Tag Archives for Medicaid

Time to resolve RI’s ongoing Nursing Home staffing crisis

Published in RINewsToday on April 18, 2021

The latest release of AARP’s Nursing Home COVID-19 Dashboard shows that both cases and deaths in nursing homes declined in the four weeks ending March 21. Although these rates are improving, chronic staffing problems in nursing homes—revealed during the COVID-19 pandemic—continue. In Rhode Island, 30% of nursing homes reported a shortage of nurses or aides, which is only fractionally better than the previous reporting period. 

AARP has come out swinging to fight for enhancing the quality of care in Rhode Island’s 104 nursing homes.

AARP Rhode Island, representing 131 members, calls for the General Assembly to ensure the quality of care for the state’s nursing home through minimum staffing standards, oversight, and access to in-person formal advocates, called long-term care Ombudsmen. The state’s the largest aging advocacy group has urged lawmakers to create a state task force on nursing home quality and safety and has pushed for rejecting immunity and holding facilities accountable when they fail to provide adequate care to residents.  It’s also crucial that Rhode Island ensures that increases in nursing homes’ reimbursement rates are spent on staff pay and to improve protections for residents, says AARP Rhode Island. 

Last December, AARP Rhode Island called on Governor Gina Raimondo to scrap Executive Order 20-21 and its subsequent reauthorizations to grant civil immunity related to COVID-19 for nursing homes and other long-term care facilities. The aging advocacy group warned that these facilities should be held responsible for providing the level of quality care that is required of them for which they are being compensated.

Rhode Island Lawmakers Attack Nursing Home Staffing Crisis

During the legislative session, the state’s nursing home staffing crisis caught the eye of Senate Majority Whip Maryellen Goodwin is a policy issue that needs to be addressed. They knew that Rhode Island ranked 41st in the nation in the number of the average hours of care nursing home residents receive, according to data from the Centers for Medicare and Medicaid Services.  The state also has the lowest average resident-care hours per day of any New England state.

On Feb. 2, the Rode Island Senate approved S 0002, “Nursing Home Staffing and Quality Care Act” sponsored by Goodwin and nine Democratic cosponsors to address an ongoing crisis in staffing nursing homes that has been exacerbated by the COVID-19 pandemic.  The bill had passed unanimously in the Health and Human Services Committee, and ultimately, the full Senate gave its thumbs up to the legislative proposal by a vote of 34 to 4.  Only one Republican senator crossed the aisle and voted with the Democratic senators.

“There is a resident care crisis in our state. Staffing shortages and low wages lead to seniors and people with disabilities not receiving the care they desperately need. The pandemic, of course, has exponentially increased the demands of the job and exacerbated patients’ needs. We must confront this problem head-on before our nursing home system collapses,” said Sponsor Senator Goodwin (D-Dist. 1, Providence).

The legislation would establish a minimum standard of 4.1 hours of resident care per day, the federal recommendation for quality care long endorsed by health care experts including the American Nurses Association, the Coalition of Geriatric Nursing Organizations, and the National Consumer Voice for Quality Long-Term Care. The bill, which the Senate also approved last year, has been backed by Raise the Bar on Resident Care, a coalition of advocates for patient care, and the Rhode Island’s Department of Health (RIDOH).

The bill would also secure funding to raise wages for caregivers to recruit and retain a stable and qualified workforce. Short staffing drives high turnover in nursing homes. Not only does high turnover create undue stress and burnout for remaining staff, but it also diverts valuable resources to recruit, orient, and train new employees and increases reliance on overtime and agency staff.  Low wages are a significant driver of the staffing crisis. The median wage for a CNA in Rhode Island is less than $15, and $1/hour lower than the median wage in both Massachusetts and Connecticut.

The legislation would also invest in needed training and skills enhancement for caregivers to provide care for patients with increasing acuity and complex health care needs.

At press time, the companion bill (2021-H-5012), sponsored by Reps. Scott A. Slater (D-Dist.10, Providence) and William W. O’Brien (D-Dist. 54) was considered by House Finance Committee and recommended for further study.

RIDOH’s Director Nicole Alexander-Scott, MD, MPH says the state agency “supports the thoughtfulness of the provisions included in the legislation and welcomes dialogue with its sponsors, advocates, and the nursing home facility industry regarding methods to sustain the necessary conditions associated with the intent of the bill.”

