Tag Archives for Medicare

Nursing facilities gear up for October vaccination deadline

Published in RI News Today on September 20, 2021

Over a month ago, the U.S. Centers for Disease Control and Prevention (Centers for Disease Control and Prevention) issued a Health Alert Network (HAN) Health Advisory to public health practitioners and clinicians about the urgent need to increase COVID-19 vaccination coverage across the United States to prevent surges in new infections that could increase COVID-19 related morbidity and mortality, overwhelm health care capacity, and widen existing COVID-19-related health disparities.

According to the July 27 Health Advisory, there is growing medical evidence that the Delta variant is at least twice as contagious as the original SARS-CoV-2 virus. It is reported that most cases of COVID-19 hospitalizations and death are in unvaccinated people; however, there are breakthrough infections in vaccinated people because of the surge of infections among the unvaccinated. This is a particular concern in nursing homes, where vaccinated residents are infected by unvaccinated staff.

The Biden Administration announced plans in August to require COVID-19 vaccinations for nursing home staff as a condition for those facilities to continue receiving federal Medicare and Medicaid funding. Rhode Island Governor Daniel J. McKee, along with other states’ leadership, took similar steps to protect nursing home residents by requiring all healthcare staff to be vaccinated and the new federal mandate will ensure consistent and equitable standards throughout the country. At a COVID-19 update held at the state capitol in early August, McKee called for the new vaccine mandate (as a term of employment) to take effect.

COVID Cases Rise in Rhode Island Nursing  Homes

Coronavirus continues to increase in nursing homes, warns AARP Rhode Island in a statement issued on September 17. According to the latest data from AARP’s Nursing Home COVID-19 Dashboard, in the four weeks ending August 22, resident cases increasing from 0.05 to 0.34 per 100 residents and staff cases increasing from 0.11 to 0.88 per 100 residents since the mid-July report.

Nationally, cases are concentrated among the unvaccinated, and those residents were three times as likely to contract COVID-19 last month compared to residents who are fully vaccinated.

The last eight months have shown vaccines to be the most effective tool in preventing COVID-19 related deaths, says AARP Rhode Island’s statement. There were modest increases in vaccination rates during this four-week period, with 92% of Rhode Island Nursing Home residents and 76% of staff fully vaccinated as of August 22.

“This month’s dashboard underscores why all staff and residents in long-term care facilities must be vaccinated as quickly as possible,” said AARP Rhode Island State Director, Catherine Taylor. “For unvaccinated nursing home residents, their risk of an infection is back up to the levels we saw a year ago. Too many people in Rhode Island who lived and worked in nursing facilities have died from COVID-19, and no one wants to see that tragedy repeated,” said Taylor.

The AARP Nursing Home COVID-19 Dashboard also found over a 300% increase in RI nursing homes reporting an urgent need for PPE in the period ending August 22, with almost 10% of facilities in Rhode Island reporting they did not have sufficient PPE.

Nursing Facilities Struggling to Maintain Adequate Staffing

While the Rhode Island Health Care Association supports Governor McKee’s decision to mandate COVID-19 vaccinations across the health care continuum, says John E. Gage, President and CEO of the Rhode Island Health Care Association, representing 64 of the 77 nursing facilities in the Ocean State, nursing homes are struggling to maintain their staffing levels to meet the state’s direct care requirements, but many are struggling to maintain that level, he says, noting that next month’s deadline requiring nursing facility staff will further strain the already “precarious staffing crisis in the state’s nursing facilities”.

Gage noted that the state’s Department of Health has surveyed facilities this week regarding the number of staff that will be unable to enter facilities in two weeks because they are unvaccinated. “It is reported that nursing facilities will lose 7% of their workforce – 706 staff of 10,137 in the workforce across all disciplines,” says Gage, noting that 495 out of the 706 are clinical staff members.

According to Gage, “Rhode Island nursing facilities are ranked the fourth best state for resident vaccinations and fifth best state for staff vaccination rates in the country. He notes, when taking a look at the Centers for Medicare and Medicaid Services data released last week, in Rhode Island 92.65% of residents are fully vaccinated compared to 84.1% nationwide. As to staff, 78.99% of Rhode Island’s nursing facility staff are fully vaccinated compared to 63.7% nationwide.

Gage says, “The vaccine mandate will further add to the challenge of staff retention and recruitment. We are facing the implementation of a minimum staffing mandate to take effect 1/1/22. There’s not adequate staff available to hire, and the legislature did not provide for adequate funding to achieve the upcoming mandate”. 

Finally, Gage notes that while visitation is currently open at Rhode Island nursing facilities there are many factors that make it difficult to stop the spread of COVID-19 from staff to residents. “Our staff are members of each and every community in Rhode Island  They interact with others outside of work who may or may not be vaccinated, and many have children under the age of 12 who are not eligible for vaccination. To further complicate matters, there are breakthrough cases among those who are fully vaccinated, especially now with the prevalence of the Delta variant,” says Gage.

