Tag Archives for Medicaid

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

Social Security must be key issue in 2024 Presidential Election

Published in RINewsToday on July 17, 2023

Last Wednesday, 178 House Democrats, (90% of the House Democratic caucus) led by Rep. John Larson (D-Conn.) introduced  H.R. 4583, the “Social Security 2100 Act of 2023.” The 108-page bill would expand Social Security’s benefits, with no cuts, and keep the system fiscally strong for decades to come. Senator Richard Blumenthal (D-Connecticut) has introduced the companion measure in the upper Chamber.

In May, to drum up support, enthusiasm, and attention for H.R. 4583, Larson, House Ways and Means Social Security Subcommittee Ranking Member, was joined by House Democratic Leader Hakeem Jeffries (D-,New York), Ways and Means Committee Ranking Member Richard Neal (D- Massachusetts) and other House leaders to announce the upcoming introduction of Social Security 2100.

“10,000 Baby Boomers a day become eligible for Social Security, making the point of acting now even more urgent, says Larson. “I am proud to be joined again by a majority of my Democratic colleagues to introduce Social Security 2100, and again, ask my Republican colleagues, whose legislation we’ve included, to join us in helping uplift the 65 million Americans who rely on it. Including lifting 5 million Americans out of poverty, providing 23 million a tax cut, and making sure that Americans are able to get the essential benefits that allow them to pay rent, buy groceries, and fill their prescriptions,” he says.

“It’s important that the Social Security benefits that working Rhode Islanders have earned keep up with the cost of living, and that’s exactly what H.R.4583 – Social Security 2100 Act will accomplish. Unfortunately, extreme Republicans in the House are trying to cut Social Security instead of strengthening it. But I am determined to fight for Rhode Island’s seniors in Congress to ensure they receive the benefits they’ve earned,” says Congressman Seth Magaziner (D-R.I.), a sponsor of the legislative proposal. 

H.R. 4583: The Nuts and Bolts

On July 12, 2023, H.R. 4583 was introduced and referred to the House Ways and Means, Education and Labor, and Energy and Commerce Committees, being introduced in the lower chamber that day.

According to a legislative fact sheet, H.R. 4583, the legislative proposal would increase and expand essential benefits to Social Security beneficiaries. Larson’s legislation would:

•   Increase benefits 2% across the board for all Social Security beneficiaries for the first time in 52 years.  

• Improve the Cost-of-Living Adjustment (COLA), so it reflects the inflation actually experienced by seniors.

• Increase benefits to boost lower income seniors.

• Improve benefits for middle-income widows and widowers from two-income households.

• Restore student benefits up to age 26, for the dependent children of disabled, deceased, or retired workers.

• Increase access to benefits for children living with grandparents or other relatives.

• Repeal the Windfall Elimination Provision (WEP) and Government Pension Offset (GPO) that currently penalize many public servants.

• End the 5-month waiting period to receive disability benefits.

• Increases benefits by an additional 5% for the most elderly and those who have been receiving disability benefits the longest, those beneficiaries who have been receiving benefits for 15 years or more.

 • Provide caregiver credits to ensure that people (mostly women) are not penalized in retirement for taking time out of the workforce to care for children or other dependents.

• End the disability benefit cliff, replacing it with a gradual offset for earnings.

• Cut taxes for 23 million middle-income beneficiaries.

• Correct an unintended flaw in how Social Security benefits are wage-indexed, to prevent benefits from dropping (a “notch”) if the wage index decreases.

• Ensure that these benefits do not result in reduced Supplemental Security Income (SSI) payments or a loss of eligibility for Medicaid or CHIP.

• Combine the Old-Age and Survivors Insurance (OASI) and the Disability Insurance (DI) Trust Funds into one fund to ensure seamless benefit payments.

• Provide the Social Security Administration with resources to improve customer service.

Social Security 2100 Pays for These Benefits by:

• Ensuring millionaires and billionaires pay their fair share by applying FICA to earnings above $400,000.

H.R. 4583 would pay for strengthening the Social Security Trust Fund and pay for the enhanced benefits by having millionaires and billionaires pay their fair share by applying FICA to earnings above $400,000, with those extra earnings counted toward benefits at a reduced rate. The bill closes the loophole of avoiding FICA taxes and receiving a lower rate on investment income by adding an additional 12.4% net investment income tax (NIIT) only for taxpayers making over $400,000.

