Tag Archives for Maureen Maigret

The RI Budget proposal, as seen by our fastest growing demographic, Seniors

Published in RINewsToday on January 22, 2024

This Tuesday, Jan. 16th, Governor Dan McKee officially kicked off the legislative debate on the state’s $13.68 billion FY 2025 Budget in his 48 minute (4,481 word) State of the State address that laid out his spending priorities.  

Over the next six months the General Assembly will hold hearings on the proposed budget blueprint, rewriting it considering state revenues identified during the May Revenue and Caseload Estimating Conferences, and priorities of the legislature.

With passage by the House and Senate and signed into law by McKee, the final FY 2025 Budget will take effect July 1. 

Governor McKee’s budget proposal, which came 2 days after the State of the State, makes funding investments in education, small business, and Rhode Island’s health care system without raising any broad-based taxes. FY 2025 Budget specifics can be found in an article published by RINewsToday on Friday, Jan. 19th – HERE.

With the official release of McKee’s 2025 budget proposal on Thursday afternoon, Jan. 18, his statement along with comments from the top House and Senate legislative leaders were quickly issued.

“The Team Rhode Island budget that I’m sending to the General Assembly today prioritizes programs and initiatives that will help raise the incomes of our fellow Rhode Islanders,” said McKee. 

“By using available resources in targeted and strategic manner, we will continue to make progress on our RI 2030 goals while putting Rhode Islanders to work in good-paying jobs on projects that will pay dividends for decades to come,” he adds.

Legislative leadership

“Over the next several months, Chairman Lou DiPalma and the Senate Finance Committee will conduct a rigorous review of all aspects of the proposed budget through their public hearing process. At this early stage, I am pleased that the budget proposal reflects some of the Senate’s top priorities, including moving our state towards universal public pre-kindergarten, increasing funding for multi-language learners, increasing access to no-cost meals for students, fully funding recommended reimbursement levels for Early Intervention and increasing Medicaid rates,” says President of the Senate Dominick J. Ruggerio.  

“Now that Governor McKee has submitted the budget, our robust review process will begin. Chairman Marvin Abney and the House Finance Committee will soon commence the public hearing process and we look forward to working collaboratively with the Senate and Governor McKee over the next several months. With the federal pandemic funds having been allocated, we must live within our means and carefully scrutinize all spending requests,” says House Speaker K. Joseph Shekarchi.  “The Senate will continue working with all partners and stakeholders to adopt a budget that meets the needs of all Rhode Islanders.” adds the Senate President.

 Aging Groups and Advocates share thoughts

“It was good to see attention to older adults’ financial security by the proposal to increase the amount of pension income that can be exempted from state income taxes which would bring an estimated $500 benefit to about 10,000 persons,” says Maureen Maigret, The Senior Agenda Coalition’s policy advisor and former Director of the RI Department of Elderly Affairs.

“The Governor is looking for ways to increase Rhode Islanders’ incomes and the Senior Agenda Coalition has been working with several partners on a legislative proposal that would save $2,000 a year for many thousands of lower-income older persons and persons on disabilities on Medicare by having the federal government pay the cost of their Part B premiums,” she says, noting that this policy would not only save seniors money they can use for basic living expenses, but would bring millions of dollars into the state economy. It would also make them eligible for a federal program that helps pay for prescription drugs.

“We hope the $10 million in proposed bridge funding for nursing homes will help them to continue to provide necessary services for their vulnerable populations and avoid more closures which are so traumatic for residents,” says Maigret. 

“Although welcome, we had been hoping for more than the modest increase of $200,000 for senior centers as it gets distributed across around 40 senior centers. We know our older population is growing and our senior centers help hundreds of older adults stay healthy and connected to their communities,” adds Maigret.

“With many older adults waiting three months or more to get home care services and the home care worker shortage continuing it is disappointing to see the reimbursement increases recommended by the Social and Human Service Rate Review Study spread out over three years especially when the Executive Office of Health and Human Services had recommended funding the recommended increases over two years. And home care is not only what persons say they prefer but it costs far less to state government than institutional care,” notes Maigret.

“AARP Rhode Island applauds the Governor’s goal of increasing financial security for all Rhode Islanders,” said AARP Rhode Island State Director Catherine Taylor in a statement released days before the release of McKee’s budget blueprint. “Everyone should be able to choose how they live as they age,” she says.

