Tag Archives for Medicaid

When the dust settles. Looking back at 2024’s legislative days

Published in RINewsToday on June 24, 2024

Over a week ago, after being in session for 49 legislative days (opening day was Jan. 2, 2024), the Rhode Island General Assembly held its final session at 4pm on June 13, 2024, and ended at about 1:30am on June 14, 2024. During this year’s legislative session 1,167 bills and resolutions were introduced in the Senate, and 1,369 in the House. This total does not include Resolutions, which were  congratulatory in nature or noted prominent Rhode Island residents who have passed away.

With the dust settling at the end of this year’s session, there were 249 bills that passed both the House and Senate, and that are now sitting on Gov. Dan McKee’s desk for his signature to enact, or to pass without signature, or to be rejected.

“This was an outstanding legislative year for Rhode Island’s seniors,” observes House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick). “In addition to all the investments for seniors made in the state budget that has been signed by Governor McKee, there were excellent bills that will be of great benefit to our aging population, he says. 

Attacking the housing crisis head on

In a joint statement, the House Speaker and Senate President Dominick Ruggerio said, “It is critical to attack our housing crisis from many different angles. Allowing ADUs in other states has been proven to make a significant impact by immediately increasing available housing supply.  We are confident that ADUs will be beneficial for the many Rhode Islanders who need flexibility in housing options, particularly seniors wishing to age in place in their communities,” they say.

Shekarchi points out the enactment of ADU legislation sponsored by House Commission on Housing Affordability Chairwoman June S. Speakman (D-Dist. 68, Warren Bristol) and Sen. Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingston) that would boost the development of accessory dwelling units (ADUs), which are also known as in-law apartments. The House Speaker is the House bill’s top co-sponsor.

“I have heard from so many seniors who would like to downsize and continue to live independently, but would enjoy the extra assurance of living on the property of their children,” he noted, thanking AARP Rhode Island and housing advocates, including Rhode Island Housing, Grow Smart RI and Housing Network RI, who pushed this “significant legislation” across the finish line. 

The bills (2024-H 7062A, 2024-S 2998A) would provide homeowners statewide the right to develop a single ADU on an owner-occupied property or within the existing footprint of their structures or on any lot larger than 20,000 square feet, provided that the ADU’s design satisfies building code, size limits and infrastructure requirements.

The purpose of the bill is to encourage the development of rental units that are likely to be more affordable than many other apartments, and also to provide opportunities for homeowners with extra space to generate income that helps them maintain ownership of that property.

To ensure that the bill achieves its goal of housing Rhode Islanders, the legislation prohibits ADUs constructed under this provision from being used as short-term rentals, and streamlines the permitting process.

In the HEALTH arena

According to Senate President Dominick J. Ruggerio, several legislative proposals in the Senate’s health care package passed the General Assembly.

“Few issues are as important as health care, and right now, our health care system is in critical condition. Health care absolutely must be accessible and affordable for all Rhode Islanders,” says Ruggerio, noting that for too many people in the Ocean State is too expensive or too difficult to get. “And we know that many health care providers are feeling enormous strain due to many factors,” he adds.

“Like providers and consumers, our community hospitals, including Fatima in my district, are facing difficult circumstances,” said the Senate President, who recognized his Senate colleagues in the development of this package of legislation.

“As we celebrate our victories in the 2024 session, we are committed to continuing our work on this issue and accomplishing all the objectives of the HEALTH initiative. “

According to Ruggerio, several legislative proposals in the Senate leadership’s HEALTH (Holistic Enhancement and Access Legislation for Total Health) initiative include legislative proposals to join five interstate licensing compacts to make it easier for Rhode Islanders to access the care they need and budget provisions to use $1 million of general revenue to purchase debts of struggling Rhode Islanders and incentivize providers to enter primary care fields.

Advocates on aging give their recap of the 2024 Legislative Session

“The Senior Agenda Coalition of RI supported several housing-related bills (that did not pass) that would benefit older adults including those sponsored by Rep. Meghan Cotter (D-Dist. 39, Exeter, Richmond, and Hopkinton)  and Sen. Linda Ujifusa (D-Dist. 11, Portsmouth, Bristol) to increase the income cap for the Property Tax Relief program to $50,000 and the credit or refund to $850 to help offset the cost, of property taxes and rents for older adults and persons with disabilities,” says Maureen Maigret, Policy Advisor for the Senior Agenda Coalition of RI (SACRI), noting the Coalition plan to continue to advocate for them next year.