Alexander-Scott states that “RIDOH takes its charge seriously to keep nursing home residents and is supportive of efforts to update standards of care to better serve Rhode Islanders in nursing facilities, as well as increase resident and staff satisfaction within nursing facilities.”

Scott Fraser, President and CEO of the Rhode Island Health Care Association (RIHCA), a nonprofit group representing 80 percent of Rhode Island’s nursing homes, says that “staffing shortages are directly traceable to the chronic lack of Medicaid funding from past governors. Period.” 

According to Fraser, state law requires Medicaid to be funded at a national inflation index, usually averaging around 3%. “Up until this year, previous governors have slashed this amount resulting in millions of dollars in losses to our homes.  Thankfully, Governor McKee is proposing to fully fund the Medicaid Inflation Index this year,” he says.

RIHCA opposes the mandatory minimum staffing the legislation now being considered by the Rhode Island General Assembly, says Fraser, warning that its passage would result in facilities closing throughout the state. “No other state has adopted such a high standard,” he says, noting that the Washington, DC-based American Health Care Association estimates that this legislation would cost Rhode Island facilities at least $75 million to meet this standard and the need to hire more than 800 employees. 

Fraser calls for the “Nursing Home Staffing and Quality Care Act” to be defeated, noting that the legislation does not contain any provisions for funding.  “Medically, there is no proof that mandating a certain number of hours of direct care results in any better health outcomes.  This is an unfunded legislative mandate. If homes are forced to close, not only would residents be forced to find a new place for their care, but hundreds of workers would also be forced out of work,” he says.

Goodwin does not believe that mandating minimum staffing requirements in nursing homes will force nursing homes to close. She noted that the legislation is aimed at ensuring nursing home residents receive adequate care and that Rhode Island is the only state in the northeast without such a standard.

“There is an un-level playing field in nursing home staffing in Rhode Island,” charges Goodwin, noting that many facilities staff 4.1 hours per day, or close to it, while others only provide two hours of care per day. “In either case, the overwhelming majority of well-staffed and poorly-staffed nursing homes remain highly profitable,” she says. 

According to Goodwin, the lack of staffing and certified nursing assistants (CNAs) is due to unreasonable workloads and low pay. “RIDOH’s CAN registry makes it clear that retention of these workers is a big issue. This is in part because they can make as much money – or more – in a minimum wage profession with much less stress,” she adds, stressing that “The Nursing Home Staffing and Quality Care Act” directly addresses these staffing challenges.

One quick policy fix is to provide nursing home operators with adequate Medicaid reimbursement to pay for increased staffing.  Lawmakers must keep McKee’s proposed increase of nursing home rates pursuant to statute, requiring a market-based increase on Oct. 2021, in the state’s FY 2020 budget. The cost is estimated to be $9.6 million.

With the House panel recommending that Slater’s companion measure ((2021-H-5012) to be held for further study, Goodwin’s chances of seeing her legislation becoming law dwindles as the Rhode Island Assembly’s summer adjournment begins to loom ever closer. There’s probably no reason to insist that a bill be passed in order to have a study commission, so this could be appointed right away if there is serious intent to solve this problem.

Slater’s legislation may well be resurrected in the final days of the Rhode Island General Assembly, behind the closed doors when “horse-trading” takes place between House and Senate leadership.  If this doesn’t occur, either the House or Senate might consider creating a Task Force, bringing together nursing home operators, health care professionals and staff officials, to resolve the state’s nursing home staffing crisis. 

Tackling surge of COVID-19 in Nursing Homes

Published ion RINewToday on December 15, 2020

Over the months, while public health officials watch the uptick in new COVID-19 cases, Congress releases two reports, one taking a snapshot of nursing home performance and resident deaths throughout the first eight months of the pandemic, and the other one sounding the alarm about the impact of COVID-19 on the nation’s nursing homes and warning it is now getting worse.  

About three months ago, Senate Finance Committee Chairman Chuck Grassley (R-Iowa) announced the release of a 67-page report on care provided in nursing homes and other long-term care facilities throughout the nation during the ongoing COVID-19 pandemic. The comprehensive report, titled “COVID-19 and Nursing Homes: What Went Wrong and Next Steps,” reviewed U.S. nursing home performance during the early fall and summer months of the pandemic. According to the report, more than two out of five deaths due to COVID-19 in the United States are linked to nursing homes and other long-term care facilities.

Stopping the Spread of COVID-19 in Nursing Homes

“Partisan finger pointing, rather than meaningful analysis, cannot serve as a useful guide for policymakers in crafting the necessary bipartisan reforms in response to the unprecedented challenges facing this entire sector and its employees working on the frontlines during this pandemic,” says the Senate Finance committee report, released on Sept. 23. It stressed that suggestions that coronavirus-related deaths in nursing facilities “are attributable solely, or even primarily, to acts or omissions by the current administration falls well short of addressing the multi-faceted problems in this sector.”

The report added, “Such a one-dimensional approach necessarily overlooks several factors that fueled the outbreak of COVID-19 in nursing homes across the United States, and around the world. Minimizing, or devoting scant attention to such factors, makes it enormously difficult for members of Congress to come together in support of long-overdue reforms and bipartisan solutions to the complex problems facing nursing homes today.” 


The report, produced by the majority staff of the Senate Finance Committee, examined what steps might have prevented these fatalities by minimizing the spread of COVID-19 in the facilities and discussed what actions could be taken now to slow the surge of deaths in nursing homes during this and future pandemics.  

While new coronavirus cases have surged to nursing homes throughout the nation and despite federal and state efforts to stall the spreading of the virus, the Senate Finance Committee report noted that facilities have already received significant relief assistance from Congress and the Trump administration totaling approximately $21 billion in addition to technical assistance, guidance and training.

The report’s findings noted that for years preceding the COVID-19 outbreak in March, private nursing homes have had widespread deficiencies in infection control and prevention.  The majority staff also found that state governments and health officials in some of the hard-hit states fell short of their responsibility to ensure quality care, and in multiple states, staffing and supply shortages persisted for years prior to the pandemic. 

Nursing homes around the world have struggled with many of the same issues as the United States during the pandemic, including Europe, the United Kingdom and Canada, noted the report.

State governments in some cases also failed to enforce federal guidelines for these care facilities as required through their participation in Medicare and Medicaid, particularly guidance provided to minimize coronavirus transmission in their facilities, noted the report. In addition, the majority staff found that nursing home staff who work in multiple facilities unknowingly played a key role in spread of COVID-19 in nursing homes. 


Finally, the Senate Finance Committee report also noted that several governors pressured nursing facilities to accept COVID-19 patients when personal protective equipment (PPE) was still in short supply and some did so even after the federal government made temporary hospitals available in their jurisdictions. 
·       
The Senate Finance Committee report provided, to members of the Senate Finance Committee with detailed background information on the many challenges that nursing homes continue to face during this year’s public health crisis. It provides Congressional lawmakers with specific recommendations, based on best practices that some facilities and public officials adopted during the ongoing pandemic to protect their residents and staff.  It also includes additional suggestions to better protect the nation’s older Americans from elder abuse, neglect and exploitation.

 
Updating the Grim Toll of COVID-19 Deaths in Nursing Homes 

Last week, U.S. Senators Bob Casey (D-PA), Ranking Member of the Special Committee on Aging, and Ron Wyden (D-OR), Ranking Member of the Finance Committee, released their report that warned that the already dire situation in nursing homes is worsening.

“It’s with great sadness that we are once again giving a grim update on the toll that COVID-19 is continuing to take on nursing homes. It’s abundantly clear that inaction has contributed to the loss of more than 104,000 mothers, fathers, grandparents, friends and neighbors who lived and worked in nursing homes and long-term care facilities across the country,” said Senators Casey and Wyden, in a statement announcing the report released on Dec. 10. “Experts are predicting that we are heading into the most severe months of the COVID-19 pandemic, marred by climbing caseloads and increasing stress on our Nation’s health care system,” they say, calling on the Senate colleagues to hammer out and pass a comprehensive COVID-19 relief bill. 

According to the eight-page report, entitled, “The Cost of Inaction: 19 Deaths an Hour and Rising,” last month, more than 15 nursing home residents died from COVID-19 per hour, with 19 residents dying each hour during the week of November 22, 2020, the most recent week reported.

The Senate Aging Committee report noted that the number of weekly COVID-19 deaths among nursing home residents has increased 133 percent since Labor Day, and 96 percent among nursing home workers during the same period. Workforce shortages have also increased since Labor Day: In November, one in six nursing homes nationwide reported that they do not have a sufficient workforce, says the report.

The Democratic Senators warned that COVID-19 cases will surge in nursing homes if Congress does not come together to hammer out bipartisan legislation to stop the spread of the pandemic.

These new report findings serve as a warning as to what will come if Congress does not come together to alleviate the COVID-19 crisis in nursing homes, says Casey and Wyden. It calls for a national strategy to save lives in nursing homes, including providing facilities with a sufficient supply of PPE, ample access to testing, resources for vaccine distribution, funding for strike teams and adequate workforce supports, and accountability measures to uphold resident rights and permit safe visits with family.

Finally, in the Ocean State…

Just days ago,the latest update of the AARP Nursing Home COVID-19 Dashboard, released by AARP’s Public Policy Institute, unveiled a new report in a series on improving the care of care provided in the nation’s nursing homes. “Rhode Island’s nursing homes continue to face alarming trends,” says the AARP report.

Using data released by the Centers for Medicare & Medicaid Services—which is self-reported by nursing homes—the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff. The dashboard will continue to be updated every four weeks.

In the four weeks analyzed, from October 19 to November 15, AARP’s dashboard reports that Rhode Island nursing homes had a dramatic increase in resident and staff cases, and a higher percentage of facilities reporting they are without a 1-week supply of PPE.

“With coronavirus surging across the country, nursing home residents and staff remain in grave danger as the virus reenters nursing homes and other facilities at an alarming pace,” said AARP State Director Kathleen Connell.  “Facilities continue to have shortages of the staff and PPE needed to keep residents and workers safe and stop the spread. Our state leaders must act now to save lives,” she said.

Connell added, “AARP will continue fighting to protect nursing home residents now and offering solutions to improve our long-term care system for the decades to come.”

For copies of Senate reports go to: https://www.aging.senate.gov/imo/media/doc/The%20Cost%20of%20Inaction.%2019%20Deaths%20and%20Hour%20and%20Rising.pdf; 

https://www.finance.senate.gov/imo/media/doc/SFCNursingHomesCOVIDMajorityStaffSFCReport23Sep2020FINAL.pdf.

The complete dashboard is available at aarp.org/nursinghomedashboard.

Democrats Will Have to Compromise if They Lose Georgia Senate Run-Off

Published in the Pawtucket Times on December 7, 2020

With Democratic presidential candidate Joe Biden taking the White House, the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM) called on Congressional lawmakers to address the needs of older Americans during lame-duck session ending Jan. 3 and throughout President Biden’s first 100 days in office.  Can Congressional lawmakers put aside political differences to pass a last-ditch Stimulus package compromise, a defense bill, and consider aging legislation piling up in just 27 days when the lame-duck session ends?  Will there be political grid lock after President Biden takes office on Jan. 20 if the GOP maintains control of the Senate block Congress from taking up legislation impacting older Americans?

Legislation Piling Up in Lame-Duck Session

“Though this is normally a time when expectations for Congressional action are low, the National Committee expects our elected representatives to act on behalf of seniors and other struggling Americans hit hard by the pandemic,” says NCPSSM president and CEO Max Richtman, in correspondence sent to Congress on Dec. 3.

Across the nation seniors are the hardest hit age group by the ongoing coronavirus pandemic.  “Eight out of 10 deaths from COVID in the U.S. have been in adults 65 years old and older. Whether as part of an omnibus funding bill, continuing resolution or COVID relief package, The National Committee is urging lawmakers to pass urgently needed measures for seniors,” says Richtman.

Richtman calls on Congress to address the Social Security “Notch” issue. He warns that if Congress doesn’t take action, workers born in 1960 and 1961, will see lower Social Security retirement benefits in the future. According to the Chief Actuary of Social Security, this will sharply reduce benefits for those born in 1960 compared to the benefits received by people born just one year earlier, creating an effect known as a “notch,” notes NCPSSM’s correspondence.

Congress can correct this notch in Social Security benefits by passing Rep. John Larson’s (D-CT) H.R. 7499, the “Social Security COVID Correction and Equity Act,” says Richtman.  The legislative proposal would increase benefits for those born in 1960 and 1961 without impact the benefits for any other beneficiary. 

In October, the Social Security Administration announced that approximately 70 million Americans would see a meager 1.3 percent increase Social Security benefits and Supplemental Security Income. “More than half of seniors receive over one-half of their income from Social Security, and it provides at least 90 percent of income for more than one-in-five seniors.  These seniors are dependent on a reasonable COLAs to maintain even a modest standard of living in retirement,” said Richtman.

With retirees experiencing financial difficulties during the pandemic, a $20 increase in their monthly check might not help them to pay for spiraling health care and drug costs, along with the expenses of purchasing personal protective equipment and cleaning supplies to keep them safe. 

Richtman’s correspondence also pushes for passage of Rep. Peter DeFazio’s H.R. 8598, “Emergency Social Security COLA for 2021 Act,” to provide Social Security beneficiaries with a 3 percent increase (or a $250 per month flat increase) which would reduce the impact of the small 2021 COLA increase. 

Protecting the Fiscal Viability of Social Security

Last August, NCPSSM and aging advocacy groups opposed President Trump’s signed executive order that would allow employers to defer workers’ payroll tax contributions for the rest of the year.  Between Jan. 1, 2021 and April 30, 2021, these employees will be required to pay back their deferred payroll taxes, doubling their FICA taxes for the first four months of 2021.  The National Committee has supported efforts to ease the burden for those affected by this hardship. 

NCPSSM correspondence also called on Congress to extend a protection to lower-income Medicare and Medicaid beneficiaries, including ‘Money Follows the Person’ (which provides funding for states to help skilled nursing care patients to remain in their homes) and impoverishment protections for the spouses of Medicaid recipients receiving long-term care.

Finally, Richtman requested extending the funding for Medicare Low-Income and Enrollment Assistance, which provides funding for State Health Insurance Assistance Programs and Area Agencies on Aging to assist low-income seniors access programs such as the Medicare Prescription Drug Program Part D Low-Income Subsidy.

NCPSSM’s “wish list”, detailed in Richtman’s correspondence, could easily be rolled into a continuing resolution that Congress must pass by Dec. 11 to get the federal government operational. But, any of the legislative proposals pushed by The National Committee would be bottled up in the Senate, by GOP Senate Majority Leader Mitch McConnell, referred to as the “grim reaper,” he Republicans maintain control of the Senate during the 117th Congress.

GOP ‘Grim Reaper’ Keeps Democratic Bills from Consideration

Last February, on Fox News Friday, anchor Bret Baier asked McConnell to confirm Democratic charges that House passed and Senate proposed legislation would never see the light of day on the Senate Floor.  At the time of this interview, the GOP Senator, controlling his chamber’s legislative agenda, confirmed that 395 bills sitting in his chamber would not be passed.

“It is true,” admitted McConnell during the Fox News interview.  “They’ve been on full left-wing parade over there, trotting out all of their left-wing solutions that are going to be issues in the fall campaign. They’re right. We’re not going to pass those.,” he said, recognizing the politics of a divided government. 

McConnell’s ‘Legislative Graveyard’ created by his blocking debate, markup and refusing to allow a vote on Democratic proposed legislation is well documented in the press and by a report released last September by Common Cause, a watch dog advocacy group with chapters in 35 states. “In fact, the Senate’s inaction has the 116th Congress on track to be the least productive in history, with just one percent of the bills becoming law [between] January 3, 2019 to September 16, 2020],” said Aaron Scherb, Common Cause’s director of legislation and author of the 2020 Democracy Scor

During an interview published on Sept. 16, 2020 in Newsweek, Scherb said, “There have been hundreds [of bills] that have been passed by the House at this point.  There have only been 158 enacted laws by this 116th Congress to this point.  Yet there are hundreds of bills that have passed the House but continue to sit in Senate Majority Leader McConnell’s desk, or his ‘legislative graveyard’ as it’s been called.”

With McConnell winning his reelection, the senator from Kentucky can only maintain control of the Senate’s legislative agenda if he can keep two GOP Senate seats up for grabs in next month’s Senate runoff in Georgia.  A Democratic win will give the party a majority 50 Senate seats, with Vice President Kamala Harris breaking a tie.

In order to pick up the two GOP Senate seats, held by incumbent Senators David Perdue and Kelly Loeffler, Democrats must successfully mobilize voters and adequately fund the campaigns of Democrat Jon Ossoff and Raphael Warnoc. At press time, millions of campaign dollars are pouring into Georgia’s Senate runoff elections, with the two GOP Senators bringing in more campaign donations because of Republican super-PACs giving them the spending edge. The Democrats are receiving their political contributions through small donors.

Even with the Democrats controlling the White House and House of Representatives, if McConnell maintains control of the Senate, legislative gridlock in the upper chamber will most certainly continue.  This will make it more difficult for the NCPSSM and other Washington, DC-based aging advocacy groups to successfully push for passage of legislation to ensure the financial security and health of seniors