AARP Rhode Island calls on the General Assembly to pass three pieces of legislation that would help to ensure financial security for all. AARP Rhode Island is pushing lawmakers to give all Rhode Islanders access to a retirement savings vehicle. We are pleased that Governor McKee called for the passage of the Secure Choice program, which would provide an optional, voluntary Roth-IRA plan to the 172,000 Rhode Island employees who do not have access to a plan through their employer,” says Taylor.

“The state must stop taxing Social Security benefits,” says Taylor. “We are one of 9 states that still tax these benefits. We encourage legislators to keep more money in the pockets of older Rhode Islanders by eliminating the state tax on Social Security,” she says.

“Lastly, we must reframe how we think about housing as we grow older, and Accessible Dwelling Units (ADUs) are part of the equation,” adds Taylor, urging the General Assembly to pass legislation providing housing options that are suitable for differing incomes, ages, and life stages. “ADUs are one way to accomplish this goal,” she notes.

This budget is an important step forward in helping our industry, says James Nyberg, president, and CEO of LeadingAge Rhode Island, a nonprofit representing providers across the long-term care spectrum from nursing facilities to home and community-based providers. “We appreciate Governor McKee and his staff recognizing our concerns and providing an infusion of funds across multiple settings to support older Rhode Islanders wherever they call home, their families, and our dedicated workforce,” he adds.  This includes the $10 million in stopgap funds to help nursing homes in critical financial distress as they await their permanent rate adjustment effective October 1. 

According to Nyberg, the October adjustment also included in the budget is expected to provide over $60 million in funding to help nursing homes address workforce challenges, the dramatically increased costs of operating their business, and remain financially viable. “We cannot lose any more nursing homes and hopefully this budget will help mitigate that well-documented threat,” he says.  

Similarly, the budget includes the phase-in of rate increases for assisted living residences and adult day providers, per the OHIC recommendations, to support these providers, consumers, workers, and families,” says Nyberg. “We also hope the proposed housing bond will help address the shortage of safe and affordable housing for seniors, the lack of which was highlighted in the Long Term Care Coordinating Council’s recent report entitled “Meeting the Housing Needs of Rhode Island’s Older Adults and Individuals with Chronic Disabilities and Illnesses,”  he adds.

“While there are financial and other challenges that persist, we look forward to working with the Administration and the General Assembly to advance these and any other initiatives to support our long-term care providers, those for whom they care, and their workforce,” says the nonprofit executive director. 

Governor’s budget doesn’t adequately address Seniors’ needs

While aging groups recognize Gov. McKee’s funding provisions that will benefit older Rhode Islanders, one aging advocate calls on the House Finance Committee to beef up funding for seniors in its budget.

“Once again, the senior population of Rhode Island is the fastest growing demographic in the state, and the most neglected,” charges Susan Sweet, former state associate director of the Department of Elderly Affairs and an advocate for seniors facing hardships and low-income difficulties. “The Governor McKee Budget provides no relief for seniors in the proposed 2025 spending plan other than a small gift to nursing homes that may help that senior care industry and a small increase of $200,000 statewide for dividing up among R.I. Senior Centers,” she says.

According to Sweet, seniors receive nothing in the budget other than a proposed tax reduction of “pension and annuity income” to begin in calendar year 2025.  In other words, nothing for this year.  She notes that the current exemption would be raised from $20,000 to $50,000 while the state remains currently only 9 of 50 states that tax Social Security and a minority of states that tax retirement pensions.

“There is also not one cent for retirees who had their pensions frozen in 2011 and have been stripped of their contracted pension benefits of a Cost of Living Adjustment (COLA) each year which they were required to sign and to contribute to from their pay each year of employment,” she says.

“Just down the road in our neighboring state of Massachusetts, there is no state income tax for Social Security or pensions. Their proposed budget includes a new $2,400 per senior payout for housing assistance, rental, or ownership costs,” says Sweet. During the State of the Commonwealth speech just one day after RI Governor McKee touted his Team RI game plan, a representative of the (Massachusetts) Senior Action advocacy group was invited and recognized as a leading voice in enabling seniors to stay in their homes with cash assistance from the state, she noted.