Social Security advocates call for passage

“By re-introducing his revised Social Security 2100 Act, Congressman John Larson once again defies the media narrative that ‘no one in Washington has the courage’ to address the program’s future,” says Max Richtman, President and CEO, of the Washington, DC-based National Committee to Preserve Social Security and Medicare, noting that the legislation extends the solvency of the Social Security trust fund for decades while also providing American seniors with an expansion of benefits.  Larson tackles the funding of the expansion of benefits by asking high earners to begin paying their fair share into the program, says Richtman. 

“At a time when House Republicans have proposed cutting benefits by raising the retirement age and other means — Congressman Larson offers a commonsense, fair, and forward-looking plan.

Not only is the Social Security 2100 Act wise policy, but it’s also overwhelmingly popular with voters across the political spectrum,” says Nancy Altman, President of Social Security Works and Chair of the Strengthen Social Security Coalition.

As the debate over Social Security heats up before the 2024 Presidential election, Altman charges that the nation’s media  refuses to “take Democratic plans to protect and expand Social Security seriously, and fails to call out Republicans for their unwillingness to state what they are for, not just what they are against.”

“Reporters are implicitly dismissing these bills because they cannot pass the House and Senate without Republican support. Instead of pressuring Congressional Republicans to introduce their own legislation, the mainstream media provides the Republicans with the cover they seek by claiming that both parties are avoiding action on Social Security” says Altman.

According to Altman, earlier this year President Joe Biden used the presidential bully pulpit at the State of the Union address to call out Republicans for their plans to cut Social Security and Medicare, forcing them to take these program cuts off the table during the debt ceiling negotiations. “If Biden champions a plan that expands benefits with no cuts, while requiring those earning over $400,000 to pay more, the mainstream media will be unable to ignore it,” predicts Altman. 

Congressional strategies regarding Social Security

On the same day that Larson introduced his legislation, Senator Sheldon Whitehouse (D-R.I.), Chairman of the Senate Budget Committee, held a hearing, “Protecting Social Security for All: Making the Wealthy Pay Their Fair Share,”  on his legislation, S. 1174, the Medicare and Social Security Fair Share Act.  A companion measure was introduced in the House by Congressman Brendan F. Boyle (D-Pennsylvania), Ranking Member of the House Budget Committee.

At the July 12th Senate Budget Committee hearing, Whitehouse explained that his legislation would bring enough revenue from the wealthiest to ensure that Social Security benefits will be paid and on time for the next 75 years and beyond.

“Right now, the cap on Social Security contributions means a tech exec making $1 million effectively stops paying into the program at the end of February, while a schoolteacher making far less contributes through every single paycheck all year,” says Whitehouse at the hearing. “That’s not fair, and my Medicare and Social Security Fair Share Act would fix that by requiring contributions to Social Security on wages above $400,000,” said the Rhode Island Senator.  

Whitehouse stressed the importance of Social Security to his Rhode Island constituents, by mentioning their comments and thoughts. 

 “I rely on my Social Security as my only source of income.  I would find it impossible to continue to live independently if Social Security were changed, reduced or eliminated.  Social Security benefits were a contract between the federal government and its citizens,” said Robert of Pawtucket.

Another Rhode Islander, Antonella of North Providence, said: “I would be very sad and depressed if there were any cuts to Social Security.  I just get by as it is.” And Laurel of Pawtucket said that without Social Security, she “would have to go back to work and probably have to work until I die.” 

Earlier this Congress, Senators Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) introduced their own bill, S. 393, the Social Security Expansion Act (Whitehouse is an original cosponsor).   The Sanders-Warren bill would expand benefits by $ 2,400 each year while fully funding the program for the next three-quarters of a century and beyond.

As to the GOP position on Social Security, the House Republican Study Committee released a plan to cut Social Security by $718 billion over 10 years.  This plan, endorsed by three-fourths of the  House GOP Caucus), would also raise the retirement age to 69 (for everyone who is currently 59 and younger), which would effectively cut benefits by an estimated 13 percent every year and especially harm low-income workers.  It would also reduce benefits for future beneficiaries who earned a “higher salary” before retirement. Also, only “modest adjustments” to the Social Security program as it operates would be made but it doesn’t clarify the changes.