“Rhode Island facilities will continue to take all steps necessary to mitigate the risks of COVID-19 infections,” says Gage, noting that vaccinations are the key to eradicating this pandemic, together with the proper use of personal protective equipment.  

The AARP Nursing Home COVID-19 Dashboard analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The full Nursing Home COVID-19 Dashboard is available  www.AARP.org/nursinghomedashboard, and an AARP story about this month’s data is available here. For more information on how COVID is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes.

A call to Congress to strengthen, expand Social Security & Medicare 

Published in Rhode Island News Today on September 6, 2021

The 2021 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance (OASI)) and the Social Security Disability trust fund (SSDI), released last week, gives Congress this stark warning: the Social Security Trust fund is heading toward insolvency in 13 years while SSDI will see its reserve funds depleted in 2057, eight years sooner than last year’s estimate. As a whole, combined, the two Social Security trust fund reserves will be depleted in 2034, a year earlier than estimated made in last year’s Trustee report.

However, there is good news. This year’s report notes that there is more than enough time for lawmakers to make up shortfalls by immediately shoring up the ailing Social Security Old-Age and Survivors Insurance (OASI) trust fund and the Social Security Disability trust fund (SSDI) by Congress increasing revenues or cutting costs to these programs.

“The theoretical combined trust funds will exhaust their reserves by 2034, when today’s 54-year-olds reach the full retirement age and today’s youngest retirees turn 75. Upon insolvency, all beneficiaries will face a 22% across-the-board benefit cut,” says a detailed analysis released by the Washington, DC-based Committee for a Responsible Federal Budget (CRFB), a non-partisan, nonprofit organization committee that addresses federal budget and fiscal issues.

According to this year’s Medicare Trustee’s report, there was no change from last year’s projections that noted Medicare Hospital Insurance trust funds would be deleted in 2026. If this occurs, physicians, acute care facilities and nursing homes would not receive their full compensation of the program (only 91% of scheduled payments), pushing the uncompensated costs on the patients to pay.

Total Medicare expenditures are projected to increase in the future at a faster pace than both total workers’ earnings and the overall economy, says the newly released Medicare Trustee report.

In light of the projected insolvency of Social Security, this year’s Trustee’s report notes that beneficiaries may receive an estimated 3.1% cost-of-living adjustment (COLA) for benefits in 2021, the highest COLA in a decade. This large increase was triggered by higher inflation rates caused by the ongoing pandemic.

Beltway Insiders Respond

“The Trustees’ projections in this year’s report include the best estimates of the effects of the COVID-19 pandemic on the Social Security program,” said Kilolo Kijakazi, Acting Commissioner of Social Security. “The pandemic and its economic impact have had an effect on Social Security’s Trust Funds, and the future course of the pandemic is still uncertain. Yet, Social Security will continue to play a critical role in the lives of 65 million beneficiaries and 176 million workers and their families during 2021.”

“The Trustees Report confirms that Social Security’s financing is strong in the near-term yet underscores why it is so important that Congress take action now to prevent 22% in cuts across the board on all benefits in 2034,” says House Ways and Means Social Security Subcommittee Chairman John B. Larson (D-CT) in a released statement. “With the loss of traditional pensions, rising health care costs, and many people unable to save enough for retirement, there is a growing retirement crisis. 65 million Americans currently rely on Social Security benefits, yet millions are suffering and can’t make ends meet, adds Larson.

Furthermore, the Trustees Report shows that this year the cost of paying out benefits will exceed the income from the Federal Insurance Contribution Act (FICA) payments,” states Larson.

The released 2021Trustee reports on the financial solvency of Medicare and Social Security trust funds once again identify unsustainable benefit promises in Medicare and Social Security programs, stated senator Mike Crapo (R-Idaho) said in a released statement.

 “The Hospital Insurance trust fund [Medicare] is projected to be exhausted around 2026; there are $60 trillion of unfunded liabilities in Social Security programs; and unfunded liabilities increased by trillions of dollars over the last year alone,” adds Crapo.

Crapo urges Congress and the White House to “work closely together with a sense of urgency to address the challenges detailed in the Social Security and Medicare Trustees Reports. However, “most Democrats want only to expand benefit promises further without generating sustainable trust fund solvency,” he said.

Seniors Depend on Social Security on Most of Their Income

“There is no need to sound the alarm, but now is the time to address Social Security’s long-term solvency – and provide an overdue boost in benefits. Phone calls and emails to Congress are definitely warranted at this critical juncture,” says Max Richtman, President and CEO of the Washington, DC-based National Committee to Preserve Social Security and Medicare, responding to the Social Security Trustee Report released August 31.