As the founder of the R.I. Minority Elder Task Force which provides financial assistance to poor RI elders in dire circumstances, Sweet regularly sees the neglect of seniors without adequate resources for the basic needs of life. “This is not a senior-friendly state, and this is not a senior friendly budget,” she states. 

Expect aging groups and advocates to gear up to push for their senior legislative priorities in the upcoming months. The budget debate now begins.

To listen to Gov. McKee’s State of the State Address on the FY 2025 Budget, go HERE. 

Details of Gov. McKee’s FY 2025 Budget. Go HERE.

To read Gov. McKee’s FY 2025 budget proposal (H 7225), go HERE.  

Hail Mary PR Effort Puts Spotlight on Inadequate RI Nursing Home Medicaid Plan

Published in RINewsToday on December 4, 2023

Last week, a campaign by Linn Health & Rehabilitation told of its efforts to keep its doors open.  With no immediate state reimbursement fix in sight, the nonprofit nursing home, established 52 years ago, launched a savvy PR move, calling it a “Hail Mary” effort to find its Christmas miracle donors and funding to prevent it from closing or forcing the displacement of 71 residents and the laying off of 150 staff members. A clever twist on the message resulted in a story on Rhode Island television stations, talk radio, and pick up by other media outlets.

For over 10 years, Linn Health, which had only recently been named a 2024 “Best Nursing Home” and “High-Performing” short-term rehabilitation home in the nation by U.S. News & World Report, has been fighting rampant inflation, rising food and utility costs, high temporary staffing agency rates, and low state Medicaid reimbursement rates that haven’t kept pace with increasing expenses – as most nursing homes have been as well. 

Linn Health & Rehabilitation is currently losing $100,000 a month, notes Richard Gamache, MS, FACHCA, chief executive officer of Aldersbridge Communities which is the nonprofit that operates the nursing facility, senior housing, affordable assisted living, and outpatient rehab for older Rhode Islanders.

“For years, we’ve operated with a slight loss, but the other Aldersbridge entities were able to subsidize that loss.  As a mission-driven provider for low-income people and those on Medicaid, we aren’t here to make money, we’re here to serve our community’s needs,” he says, noting that the gap between the facility’s costs and its daily Medicaid rate is now just too great.

“Bleeding Cash” drastically impacts facility’s bottom line

Gamache noted that Aldersbridge Communities had been able to support its nursing home but it has now reached a “tipping point.”  During COVID the federal and state governments were very generous with grants. “That’s no longer an option, and the money is running out quickly,” he says.

“We’re in dire straits, financially,” admits the seasoned CEO, who has been in the long-term care field for over 43 years.  “We’re struggling.  We have some vendors who understand and are being patient with us, and others who tack on charges if we don’t pay on  time,” he says.

“Eighty-two percent of our residents are on Medicaid and don’t have families who can take care of them. We are their family and support system, and some have been discharged from other assisted living communities because they ran out of money,” he says. 

In recent months, Gamache reports he has meet with peers, East Providence lawmakers, state officials, and even nursing facility trade groups seeking a viable solution to the state’s Medicaid reimbursement issues. “I have proposed options such as bridge funding and higher Medicaid reimbursement rates, as many other states have done, to address this nationwide problem. It seems only nursing home residents, their families, employees, leaders of surviving homes that are hanging by their fingernails, and some advocacy groups care about the financial predicament we are in. We’ve made everyone aware and we will not stop fighting for funding that we need,” he says.  

According to Jamie L. Sanford, LNHA, LCSW, administrator of Linn Health & Rehabilitation, since 2022, six nursing homes in Rhode Island have shut their doors permanently, not counting the four that closed prior to the COVID-19 pandemic. Three more have filed for bankruptcy, she says, noting that many nursing homes throughout the nation are in the same financial predicament. 

“Linn’s Medicaid reimbursement rate averages $255 per patient per day, and it costs $411 to care for each patient per day,” states Sanford. “The general population thinks that nursing homes make a lot of money. Perhaps that’s true in some for-profit organizations where they are owned by large corporations, but nonprofit homes are robbing Peter to pay Paul. These are the homes – like us – that are on life support, operationally speaking,” she notes.