Maigret warned that with a growing older population the need for more accessible housing will increase and the Coalition supported and will continue to support bills to create greater accessibility in new housing.  

Maigret stated that SACRI will also continue to support legislation to create a caregiver tax credit as provided for in 2024 legislation sponsored this year by Rep. Susan Donovan and Sen. Linda Ujifusa. “Our caregivers are valued and deserve our support. A caregiver tax credit will help the many R.I. family caregivers who provide thousands of hours of care for spouses and parents often spending thousands of dollars of their own money to give their loved ones a better, more comfortable life,” she says.

She noted that SACRI also plans to build on its efforts to further expand the Medicare Savings Program to help more lower-income persons on Medicare afford needed healthcare by covering required co-pays and deductibles and to continue its work to promote quality long term care through support for staffing standards, worker training programs and Medicaid enhanced reimbursement for private rooms to help with infection control issues that became so apparent during the Covid pandemic.

SACRI will also push next legislative session to enact legislation to establish a formula for state funding to support local senior centers and programs based on a community’s population of those 65 years and over.  

Raise the Bar on Resident Care and other advocates successfully pushed the passage of H 7733 and S 2621 legislation sponsored by Rep. Scott Slater (D-Dist. 10, Providence) and Sen. Bridget Valverde (D-Dist. 35, (East Greenwich, North Kingstown, South Kingstown) that would establish the Nursing Home Work Standards Board (NWSB). According to Raise the Bar, NWSB will help stabilize the nursing home system by establishing training standards, promoting caregiver rights, depoliticizing funding allocations and implementing financial oversight of nursing homes.  A 13-member board (including frontline staff, nursing home management representatives, state government and community organizations will work with Medicaid to ensure comprehensive and informed decision-making.

“In 2023, Minnesota passed its own Nursing Home Workforce Standards Board and just voted to raise wages for caregivers to over $23 an hour in 2027 while guaranteeing 11 paid holidays. Here in Rhode Island, the Workforce Standards Board is a critical step toward transforming nursing home jobs into sustainable careers that can support a family and provide quality resident care. Now we need Governor McKee to show his support and sign this bill into law,” said Jesse Martin, Executive Vice President of SEIU 1199 New England, member of Raise the Bar on Resident Care.

Raise the Bar also advocated for the passage of the Financial Transparency Act (S 2604 | H 8204) but ultimately pulled the bill in order to re-adjust some of its language. This legislative proposal, S 2604, sponsored by Sen. Dawn Euer (D-Dist.13, Newport, Jamestown) and its companion measure, H 8204, sponsored by Rep. Matthew Dawson (D-Dist.65, East Providence) would require nursing homes to provide annual, audited financial statements that include detailed income, expenses, and cash flow, alongside transparent ownership information to prevent for-profit owners from misusing Medicaid and Medicare dollars. “We look forward to advocating for its passage in next year’s legislative session to ensure all for-profit nursing homeowners are held accountable to investing public dollars appropriately in direct care,” continued Jesse Martin. 

Advocates for Better Care in Rhode Island, a grassroots community organization founded to advocate for the rights and interests of residents of long-term care facilities in RI, celebrates the passage of S. 2263. The Long-Term Care Residents Rights Camera Bill, notes Director Kathleen Gerard. 

“The legislation gives residents of nursing homes and assisted living facilities and their legal representatives the right to install a monitoring device in their room provided all residents in the room consent. The consent can be withdrawn at any time, and a variety of safeguards exist to protect resident privacy,” says Gerard.

The legislation, S 2263 A, sponsored by Sen. Dawn Euer (D-Dist. 13, Newport, Jamestown, who chairs the Senate Committee on Judiciary and H 7969 A, sponsored by Deputy Majority Leader Jason Knight (D-Dist. 67, Barrington and Warren) has been signed by the governor and will take effect Jan. 1, 2025.  

According to Gerard, the legislation was first introduced in this form in 2021, but the care staffing crisis and massive 138% increase in serious deficiencies cited in RI long-term care facilities since 2022 made it even more urgent to finally pass it this year.

“Speaker Shekarchi worked tirelessly to reach a compromise that was acceptable to the various parties supporting and opposing the bill, and long-term care residents will consequently soon be able to have their care and condition monitored remotely by loved ones and care-partners, resulting in more peace of mind for everyone,” she says. 