It is important to note that three fourths of the House GOP caucus endorse the RSC budget, making cuts to Social Security and Medicare.

According to SSW’s Altman, while Democratic proposals (Larson, Whitehouse and the Sanders- Warren proposals) to expand Social Security and Medicare are popular with Democratic, Republican and independent voters, Republican politicians have chosen to not co-sponsor any of these bills.

My final thoughts…

Polls show that Social Security and Medicare, two of the nation’s largest social safety net programs, are extremely popular. According to a poll released in March 2023 by the Associated Press and NORC Center for Public Affairs research, 79% of Americans are opposed to reducing the benefits that Social Security beneficiaries receive.  As to raising Social Security’s eligibility age from 67 to 70, 75% of American’s were against it.

Another poll released last March found that nearly 9 in 10 Americans say they oppose reducing spending on Social Security or Medicare, according to polling from Axios.  

The Congressional debate on financially shoring up Social Security and expanding benefits is of   extreme interest to 66 million older and disabled people (175,840 beneficiaries in Rhode Island), who rely on monthly payments from the program.  But the Social Security debate must include America’s younger generations, too. 

With 477 days left before the 2024 presidential elections, expanding Social Security and making the program fiscally sound and to ultimately be available to Gen Exers (1965 to 1979), Millennials (1980 to 1994), Gen Z (1995-2012) and Gen Alpha (2013 to 2025) must become a key election issue. Social Security beneficiaries and America’s younger generations must call on Congress to expand Social Security benefits and ensure its fiscal viability for every generation.  “Keep Your Hands Off Social Security” must be the powerful message they send to all presidential and congressional candidates before the upcoming 2024 presidential election.     

To review the text of Larson’s H.R. 4583, “Social Security 2100: A Sacred Trust Act,” go to https://larson.house.gov/sites/evo-subsites/larson.house.gov/files/evo-media-document/final-2023.07.11-text-of-social-security-2100-act.pdf.

To watch a video of Larson’s May press conference announcing the upcoming introduction of H.R. 4583, the Social Security 2100, go to https://www.youtube.com/watch?v=WO8QYRRQ-UQ.

Here is a copy of RSC’s FY 2024 Budget, Protecting America’s Economic Security https://hern.house.gov/uploadedfiles/202306141135_fy24_rsc_budget_print_final_c.pdf.

New Census data reports the graying of U.S. population 

Published in RINewsToday on June 26, 2023

The nation’s population continues to gray and this is documented by a series of demographic profiles from the 2020 Census recently released. The release of this updated census data must be a wake-up call to Congress and federal and state officials who oversee aging programs and services.

According to Zoe Caplan, statistician demographer in the U.S. Census Bureau’s Sex and Age Statistics Branch, the U.S. population age 65 and over grew from 2010 to 2020 at the fastest rate since 1880 to 1890. The nation’s over-age-65 population grew nearly five times faster than the total population over the 100 years from 1920 to 2020, says Caplan in a May 25, 2023 posting on the agency’s website.

In her posting, Caplan says that in 2020, a whopping 1 in 6 people in the United States were age 65 and over. In 1920, this statistic was just 1 in 20. 

The 2020 Census reported that the older population increased by 50.9 million, from 4.9 million (or 4.7% of the total U.S. population) in 1920 to 55.8 million (16.8%) in 2020. This represents a growth rate of about 1,000%, almost five times that of the total population (about 200%).

Growth in older population spiked 2010-2020

According to Caplan, the older population has been growing for the past century but the decade before 2020 saw its fastest increase since 1880 to 1890. “From 2010 to 2020, the age 65 and over population experienced its largest-ever 10-year numeric gain — an increase of 15.5 million people. The next largest 10-year numeric increase, 5.7 million between 1980 and 1990, was less than half that size,” she says.

From 2010 to 2020, Caplan stated that the 65 and over population experienced the largest-ever percentage-point increase, from 13.0% to 16.8% of the total population. “Before 2010, it took 50 years (from 1960 to 2010)  for the nation’s older population’s share of the total population to grow by the same number of percentage points,” she said.