Joseph Wendelken of the RI Department of Health says that the state is attempting to ease the financial burden of facilities providing care to Rhode Island nursing facility residents. “Nursing homes in Rhode Island received an increase in Medicaid reimbursement rates on October 1, 2023. The increase varied by facility, but it was approximately 6.9%. Per Rhode Island legislation, there is a mandatory review of nursing home expenses every three years called the ‘re-array.’ The current re-array is in progress and any potential increase in the nursing home rates would begin as of October 1, 2024,” he noted.  

But facilities can’t wait a year for the state’s Medicaid adjustment to kick-in and immediate action must be taken. “Essentially, the state is breaking its own law by not conducting the re-array every three years, which was put in place to keep up with the national nursing home inflation index. The last re-array was in October of 2012. Even with an increase next fall, it won’t be enough to help close the funding gap now,” charges Michael Cole, vice president of the Board of Trustees for Aldersbridge Communities.

It’s time for a savvy PR campaign   

With no immediate financial solutions in sight, Gamache and his management team staff have been working on their own grassroots PR campaign, calling it a “Hail Mary” effort, to save Linn Health from having to displace its staff and residents.  

Linn Health’s PR campaign was seen as the next logical step to quickly tackle its financial problems, after months of alerting staff officials of the need for action. 

“Everyone with the authority to do something to help has all the information they need. Now we need action. I often hear, ‘there’s not enough money in the budget’ but the fact is, these are policy decisions. It’s about priorities,” says Gamache. 

“Do we value our older adults enough to provide for their basic needs? What kind of values do we have as a state and as a society?” asks Gamache. 

“Now it’s time to get the story into the public domain. Many people feel that nursing homes are making money hand over fist and that we’re all diverting funds to pay for yachts,” says Gamache. “Although it’s true that there are some bad apples in this profession, I believe most of us want to do what’s right, and for Linn Health and Aldersbridge Communities, a mission-driven non-profit, we’ve always cared more about better outcomes for our people than more income. We just can’t afford to operate much longer,” he warns.

The residents and staff at Linn are doing everything they can, including holding baked goods sales to raise funds. “No one wants to leave Linn, and no one wants us to be sold to another organization,” Sanford comments. “During this season of holiday miracles, we’re working to find donors who believe in what we’re doing now, and for our future. There must be a donor out there who can help us fight the proverbial ‘grinch’ that is causing nursing homes to disappear throughout the country and in our state. All we want for Christmas is to keep caring for our residents who depend on us,” she says.

“This situation exemplifies the dire straits that RI nursing homes are in, especially the community-based ones like non-profit providers.  We have been working with state officials, including the Governor’s office, EOHHS, the Health Department, and other stakeholders to highlight the crisis and the need for immediate action,” says James Nyberg, president and CEO of LeadingAge Rhode Island.  LeadingAge, founded in 1989, is a not-for-profit membership organization of not-for-profit providers of aging services, including not-for-profit nursing homes, assisted living residences, and senior housing providers, and adult day health services. 

“They have recognized our concerns and we are hopeful that some action will be taken ASAP to provide an infusion of funding.  Any nursing home closure has profound and disruptive consequences for residents, staff, families, and the broader community.  With six nursing homes closing and three in receivership, how many more proverbial canaries in the coal mine do we need?” adds Nyberg.

“Unfortunately, Linn Health’s story is emblematic of a wider crisis facing Rhode Island nursing facilities.  Nursing facilities are facing unprecedented increases in nearly all aspects of providing care – staffing costs, energy prices, inflation on food, medical supplies, etc. At the same time, Medicaid rates have not kept pace,” says John Gage, president and CEO of the Rhode Island Health Care Association.  In 2023, RI’s nursing homes are being paid by Medicaid based on the actual allowable cost of care from 2011 with an average of approximately 1% increase annually,” he said.  RIHCA was founded in 1972, and has 63 skilled nursing facilities who are members.

Finally, Maureen Maigret, former Director of the RI Department of Elderly Affairs who serves as a member of the Long-Term Care Coordinating Council and chair of its Aging in Community Subcommittee, weighs in. “The financial challenges faced by Linn Health are worrisome and point to a need for the State to take a very close look at the financial status of Rhode Island nursing homes in general,” she said, noting that few persons can afford privately paid nursing home care at an average cost of $113,000 per year. 