“A legislative proposal we backed this year and that we hope to see enacted next year was introduced by the Rhode Island Department of Health.  The legislation, (S 2818 sponsored by Sen. Joshua Miller (D-Dist. 28, Cranston, Providence and H. 7819 sponsored by Rep. June S. Speakman), would improve financial transparency in nursing home ownership and prevent the rapid extraction of equity from facilities that we see with many private equity firms, real estate investment trusts, and investor groups,” says Gerard.

Next legislative session, Gerard says Advocates for Better Care in Rhode Island will also continue to advocate for legislation requiring assisted living facilities to support family councils.   This requirement already applies to nursing homes, she notes.

“We’ve Only Just Begun, says Sandra Paquette, representing Advocates for COLA Restoration and Pension Reform, a non-profit representing 4,700 retirees. “Our group numbers continue to increase, along with our determination and commitment, to fight for the justice which was so unnecessarily and ruthlessly taken away,” she says. .

According to Paquette, there were legislative proposals pertaining to current and future state and teaching retirees, which did not reach the floor of the House or Senate. One legislative proposal applied to those active employees whose retirement is based upon an arbitrary “rule of 95”. This translates into a calculation where the years of service and the age of those wishing to retire must add up to 95. The law would have changed this total to 90. Another one for which we strongly advocated, and for which we provided thousands of letters, verbal testimony and volunteer lobbying sessions was Pat Serpa’s (D-Dist. 27, West Warwick, Coventry and Warwick), H-8193, would have restored a compounded Cost of Living Adjustment (COLA) to all current and future retirees, and would have been enacted as of July of this year.

“Our goals for next year will remain— to advocate through testimony, letters, media and lobbying–for the passage of the two bills which will provide the now essential support to the victims of the 2011 Rhode Island Retirement Security Act,” says Paquette.

And here are specifics about other bills that impact seniors:

Next November, Let Seniors Vote on Social Security Fixes  

Published in RINewsToday on May 13, 2024

By Herb Weiss

The recently released 2024 Social Security and Medicare Trustees report shows an improved outlook for these programs. This year’s projections show that Social Security can pay its benefits and cover administrative costs now until 2035, one year longer than projected in last year’s report. But, after that, it can only cover 83 percent of benefits, even if Congress fails to take no action to fix the program to ensure its financial viability.  

Medicare’s fiscal health improves even more, says the Medicare Trustees Report. It projects that the program’s Part A (Hospital) fund will be able to pay 100% of scheduled benefits until 2036 — a full five years later than estimated by the trustees last year. 

Under the Social Security Act of 1935, the Board of Trustees is required to submit the annual reports on the current and projected financial status of the trust funds to Congress on April 1 each year. 

It’s Time for Congress to Protect Social Security

“This year’s report is a measure of good news,” says Martin O’Malley, Commissioner of Social Security, in a statement recognizing the impact of “strong economic that have yielded impressive wage growth, historic job creation and a steady, low unemployment rate.”  

“So long as Americans across our country continue to work, Social Security can — and will — continue to pay benefits,” says O’Malley, calling on Congress to take action to ensure the financial viability of the Trust Fund “into the foreseeable future just as it did I the past on a bipartisan basis.”  

“I will continue to urge Congress to protect and support Social Security and restore the growth of the funds. Whether Congress chooses to eliminate the shortfall by increasing revenue, reducing benefits, or some combination, is a matter of political preference, not affordability,” observes O’Malley, noting that there are several legislative proposals that address the shortfall without benefit cuts — it should debate and vote on these and any other proposals. 

Social Security Advocacy Groups. Key GOP Lawmaker Issue Statements 

With the May 6 release of the 2024 Social Security and Medicare Trustees report, statements were generated by Social Security advocacy groups and Congressional lawmakers to give their take on the projections. 

Even with the report pushing back the expected depletion dates for Social Security and Medicare, Max Richtman, President & CEO, National Committee to Preserve Social Security & Medicare (NCPSSM) called for Congress to immediately act to strengthen the Social Security program for the 67 million beneficiaries. “We cannot afford to wait to take action until the trust fund is mere months from insolvency, as Congress did in 1983.  The sooner Congress acts, the less painful the remedies will be, says Richtman.