The 2020 Census Data reveals that while the nation’s population grew from 2010 to 2020, the size and rate varied by age groups for other age groups. The 65 to 74 age group was the largest of the older cohort groups, with 33.1 million people, representing over half of the age 65 and over population (or 1 in 10 Americans), she said.

“The 65 to 74 age group experienced the largest growth of any older age group the previous decade,” says Caplan, noting that its numbers grew by 11.4 million or (52.5%), increasing from 21.7 mil­lion in 2010 to 33.1 million in 2020.  

Caplan says that the 75-to-84 age group grew at about half that rate (25.1%) but is expected to pick up the pace in the next decade as baby boomers age into this group. Additionally, she noted that the 85-to-94 age group had a relatively slower growth (12.6%) than other older age groups, increasing from 5.1 million to 5.7 million.  The population 95 years and over also expe­rienced a large growth rate (48.6%), increasing from about 425,000 in 2010 to 631,000 in 2020, she added. 

The 2020 date also indicated that for those people age 70 and over, males experienced a larger percentage growth between 2010 and 2020 (42.2%) than females (29.5%). Meanwhile, the percentage of centenarians have grown 50% since 2010, the fastest recent census-to-census percent change for that age group.  

Finally, while the U.S. population age 65 and over population grew, the Census 2020 data indicated that the nation’s population remained relatively young when compared with other nations. Caplan noted that Japan has the largest percentage (28.5%) of older residents.  Many European countries, along with Canada and Hong Kong, have larger percentages of older residents than the United States, says Caplan, noting that the United States ranked 34th (16.8%) among these places.

Japan had the largest share (28.5%) of older residents. The United States ranked 34th (16.8%) among these places. Many European countries, along with Canada and Hong Kong, had higher shares of older residents than the United States, adds Caplan.

Nation’s median age creeps closer to Age 40

Just last week, the U.S. Census Bureau reported that the nation’s median age increased by 0.2 years to 38.9 years between 2021 and 2022.  Median age is the age at which half of the population is older and half of the population is younger.

“As the nation’s median age creeps closer to 40, you can really see how the aging of baby boomers, and now their children — sometimes called echo boomers — is impacting the median age. The eldest of the echo boomers have started to reach or exceed the nation’s median age of 38.9,” said Kristie Wilder, a demographer in the Census Bureau’s Population Division in a statement released on June 22, 2023.

“While natural change, nationally, has been positive, as there have been more births than deaths, birth rates have gradually declined over the past two decades. Without a rapidly growing young population, the U.S. median age will likely continue its slow but steady rise,” she says.

According to the statement, a third (17) of the states in the country had a median age above 40.0 in 2022, led by Maine with the highest at 44.8, and New Hampshire at 43.3. Utah (31.9), the District of Columbia (34.8), and Texas (35.5) had the lowest median ages in the nation. Hawaii had the largest increase in median age among states, up 0.4 years to 40.7.

No states experienced a decrease in median age. Four states — Alabama (39.4), Maine (44.8), Tennessee (39.1), West Virginia (42.8), and the District of Columbia (34.8) — had no change in their median age from 2021 to 2022.

Can Rhode Island cope with a population growing older?  

“It is no secret that the Rhode Island population is growing older,” says Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, whose Subcommittee was charged with looking at Rhode Island’s older population, its demographics, services and programs to assist them to age in place in the community along with identifying gaps in services. “We issued a comprehensive report in 2016 showing that persons age 65 and over in Rhode Island would go from 14.4% of the state population in 2010 to 25% by 2040,” she said.  

According to Maigret, the US Census 2021 estimates shows the state’s 65 and over population is now at 18% and some its communities have already reached 20%. “Our older population is also becoming more diverse. White older adults went from 93.4% in 2010 to 86.4% in 2021 (RI Healthy Aging Data Report.) while Hispanic older adults increased from 3.8% to 6.5%. Our Subcommittee continues to work to implement recommendations we made in nine different areas important for aging in the community,” adds Maigret, noting that she has been working with advocates and legislative champions to implement and put them into law or practice.

“We have made some significant progress in expanding home care for those not impoverished enough to be on Medicaid, to expand respite services for caregivers and this year to fund the Office of Healthy Aging and Disability Resource Center. But we still have much more work to do,” says Maigret.