“So unless skilled care is paid by Medicare, Medicaid becomes the payer for a large percent of nursing home care in Rhode Island and rates must be adequate to provide the quality care we expect our loved ones to receive if they need the round the clock care provided in nursing homes,” Maigret adds. 

Linn is asking that interested charitable organization and donors willing to help Linn Health & Rehabilitation’s financial situation to contact Aldersbridge Communities Director of Development, Elise Strom at estrom@aldersbridge.org, 401-438-4456 ext. 136.

Increased funding must be tied to nursing home mandated minimum staffing

Published in RINewToday on Sept 25, 2023

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards. The proposed rule seeks to would ratchet up the quality of care in the nation’s 18,700 skilled nursing facilities, delivering care to 1.2 million residents each day.

“Establishing minimum staffing standards for nursing homes will improve resident safety and promote high-quality care so residents and their families can have peace of mind,” said HHS Secretary Xavier Becerra in comments on Sept. 1, 2023. “When facilities are understaffed, residents suffer. They might be unable to use the bathroom, shower, maintain hygiene, change clothes, get out of bed, or have someone respond to their call for assistance. Comprehensive staffing reforms can improve working conditions, leading to higher wages and better retention for this dedicated workforce,” says Becerra.

The Nuts and Bolts of CMS’s proposed ruling

Under CMS’s proposal, nursing homes participating in Medicare and Medicaid would be required to meet specific nurse staffing levels that promote safe, high-quality care for residents. Nursing homes would need to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident, per day, and 2.45 hours of care from a nurse’s aide per resident, per day, exceeding existing standards in nearly all states. CMS estimates approximately 75% of nursing homes would have to strengthen staffing in their facilities. As the long-term care sector continues to recover from the COVID-19 pandemic, the proposed standards take into consideration local realities in rural and underserved communities through staggered implementation and exemptions processes.

In addition, nursing homes would also be required to ensure a registered nurse is on site 24 hours a day, 7 days per week, and to complete robust facility assessments on staffing needs. Facilities would continue to be required to provide staffing that meets the needs of the individual residents they serve, which may require higher levels of staffing above the proposed minimum standards.  

CMS also proposed to require states to collect and report on compensation for workers as a percentage of Medicaid payments for those working in nursing homes and intermediate care facilities. These policies build on CMS’ recent proposals to support compensation for direct care workers in home and community based settings and to publish Medicaid data on average hourly pay rates for home care workers. This enhanced transparency will aid efforts to support and stabilize the long-term care workforce across settings strengthening access to high-quality long-term care both at home, in the community as well as in nursing homes and other facilities.

Attracting and supporting Nursing Home staff

Additionally, CMS announced a national campaign to support staffing in nursing homes. As part of the HHS Workforce Initiative, CMS will work with the Health Resources and Services Administration and other partners to make it easier for individuals to enter careers in nursing homes, investing over $75 million in financial incentives, such as scholarships and tuition reimbursement. This staffing campaign builds on other actions by HHS and the Department of Labor to build the nursing workforce.

More than 500,000 direct care workers provide care in nursing homes, assisting residents with daily tasks, such as bathing, dressing, mobility, and eating. This work, often performed primarily by women of color, is significantly undervalued. Direct care workers across long-term care settings earn low wages, rarely receive health and retirement benefits, and experience high injury rates. Improving working conditions and wages will lead to improvements in the recruitment and retention of direct care workers and enable nursing staff to provide safer care.  

CMS and the HHS Office of the Inspector General called for increased transparency and enhance enforcement of existing standards. This would result from increased audits of nursing homes’ staff, improving nursing  home inspections, oversight as to how nursing homes spend taxpayer dollars and cracking down on prescribing inappropriate antipsychotic drug prescribing practices.  The proposed rule would also undertake new efforts to improve resident safety during emergencies. 

Mandating more staffing during a severe labor shortage – pushback on an unfunded mandate

“It is unfathomable that the Biden administration is proceeding with this federal staffing mandate proposal. Especially when just days ago, we learned that CMS’ own study found that there is no single staffing level that would guarantee quality care, says Mark Parkinson, President and CEO of the American Health Care Association, a national nursing home trade group representing 14,000 nursing homes and other long-term care facilities across the nation taking care of five million residents each year.