In responding to comments that Social Security is going ‘bankrupt, Richtman says: “Revenue always will flow into Social Security from workers’ payroll contributions, so the program will never be ‘broke.’ But no one wants seniors to suffer an automatic 17% benefit cut in 2035, so Congress must act deliberately, but not recklessly.  A bad deal driven by cuts to earned benefits could be worse than no deal at all.” 

Richtman warns that seniors will take a devastating financial hit if Congress is forced to make cuts in 2035. “Average Social Security benefits are already very modest — about $23,000 per year, which is only $3,000 higher than the federal poverty line for a household of two,” he says, noting that wealthier beneficiaries can afford to contribute more to the program without hurting them financially. 

“Social Security has an accumulated surplus of $2.79 trillion. It is 90 percent funded for the next quarter century, 83 percent for the next half century, and 81 percent for the next three quarters of a century. At the end of the century, in 2100,” says Nancy Altman, President of Social Security Works, noting that the program is projected to cost just 6.1 percent of gross domestic product (“GDP”). 

Like the SSA Commissioner and NCPSSM’s Richtman, and Altman urges Congress to act sooner rather than later to ensure that Social Security can pay full benefits for generations to come, along with expanding Social Security’s modest benefits. “That will restore one of the most important benefits Social Security is intended to provide to the American people — a sense of security,” she says.

As to Medicare, the released report notes the life expectancy for Medicare part A Trust Fund is extended another five years. 

“It’s great news that the Part A trust fund has an additional FIVE years before it becomes depleted, partly because of the unexpected strength of the U.S. economy.  But current and future seniors expect action to keep the trust fund solvent for the long-term,” said Richtman.

“We support President Biden’s plan to strengthen Medicare’s finances, as laid out in his FY 2024 and 2025 budgets,” says Richtman, noting that the president’s plan would bring more revenue into the program, rather than cutting benefits as some Republicans have proposed.  “Building on the prescription drug pricing reforms in the Inflation Reduction Act, the President’s budget proposal would lower Medicare’s costs — and some of those savings would be used to extend the solvency of the Part A trust fund,” he says.

According to Richtman, beyond trust fund solvency, the Trustees reported that the standard Medicare Part B premium will rise next year to $185 per month – a $20 or 6 percent monthly increase. “Any premium increase is a burden to seniors living on fixed incomes, who too often must choose between paying monthly bills or filling prescriptions and getting proper health care.  Seniors need relief from rising premiums and skyrocketing out-of-pocket health care costs. Fortunately, the Biden administration is taking steps to reduce those costs,” said Richtman.

Key GOP Chair  Responds to Trustee Reports

Chairman Jodey Arrington (R-TX), of the House Budget Committee, quickly released a statement, responding to the release of the 2024 Social Security and Medicare Trustees report.

According to Arrington, the House Budget Committee’s Fiscal Year (FY) 2025 Budget, while not making any changes to Social Security or Medicare benefits, provides a way to prod Congress and the President to address the fiscal insolvency of these programs. The Budget Committee has also reported the Fiscal Commission Act, which will also give Congress the tools it needs to save and strengthen these vital programs,” he noted.

“We have the highest levels of indebtedness in our nation’s history, an inflationary and anemic economy, and the two most important senior safety net programs facing insolvency, says Arrington, noting that this year’s trustees report “only reiterates why we need a bipartisan Fiscal Commission to address the Social Security and Medicare Trust Funds and the $140 trillion unfunded liability on America’s balance sheet.”

“Republicans and Democrats have both proven they will not fix Social Security and Medicare on their own. We must put our seniors and country first and work together to find a solution,” he charges. “Doing nothing is condemning our seniors to automatic benefit cuts and our country to a future debt crisis,” he says.

Fixing Social Security…A Difference in Perspective.

Both NCPSSM and Social Security Works strongly endorse financially shoring up Social Security by bringing in more money into the trust fund by increasing the payroll wage-cap to require higher-income beneficiaries to pay a higher Social Security payroll tax.  Both Social Security advocacy groups endorse Rep. John Larson’s (D-CT) Social Security 2100 Act, a legislative proposal would maintain the current payroll wage cap (currently set at $168,600), but subjecting wages $400,000 and above to payroll taxes, as well — and dedicating some of high-earners’ investment income to Social Security. 

On the other hand, Republican lawmakers call for cutting earned benefits of younger workers by raising the full-retirement age, means-testing, and replacing the exiting COLA (CPI-W with the Chained CPI-U) that would result in a lower COLA over time. Also, no COLA’s would be provided to high income earners.  

Social Security is considered the third rail a nation’s politics.  Political pundits say that contact with the rail is like touching this high-voltage rail that can result in “political suicide.”  That is why the GOP-controlled House Budget Committee has proposed to create a fiscal commission to give lawmakers political cover to enact the cuts without having to vote on the record.  

Over two months ago, the most recent budget hammered out by the Republican Study Committee, endorsed by 80 percent of the House Republicans, calls for over $1.5 trillion in cuts to Social Security in just the next ten years., including an increase in the retirement age to 69 and cutting disability benefits Medicare costs for seniors by taking away Medicare’s authority to negotiate drug costs, repealing a $ 35 insulin, and $ 2,000 out-of-pocket cap in the Inflation Reduction Act. 

 Additionally, the House GOP budget transitions Medicare to a premium support system that the Congressional Budget Office has found would raises premiums for many seniors.  Finally, it calls for cuts in Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program by $ 4.5 trillion over ten years, taking health care  coverage away from millions of people. 

While President Donald Trump, the GOP’s presidential candidate, has previous said he wouldn’t make cuts to Social Security, recent interviews reveal a change.  According to a March 11, 2024 web posting by CNN’s Kate Sullivan and Tami Luhby, former President Donald Trump, the Republican candidate for president, “suggested[ in a CNBC interview] he was open to making cuts to Social Security and Medicare after opposing touching the entitlement programs and attacking his GOP presidential primary rivals over the issue.”

At the Polls

Legislative proposals to fix the ailing Social Security and Medicare programs are different as night and day. Rather than to  continue to debate the fine points, let’s put the differing policies on the ballot. With just 177 days left before the upcoming November presidential election, Congress must vote on Democratic and Republican legislative proposals, detailing differing provisions as to how these programs can increase the financial stability of these programs. Larson has already thrown his legislative proposal into the hopper, but it won’t see the light of day with a GOP controlled House.    

Last year, 66 million Americans received Social Security benefits.  This year’s Trustee’s report must send a clear message to these beneficiaries that how Congress acts during the next decade will either make or break the Social Security program. 

So, now House Speaker Mike Johnson, (R-La) and Senate President Charles E. Schumer (D- NY) must allow a vote on both Republican and Democratic legislative proposals in their respective chambers.  Let Senate and House lawmakers go on the record and publicly be tied to a vote as to which legislative political strategy they endorse to financially shore up Social Security and Medicare.  Of course, this can give voters a score card. And if this political issue is as important to them as the economy, abortion, and immigration, they can decide at the ballot box who they should bring back to Capitol Hill. 

That’s the American way to do it.

Shortage of direct care professionals a local and national concern

Published in RINewsTdoay on April 22, 2024

Last week, at  the Senate Dirksen Building, Room SD-562,  Chairman Bob Casey, of the U.S. Special Committee on Aging, (D-PA), showcased S. 4120, legislation that he introduced with U.S. Senators Tim Kaine (D-VA), and Tammy Baldwin (D-WI). The Long-Term Care Workforce Support Act, introduced during the 118thCongress, would ensure that direct care professionals have a sustainable, lifelong career by providing substantial new funding to support these workers in every part of the long-term care industry, from nursing homes to home care, to assisted living facilities.

The Senate Aging Committee details a number of statistical findings showing the need for Congress to address the nation’s severe ongoing direct care professional workforce shortage. “A recent survey revealed 92% of nursing facility respondents and nearly 70% of assisted living facilities reported significant or severe workforce shortages.

In 2022, a survey of nursing facilities showed more than 50% of the facilities were limiting the number of new admissions due to staffing vacancies or shortages.  Another recent survey of Home and Community Based Service providers showed that all 50 states were experiencing home care worker shortages, and 43 states reported that some HCBS provider groups have closed due to worker shortages,” says the fact sheet.

Addressing the cause

By improving compensation, benefits, and support systems, S.4120  would ensure the United States has a “strong, qualified pipeline of workers to provide desperately needed care for older adults and people with disabilities.” notes a statement announcing the introduction of Casey’s legislative proposal.  

Specifically, S. 4120 would increase the number of direct care professionals, especially in rural communities.  It also would provide pathways to enter and be supported in the workforce for women, people of color, and people with disabilities.

S. 4120 would also improve wage compensation for direct care professionals to reduce vacancies and turnover.  It ensures that direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and provided fair compensation.

The legislative proposal also documents the need for long-term care, identify effective recruitment and training strategies, and promote practices that help retain direct care professionals. It also would strengthen the direct care professional workforce in order to support the 53,000,000 unpaid family caregivers who are providing complex services to their loved ones in the home and across long-term care settings.

At press time, S. 4120 is endorsed by 50 organizations, including Domestic Workers Alliance, SEIU, AFSCME, Caring Across Generations, National Coalition on Aging (NCOA), Justice in Aging, National Partnership for Women & Families, National Council on Independent Living (NCIL), and the National Disability Rights Network (NDRN).

And a companion legislative proposal was introduced in the House by Congresswoman Debbie Dingell (D-MI).

Senate Aging Committee puts spotlight on Direct Care Staffing Shortage 

The April 16th hearing entitled, “The Long-Term Care Workforce: Addressing Shortages and Improving the Profession,” examined the challenges currently facing long-term care workers who are often underpaid and overworked, leading to widespread worker shortages that threaten the availability of care for those who need it.  

“It’s a crisis that stems largely from a lack of support for and investment in our caregiving workforce,” warns Casey in his opening statement. “Between 50 to over 90 percent of long-term care settings and providers report significant staffing shortages, affecting their ability to provide services, accept new clients, or even to remain open,” he says.

Casey noted that many direct care professionals have to work multiple jobs or overtime just to be able to support themselves and their families.  In 2022, their medium wage was just above $15 dollars an hour, well below what is paid for warehouse and convenience store jobs, per Casey.

“The direct care workforce, the majority of whom are women of color, are more likely to live in poverty compared to the general public,” notes Casey.

“Cumbersome federal regulations, requirements, and protections” and a “one-size fits all approach” won’t fix the direct care staffing shortage, responds Ranking Member Mike Braun (R-IN).

“To grow the long-term care workforce, the federal government should make it easier for people to enter by removing barriers,” says Braun, in his opening statement, calling for “productive approaches to build and grow the care professions.”

Overworked and not enough money

Nicholas Smith, a direct support professional at SPIN, a Pennsylvania-based organization that provides lifespan services for over 3,000 people with intellectual disabilities and autism, came to testify. “I work nearly 65-70 hours a week… due to my work, I have missed family events, nieces’ and nephews’ recitals, and school functions… a lot of people are leaving this field to make more money,” said the Philadelphia resident who has worked in the long-term care industry for over 25 years.

According to Smith, the national average for direct service professional wages is only $15.43 in long-term care. “We spend time training new hires only to lose them because they cannot make a living wage,” he says, noting that other industries are offering more money.

“While people want to stay in this field, they cannot make ends meet. Pennsylvania has a long waitlist for home and community-based services, and this is due to the workforce crisis,” he says.

In her testimony, Brooke Vogleman, a licensed Practical Nurse with Huntington, Indiana based TLC Management, stated:  “I’ve seen what happens when long-term care facilities lack workers, resources and government support, like during the pandemic. Many of my colleagues got burned out and left the profession, forcing facilities to rely on costly temporary staffing agencies.”

Vogleman called on federal policy makers, including members of the Senate Aging Committee, to address the challenge through “targeted investments, not blanket mandates.”  

For instance, she told the Senators that LPNs are integral to the facility’s interdisciplinary team. “Staffing mandates that do not include our contributions to patient care or recognize us as nurses are very concerning to me and will have unintended consequences on residents,” she says.

Staffing mandates will force facilities to depend more on expensive staffing agencies, warns Vogleman. “Personally, I’m concerned they will actually increase staff burnout, as current caregivers will be stretched thin and working longer hours in order to comply with these impossible standards,” she says.

Matthew Connell, Ed.D., of Ivy Tech Community College of Indiana, came to share the work and achievements of his community college in addressing the shortage of healthcare and long-term care workers in Indiana.

According to Connell, serving more than 190,000 students at 19 campuses and 26 satellite locations as well as on-line, graduates more associate level nurses in Indiana.  Nearly half of these students are pursuing college credit while in high school. Ivy Tech is the nation’s single largest provider of dual credit.

Ivy Tech’s programs are especially designed to help graduates enter the workforce quickly and provide critical services for the state’s long-term care population at a tuition rate that is the lowest in the state, he notes. “One in three Registered Nurses [in Indiana] is an alum. More than 90% of its nursing graduates choose to remain in Indiana, working in hospitals and care settings,” he adds.

The last witness, Jasmine L. Travers, assistant professor at New York University’s College of Nursing,  concisely summed up how to fix the nursing shortage.  She suggested: “To improve access to and quality of long-term are, we must ensure that all direct care workers receive a living wage, a safe, respectful work environment, opportunities for advancement, adequate training, and accessible benefits to maintain their health and well-being.  Only when we recognize that these workers are critically important, hardworking processionals, can we begin to improve equity and health outcomes for staff and patients alike.”

Putting the spotlight on Rhode Island’s Direct Care Staffing Shortage

According to John E. Gage, MBA, NHA, President & CEO, of the Rhode Island Health Care Association (RIHCA), the Covid-19 pandemic had a dramatic impact on the healthcare sector across the country and especially in Rhode Island, and a disproportionate impact on nursing facilities. On a national level, in February 2020 nursing facilities workforce totaled 1,587,000. Today, it is 1,462,800, down by 124,200 or 7.8%. In Rhode Island, it is more dramatic. Pre-pandemic RI nursing facility workforce was 9,797 (2/2020). Current BLS data shows the most recent number of workers in RI nursing facilities is 8,300 – down 1,497 workers or 15.3%.  This is just about double the rate of loss of workers post-pandemic in RI compared to the national statistics.

“There are some local efforts to attract workers back to RI nursing homes,” says Gage, noting that there is a need to be laser-focused on workforce development efforts. 

Gage calls for RI Medicaid to increase reimbursements to nursing facilities to cover today’s actual cost of care, not on facility costs from 2011 (13 years ago!) with minimal average inflationary increases in the 11 years since the price-based reimbursement methodology began in 2013.  According to Gage, RI nursing facilities need an adequate, sustainable reimbursement system to foster continued high-quality care and services and provide nursing home with rates that enable them to retain current workers and recruit more caregivers.

RIHCA, a non-profit trade association representing more than 80 percent of the nursing homes in the state, and its parent organization, the American Health Care Association (AHCA) support the legislative efforts of Senator Casey’s Long-Term Care Support Act. “We support all efforts to increase Medicaid rates to enable facilities to regain and grow their workforce – both direct care and ancillary staff, to enhance the quality of care and quality of life for our nation’s and RI’s most frail elder citizens today and for the years ahead,” he says. 

“It is heartening to see the Senate Committee on Aging and leading members of Congress addressing the care worker crisis in long term care including supporting our many thousands of unpaid caregivers who provide a significant portion of long term supports and services,” says Maureen Maigret, policy advisory of the Senior Agenda of RI (SACRI). Multifaceted solutions are needed, adds Maigret that include supporting training programs for nurses and paraprofessionals, career ladders and providing adequate Medicaid provider payments as Medicaid is the primary payer for long term care.

According to Maigret, in homecare alone, 75% of persons referred for subsidized home and community care through the state Medicaid or the Office of Healthy Aging Home Cost Share program are waiting two months, and often longer, to get services. “Our nursing homes are challenged to recruit the nursing staff needed to provide resident-centered quality care. Federal funding during the pandemic brought some funding in to support worker wages but that funding has ended,” she says.

“The state Healthcare Workforce Initiative led by the Executive Office of Health and Human Services and the Department of Labor has been looking at needs across the healthcare system and addressing some of the training and education issues,” says Maigret, noting that advocacy groups, such as the SACRI, support the Medicaid reimbursement rate increases as recommended by the Office of the Health Insurance Commissioner. “These rate increases are necessary to reduce service wait lists and provide livable wages for direct care staff many of whom are women and women of color,” she says. 

Over 23 years ago, in his weekly commentaries in the Pawtucket Times, this writer reported on the crisis of a direct care staffing shortage and inadequate reimbursement being paid to  nursing facilities to care for Rhode Island’s fail seniors. Isn’t it finally time for the Rhode Island General Assembly to come up with the necessary funds and strategy to fix these problem once and for all?

To watch the Senate Aging Committee hearing held on April 16, 2024, go to https://www.aging.senate.gov/hearings/the-long-term-care-workforce-addressing-shortages-and-improving-the-profession