“I am especially concerned that studies show some 80% of persons age 65+ will not be able to afford two years of home care and many may need more than that. So that is something we need to address by changes in Medicaid and Medicare providing support for unpaid family caregivers who provide enormous amounts of long-term care to loved ones in need.  We also be providing more funding for local senior center programs that are shown to promote health and reduce social isolation with its negative health outcomes,” says Maigret.

Maigret says that funding for the Village Common of RI that, an organization that provides trained and vetted volunteers in local villages to provide supports such as transportation to medical appointments, grocery shopping, friendly visits, minor home tasks — all types of supports to help older adults remain in their own homes, should also be allocated. “More communities are interested in starting these types of volunteer programs of mutual support but funding is needed to support the infrastructure,” she advises.  

Maigret expresses concern that so many older Rhode Islanders are economically insecure. Twenty seven percent of older households are living on less than $25,000/year yet it costs an older Rhode Island couple in good health renting their home about $41,448 annually to meet basic living expenses (Elder Index).

“Economic insecurity is a special problem for older women who comprise 56% of the state’s 65 and over population and are more likely to live alone,” she says noting that their average Social Security checks amounts to $11,584 compared to $14,578 for men, and mean personal income for women is about $25,000 less than older males.

Maigret encourages state leaders to pay attention to these “age-related” demographics as they consider budget and policy priorities. And she would like to see each of the state’s communities assess their age-friendliness, like Newport, Cranston and Providence have done.” Other communities should follow Pawtucket’s lead of promoting fitness for older adults by creating  adult outdoor exercise area adjacent to its senior center or in local parks.

Addressing the State’s Shrinking Health Care Workforce

“The main focus in addressing issues related to meeting the needs of the state’s growing older population is to address the critical need for a robust healthcare workforce,” says John Gage, President & CEO of the Rhode Island Health Care Association.  “Reimbursement must support appropriate staffing levels at livable wages throughout the long-term care continuum – home care, assisted living residences and nursing facilities,” he says. 

“As the generations shift, there will be a greater need for long-term care supports and services with a shrinking workforce.  Sustainable funding is essential to the ability to provide this care, and it has never been more evident than today,” warns Gage.  “In the wake of the Covid-19 pandemic, current statistics from the U.S. Bureau of Labor Statistics indicate that Rhode Island’s nursing home workforce is down some 20% from pre-pandemic levels,” he says, stating a detailed analysis of the workforce for hospitals and nursing homes indicates that  nursing home RNs have declined by 16.5%, LPNs by 18.3% and CNAs by 25.4%.  It is estimated that, nationwide, recovery of the nursing home workforce will not occur until 2027 based on the small, incremental improvements quarter over quarter, adds Gage.

“Presently, 17% of our neighbors are aged 65 and older, and nearly a quarter (24%) are age 60 and above!  Recognizing this trend, we are actively engaged in anticipating and meeting the needs of our growing population of older adults in our state,” says Director Maria Cimini, of the Rhode Island’s Office of Healthy Aging.

“At numerous State and non-profit spaces, we are present to ensure that the needs of older adults are central to discussions surrounding  health care, housing, transportation, education, accessible communities, and caregiving,” she adds.

“We embrace the opportunity presented by the recently passed Legislative Commission to Study the Services and Programs for Older Adults to collaborate with Rhode Islanders working with seniors. Together, we will share our experience with aging populations, promote valuable resources, and identify what we all need to make RI a great place to grow up and grow old,” says Cimini.

For a copy of the 2020 Census Brief, “The Older Population: 2020,” go to https://www2.census.gov/library/publications/decennial/2020/census-briefs/c2020br-07.pdf.

For a copy of the LTCCC’s Aging in Community Subcommittee June 2016 Report, “Aging in Community” go to  https://www.rilegislature.gov/Reports/AiC%20Full%20Final%20Report%206.13.16.pdf.

For a copy of the LTCCC’s Aging Community Subcommittee December 2016 Strategic Plan, “Aging in Community, go to https://www.rilegislature.gov/Reports/Building%20an%20Age-Friendly%20Community.pdf.

For a copy of Rhode Island Healthy Aging Data 2020 Report, go to

Home