“At the very same time, nursing homes are facing the worst labor shortage in our sector’s history, and seniors’ access to care is under threat. This unfunded mandate, which will cost billions of dollars each year, will worsen this growing crisis, warns Parkinson, noting that the proposed rule requires nursing homes to hire tens of thousands of nurses that are simply not there and then penalizes the facilities and threatens to displace hundreds of thousands of residents.

“Already, hundreds of nursing homes across the U.S. have closed because of a lack of workers,” states Parkinson. 

​John E. Gage, President, and CEO of the Rhode Island Health Care Association, with offices in Warwick, agrees with Parkinson’s assessment of the harm such proposals will trigger and its devastating impact on nursing homes and residents. “The federal staffing proposal is unfunded and is being implemented at a time when additional staff is simply not available,” he said.  

According to Gage, six Rhode Island-based facilities have closed since the beginning of the pandemic in March 2020. Three others are currently in receivership. Arbitrary federal staffing mandates will result in more closures, and residents will be displaced from their homes just as they were most recently when Charlesgate Nursing Center in Providence was forced to close because of skyrocketing costs, a scarcity of staff and chronically inadequate Medicaid funding. 

Unintended consequences of mandating minimum staffing

James Nyberg, president, and CEO of LeadingAge Rhode Island, with offices in East Providence, views see a staffing ratio mandate as a blunt enforcement instrument that does not consider the numerous challenges facing providers, including Medicaid underfunding, lack of workforce, and the diversity of resident needs. Moreover, the imposition of severe financial penalties on homes that are unable to meet a staffing ratio is counterproductive: fines siphon off scarce resources that providers need as they seek to address their workforce and resident care needs,” he says. 

“Our state’s experience illustrates the numerous challenges and unintended consequences of a staffing ratio mandate: the severity of fines, how compliance is measured and calculated, compliance costs, backlogs of people in hospitals waiting for skilled nursing care after admissions have been reduced due to a lack of staff and other access-related issues,” notes Nyberg, noting that even those homes that are currently able to comply with the staffing ratio are doing so at an unsustainable cost. 

While Kathleen Heren, executive director of the Alliance for Better Long-Term Care and the state’s Long-Term Care Ombudsman, supports HHS’s minimum staffing standard, the administration must adequately fund to train recruited workers and to pay a livable wage to retain them. “Rhode Island doesn’t have an issue with its nursing home inspection process as other states do, she says, noting that newly hired RI Department of Health surveyors are “doing a great job.” 

“RIDOH surveyors only cite facilities, when necessary,” says Heren, noting that administrators can challenge any cited deficiency if they view it as unfair, and she doesn’t see a problem in the use of antipsychotic medications in Rhode Island facilities “but acknowledges that there’s always room for improvement.”

Direct Caregivers, mainly women, undervalued despite significant work demands

“Almost 80 percent of nursing home care is paid for with government programs (Medicare and Medicaid), so it is hugely important that those dollars provide quality care,” says Maureen Maigret, chairperson of the aging in community subcommittee for the Long Term Care Coordinating Council.  She noted that studies show a clear relationship between staff levels and quality care but there is tremendous variation across the states in hours of direct care staff provided in nursing homes. 

“Rhode Island has required 24/7 RN staffing for many years and a 2021 state law requires minimum direct care staffing levels although implementation has been challenging due to the critical workforce shortage. Importantly, the proposed federal regulation would require states to report on compensation for workers as a percentage of Medicaid payments. For too long our direct care workers, mostly women, have been undervalued despite the significant demands of their work. It is time for them to receive a living wage and  shedding light on where our Medicaid dollars are going will help advocate for better wages helping to recruit and retain these essential workers,”  she says.

There will be a 60-day comment period for the notice of proposed rulemaking, and comments must be submitted to the Federal Register no later than November 6, 2023.  

For a copy of the federal register detailing CMS’s proposed rules on minimum staffing issued on Sept. 6, 2023, go to 

https://www.govinfo.gov/content/pkg/FR-2023-09-06/pdf/2023-18781.pd

For a copy of a CMS Fact Sheet on CMS’s proposed rules on minimum staffing, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid