Advocates on aging issues review their priorities for Gov. McKee’s policy agenda

Published in RINewsToday on Nov. 14, 2022

Over 3 months ago, the Senior Agenda Coalition of Rhode Island (SACRI) invited the six Gubernatorial candidates to give the details of their aging policy positions to hundreds gathering at East Providence High School, and watching virtually. With the dust settling after the Nov. 8 midterm elections, aging advocates are asking the winner, Gov. Dan McKee, to place a high priority on enacting aging policies that he supported during SACRI’s 143-minute forum.

McKee goes on the record

McKee addressed the issue that Rhode Island nursing home and home care providers can’t provide sufficient and sustainable wages to attract and retain workers because of low state reimbursement. When questioned about how he would rebuild and sustain a viable workforce to provide services to seniors and persons with disabilities, the Governor stated he has addressed staffing issues at home health agencies and nursing homes by expanding the Wavemaker Fellowships to include healthcare workers and increasing reimbursement rates for home health agencies by $900,000 annually.

More seniors prefer to age in place at home in their community rather then enter nursing homes. McKee gave his thoughts about Medicaid rebalancing and expanding the program to keep seniors at home. He touted the $10 million invested this year to rebalance the long-term care continuum, announcing his plans to soon issue an Executive Order to direct state agencies to review existing policies through

At the forum, McKee stated he will also direct all state agencies to appoint a representative to a task force, also including municipalities and community-based nonprofits, that will create a Statewide Aging Plan to determine where federal monies and grants can be utilized to support older Rhode Islanders.

During the mid-1990s the Department of Elderly Affairs (DEA) had a staff of 65. Demoted to the Office of Healthy Aging within the state’s Department of Health and Human Services, Gov. McKee went on record that he will support legislation next year to make the state’s Office of Healthy Aging a full cabinet department. He pledged to provide an adequate budget and staffing to oversee its programs and services to Rhode Island’s growing senior population.   

Gov. McKee also supported a yearly cost-of-living increase to the state Supplemental Security Income payment in the 2024 proposed budget. He also supported the increasing of eligibility for the Medicaid Savings Programs for seniors and people with disabilities in the proposed 2024 budget by eliminating the asset test and increasing eligibility to at least 185% Federal Policy Level. 

With the state passing $250 million in funding for housing, Gov. McKee agreed to provide an adequate amount to support senior housing.  He stated: “we’re off and running”, noting that he recently announced an investment of $80 million to construct 825 units in 17 communities.  The Governor noted that his 2030 plan speaks specifically on the issue of senior housing.

Make aging policy a priority

“With the growing needs of seniors throughout the country and within our state it is time to return to a function of government which “had teeth” to enact change for elders who were at risk,” says Bob Robillard, LMHC, President of Rhode Island Senior Center Directors Association, representing 34 Senior Centers, noting that his aging group is pushing for the passage of bipartisan legislation next session that will elevate the Office of Healthy Aging to a full department – cabinet – status. 

According to Robillard, having a seat at the table as a cabinet position, the Director would directly advocate with the Governor’s Office to address unmet needs and seek creative solutions for our seniors. 

Robillard also urged the Governor to continue efforts to develop secure and affordable housing that meets the need for increased  homelessness of Rhode Island seniors. ”Their income level and having to make difficult choices to survive each month is seen in our interactions with seniors every day, and they are increasingly utilizing food banks, emergency services, and our centers, and funding these basic services needs to be a top priority,” he says.

While some federal funds have been used to address this issue, Robillard says there is a “global need for a full and comprehensive Aging Plan for Rhode Island including the voices of direct service providers like the Senior Centers, senior advocates, caregivers and, of course, seniors, themselves.” 

Finally, Robillard believes that there should be a strong focus on transportation for seniors to access their community. “Safe, respectful and person-centered transportation in our rural areas throughout our state needs to be a focus,” he says, noting that if you cannot access your community in these ways then you cannot participate in them either.

With Rhode Island experiencing a critical shortage of homecare workers, Maureen Maigret, chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee, calls on Gov. McKee to provide funding in the FY2024 budget to increase wages for CNAs working in home care. “The current budget includes $10 million to rebalance long term care. These funds should be used for wage increases for homecare direct care staff as an initial step to bring these invaluable workers fair wages,” says Maigret.

“It is also important to provide more resources to the Office of Healthy Aging and support for local senior services. Governor McKee started to increase funds for local aging services in the current budget and the Office of Healthy Aging has requested funding to provide each community ten dollars per person aged sixty-five and over next year,” adds Maigret, urging the Governor to include this in the budget he presents to the legislature for FY2024 as well as other funding requested by the Office including $.5million to support the state’s Aging and Disability Resource Center known as THE POINT. 

Gerontologist Deb Burton calls for the Governor to move forward to pass an Olmstead Plan to create opportunities for individuals to live in the least restrictive environments. “The Olmstead Plan would fit hand in glove with providing resources for individuals to age in the community, and not in institutions,” says Burton, who serves as Executive Director of RI Elder Info.  

Finally, Vincent Marzullo, well-known aging advocate who served as a federal civil rights and national service administrator, suggests that McKee direct the RI Commission for National/Community Service to identify AmeriCorps (national service) opportunities that would help build capacity and service delivery for our local senior centers and human services offices.  “Their needs have grown considerably during COVID,” says the West Warwick resident.

Editor’s Note: During the COVID weekly press conference time, Gov. Raimondo noted that changes need to be made in how people live in Rhode Island’s nursing homes, both from a communicable disease point of view, and from a humanity point of view. She announced a fund of $5 million to be put aside to support nursing homes transitioning their physical “plants” to be single room – single bathroom accommodations. Since Raimondo left office, there has been acknowledgement that this fund was set aside, but no action taken to address the mandate moving forward.

Gubernatorial Candidates Put Spotlight on Rhode Island’s Fragmented LTC Continuum

Published in RINewsToday on August 8, 2022

Last week, hundreds of seniors and aging advocates gathered at East Providence High School to learn more about aging policy positions from 6 Rhode Island Gubernatorial candidates. Many more watched virtually as the event was streamed online.

During the 143-minute forum, the invited Gubernatorial candidates (five Democratic and one Republican, gave two-minute responses to seven questions previously given to them and hammered out by the Senior Agenda Coalition of Rhode Island (SACRI) and its 17 cosponsors, that would elicit how each, if elected Governor, would fix Rhode Island’s fragmented long-term care continuum and provider payment systems.

According to Bernard J. Beaudreau, Executive Director of the Providence-based SACRI about 300 seniors and aging advocates came to personally see the Gubernatorial candidates outline their position on aging issues. Multiple platforms on Facebook and YouTube were promoted by a variety of senior advocacy groups that resulted in the over 300 virtual audience. Some held “watch parties” at one or more of the 12 senior centers, with approximately 135 people participating from throughout the state.

Before the forum began at 10:00 a.m., Deborah Burton, Executive Director of RI Elder Info, one of the forum’s sponsors, provided the welcome, explaining why it was so important for older voters to understand the aging agenda of the next Rhode Island Governor and their commitment to funnel funding and resources to the state’s aging program and services. “The policies of the incoming Governor will impact a large number of baby boomers in the state,” said Burton, noting that the Gen X’s, often forgotten, are right behind them. “We need to have a system [long-term care continuum] in place that is effective, that is funded, and is what we need and want as we age,” she said.

“It was very evident that these candidates came prepared and took the forum and all the issues impacting older Rhode Islanders very seriously,” said a very pleased Beaudreau.

Talking the Talk about Senior Issues

Here is a sampling of policy issues touched on by the candidates:

The attending candidates gave their thoughts as to how they would rebuild and sustain a viable workforce of nursing homes and homecare providers.

Two term Secretary of State Nellie Gorbea said she felt that we, as a society, do not value caregiving. She called for investing in the workforce of nursing home providers by increases tothe state’s Medicaid rates. The educational sector can become a pipeline to “nurture and grow” jobs for this sector, she said.

Governor Dan McKee stated he addressed staffing issues at home health agencies and nursing homes by expanding the Wavemaker Fellowships to include healthcare workers and increasing reimbursement rates for home health agencies by $ 900,000 annually. McKee also noted that in last year’s budget it gave the state’s nursing facilities a cost-of-living increase to ensure funding to increase their workforce.

Healthcare provider businesswoman Ashley Kalus, a Republican candidate, also called for increasing the Medicaid reimbursement rate. “Respect long-term care as a career choice which means there needs to be a path from home health care aide, to certified nursing assistant, licensed practical nursing, registered nurse and Nurse Practitioner through apprenticeship and training programs,” she said.

Former CVS Executive Helena Foulkes supports expanding Medicaid, but we must hold the nursing homes accountable to make sure that the increases of state funding go to workers and not to equity owners of nursing homes.

Healthcare advocate Dr. Luis Daniel Luis Muñoz says we should increase reimbursement rates for providers. He calls for the creation of a state-based medical school to create more dental professionals and physicians. “That is how we can increase the providers necessary to serve Rhode Islanders,’ he says.

Former Secretary of State Matt Brown blamed Rhode Island’s staffing shortage on the General Assembly slashing Medicaid reimbursement rates over the years. He called for an increase in Medicaid reimbursement rates and increasing minimum wage to direct care workers in Medicaid nursing facilities to $20 per hour. This would attract workers from Southern Massachusetts, he predicted.

The attending candidates also gave their thoughts as to their strategies for Medicaid rebalancing and the program’s expansion to improve home and community-based care opportunities along with ensuring financial viability of nursing homes.

Muñoz called for a targeted approach to supplementing wages for providers taking care of seniors, noting that “twenty dollars is not a livable wage. We lost the culture of taking care of people,” he said, “but it will take money, increasing providers; but programmatically the state needs to make a commitment to expand its community and home-based programs working with multiple departments, to bring back this culture of care.”

Brown warns that 87 percent of nursing homes are in risk of closing and the state must address this by increasing Medicaid rates so as to give these facilities the financial stability they need. As to home care, pay must be increased to direct home care workers. But do not forget about family caregivers.

“We do not have an adequate paid Family Leave program in the state,” he says. As Governor, Brown would call for creation of a program to give 16 weeks of adequate pay.

Kalus calls for seniors to be placed in the least restricted setting. There should be adequate senior housing available to allow a person to live independently in the community. “We must reimage the continuum of care,” says Kalus, stressing that different types of care must be working together.

According to Kalus, if you go to a hospital there should be an incentive to discharge you to a nursing home with rehab, if that is possible, and then provide an incentive to move a person to less restricted continuum of care from there, such as home care and then independent living. An organization, like an Accountable Care Organization, must ensure there are no incentives to keep you in one type of care environment, over a less restrictive one, she says.

McKee touted the $10 million dollars invested this year to rebalance the long-term care continuum. He announced that he plans to shortly issue an Executive Order to direct state agencies to review existing policies through a healthy aging lens and address accessibility and impacts on Rhode Island’s aging population. He will also direct state agencies to appoint a representative to the task force that will create a Statewide Aging Plan.

Foulkes called for the state to create a long-term comprehensive plan for providing programs and services for seniors. Politicians seem to implement short term fixes year to year, making small timeframe moves. She urges improving discharge planning and technology and compensating family members to keep seniors at home. Nursing home care should be changed to provide single rooms with single-use bathrooms to ensure their dignity of living in a nursing home, and prevent spread of infectious diseases, a lesson learned from the pandemic.

Gorbea says Rhode Island is “clearly off the mark” as to how it spends its Medicaid dollars on home care services. Twenty six percent of the state’s Medicaid budget is spent on home care, compared to many states allocating over 41 percent. “That’s where we have to go,” she says. “If you are going to encourage people to stay at home, you must have housing and transit options,” she notes.

In Retrospect…

“While there were similar opinions, each candidate presented their own perspective,” said SACRI’s Beaudreau, noting that he did not hear anything anyone said that would be objectionable to aging advocates. “We now have on record their pledge and commitment that there will be a plan and anaction agenda that will benefit all seniors of the state,” says Beaudreau, “if they are elected Rhode Island’s 77th Governor next November.

“It is clear we have a slate of very quality candidates,” says Beaudreau at the conclusion of the forum.

Maureen Maigret, chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee and SACRI Board Member stated, “the Forum exceeded my expectations in terms of attendance (in-person and virtual), and I consider it an absolute success.”

Maigret reported that all candidates supported: “making the Office of Healthy Aging a full cabinet/department with review of sufficiency of resources; expansion of Medicare Savings Program which I have been advocating for at least 5 years and adding a state COLA to SSI payments; requiring better data on minority older adult inclusion; addressing community living, housing and transportation needs of older persons and developing and implementing a comprehensive, interdepartmental strategic Plan on Aging.

What was most important is that this event made them really pay attention to the fact the state has a significantly growing number of older persons which calls for transformative change. By highlighting some policies needed to address these demographic changes and getting candidates on record in support of them, they can be held accountable,” says Maigret. “The other significant outcome was to have so many co-sponsors come together in support of the policies put forward,” she added.

“There needs to be immediate leadership and follow-thru with all appropriate stakeholders to design and implement a seamless state/local delivery system for “aging in place” services, including increased care payments and efficient reimbursement to providers,” says Vincent Marzullo, well-known aging advocate who served as a federal civil rights and national service administrator. “With vision and commitment, Rhode Island can be a more appealing retirement community by aggressively addressing healthcare disparities and elevating the RI Office on Healthy Aging to full Departmental status with broader authority/responsibilities. This conversation must now include our General Assembly leaders,” said Marzullo, a West Warwick resident who serves on SACRI’s Board.

Co-sponsoring this event was a broad coalition of 18 service providers and advocates: 

A Community Together, Alzheimer’s Association of RI, Carelink, Community Partners Network of RI, Economic Progress Institute, Leading Age RI, NAACP Providence Branch, Ocean State Center for Independent Living, PACE, Progreso Latino, RI Assisted Living Association, RI Elder Info, RI Health Care Association, RI Organizing Project, RI Senior Centers Directors Association, SEIU Healthcare 1199, Senior Agenda Coalition of RI and Village Common of RI.

To watch the forum, go to https://www.youtube.com/watch?v=okQ5FguKMao.

For info about the Senior Agenda Coalition of Rhode Island, go to https://senioragendari.org/.