation Collaborative (CTC).  Fortunately, the CTC, in partnership with the Rhode Island Department of Health, is offering such training now through the state’s Geriatric Education Center. 

“And with a projected need for close to a 30% increase in home health aides and personal care attendants, the workforce shortage will worsen dramatically if we fail to increase direct care staff wages and expand training staff to care for persons with ADRD,” warns Maigret, noting that this is why SACRI is advocating for funding to increase direct care staff wages to a minimum of $20 an hour. 

“As the prevalence of people living with dementia continues to increase in Rhode Island, the health system and long-term care continuum will be challenged by the findings highlighted in this report,” says Nancy Sutton, MS, RD, the Rhode Island Health Department’s (RIDOH) Chief, Center for Chronic Care and Disease Management. “RIDOH, the Rhode Island Alzheimer’s Disease and Related Disorders Advisory Council, and our many partners are committed to continuing efforts to educate the public on the importance of speaking to a healthcare provider about memory concerns, she said.

Sutton says, “with the support of federal funding, resources such as a Brain Health Toolkit are being developed to support health system partners in their engagement in conversation with patients and caregivers about the importance of early detection and navigating complex systems of care and community resources to support people living with dementia.”

“We know that age is a big risk factor for Alzheimer’s Disease and Related types of Dementia (ADRD),” said the RI Office of Healthy Aging (OHA) Director Maria Cimini. “As Rhode Islanders age if they or their caregivers are concerned about memory loss, we encourage them to talk to their physicians and get connected to resources through the Point, 401-462-4444 or through myoptionsri.gov to help navigate this journey.” 

At OHA, we have worked to build comfort and capacity among physicians through a recent Alzheimer’s Disease Programs Initiative (ADPI) grant with the focus of expanding the Dementia-Capable Home and Community Based Services which include outreach and education of primary care/direct service providers in identification, diagnosis, referral, and care planning process for ADRD and to provide services supportive of individuals living with dementia and their family caregivers within the statewide Aging and Disability Resource Center. OHA and its partners developed a provider resource tool to assist providers with referring patients with cognitive symptoms and family caregivers to services; and it also provides guidance to providers in conducting care planning, and billing for dementia-related services. That resource can be found here: https://oha.ri.gov/resources/oha-resource-center.

For a copy of the 2023 Alzheimer’s Disease Fact and Figures, go to: https://www.alz.org/alzheimers-dementia/facts-figures.

For a copy of the accompanying special report, The Patient Journey in an Era of New Treatments, to https://www.alz.org/media/Documents/alzheimers-facts-and-figures-special-report.pdf.

The Alzheimer’s Association’s  24/7 Helpline clinicians guide callers to financial assistance programs that may help pay for respite or a needed break. Caregivers will also find programs and services offered by this organization, too. For details, go to https://www.alz.org/ri.