According to Richtman, Social Security has never missed a benefit payment in its 86-year history, but remains strong. Even if no Congressional action is taken and the Trust fund becomes deleted, Social Security could still pay 79% of the benefits with revenue coming from regular worker’s payroll contributions. “But that poses a huge financial risk for the millions of retirees who depend on Social Security for most if not all of their income.  It also raises a serious political risk for members of Congress who fail to boost the program’s finances so that the trust fund remains solvent beyond 2034,” he says. 

Living on an average monthly benefit of $1,540 is tough to do, says Richtman, as retirement savings dwindle, pensions disappear and the soaring cost of senior housing and medical care.  

Nancy Altman, President of Social Security Works (SSW) and chair of the Strengthen Social Security Coalition, agrees with Richtman’s assessment of Social Security’s fiscal solvency and impact on the retiree’s income. “Today’s report shows that Social Security remains strong and continues to work well, despite the once-in-a-century pandemic. That this year’s projections are so similar to last year’s proves once again that our Social Security system is built to withstand times of crisis, providing a source of certainty in uncertain times,” she says.

“We don’t have a Social Security crisis, but we do have a retirement income crisis — made worse by the pandemic, which, among other economic impacts, forced millions of workers to retire earlier than planned. The solution is to expand Social Security, as President Joe Biden has promised to do,” suggests Altman.

According to SSW, “about one out of two married senior beneficiaries and seven out of 10 unmarried senior beneficiaries and almost one out of tow unmarried beneficiaries rely on Social Security for virtually all their income.”

Mustering the Political Will 

Richtman calls for Congress to closely look at Congressman John Larson (D-CT) legislation to fix and expand the nation’s ailing Social Security program. “For over six years, Congressman John Larson has been driving efforts to strengthen Social Security by adjusting the payroll wage cap so that high income earners begin paying their fair share,” he notes.

Larson has also proposed an across-the-board boost for all retirees, enhanced benefits for the most vulnerable seniors, and a more accurate formula for calculating annual cost-of-living adjustments (COLAs) so that benefits truly keep pace with inflation, says Richtman, noting that the Connecticut Congressman’s  proposals also align with President Biden’s initiatives to strengthen and expand Social Security. 

“Of course, the default response from conservatives will be to suggest, indirectly or otherwise that Social Security benefits must be cut to address the program’s funding shortfall,” states Richtman said. “Some will insist that Social Security be privatized, which would gamble workers’ hard-earned retirement benefits on Wall Street. Meanwhile, conservatives likely will oppose common sense revenue-side measures that would actually boost benefits, including Rep. Larson’s proposed adjustment of the payroll wage cap.”  For Congress to act to advance legislation to strengthen and expand Social Security, voters must put political pressure on their elected officials “to muster the political will to get it done,” says Richtman.

A Final Note…

It’s better to make changes to ensure Social Security’s solvency now, rather than waiting, suggests CRFB, a delay only adds more costs to fixing trust fund shortfalls in a timely fashion.“ Acting now allows more policy options, lets policymakers phase in changes more gradually, and provides more time for workers to adjust their work and savings, if necessary,” the fiscal advocacy group says.

The clock is ticking. There are almost 4,500 days until the project insolvency of the Social Security trust fund. It is now time for Congress to find viable, bipartisan solutions to fixing Social Security and Medicare, once and for all. 

The 276-page 2021 Social Security Trust Fund report is available by going to https://www.ssa.gov/oact/TR/2021/tr2021.pdf.

It’s time. Staff vaccinations required for nursing homes as 10 RI facilities see new COVID cases

Published in Rhode Island News Today on August 24, 2021

With the COVID-19 Delta variant spiking across the country especially among the unvaccinated, last Wednesday, President Joe Biden announced at an afternoon address at the White House that the U.S. Department of Health and Human Services will require nursing homes to require all workers to be fully vaccinated against COVID-19 as a condition for those facilities to continue receiving federal Medicare and Medicaid funding.

According to federal data, of the 1.6 million nursing home workers across the  nation, about 540,000 — 40 percent of the work force — are unvaccinated.  

Since the spread of the Delta variant, there has been a rise in the number of COVID-19 cases, especially in those states that have low rates of vaccinated workers. Both the U.S. Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) data confirm a strong relationship between the increase of COVID-19 cases among nursing home residents and the rate of vaccination among nursing home workers.

These new emergency federal regulations, crafted  by CDC and CMS, would apply to nearly 15,000 nursing home facilities, which employ approximately 1.6 million workers and serve approximately 1.3 million nursing home residents.

Rhode Island Gov. Dan J. McKee, along with other states, has already taken a similar step to protect nursing home residents by requiring all staff to be vaccinated and the new federal mandate will ensure consistent and equitable standards throughout the country. 

At a COVID-19 update held at the state the state capitol in early August, McKee called for the new vaccine mandate (as a term of employment) to take effect on Oct. 1st.

On August 23rd, Pfizer’s vaccine was fully approved by the FDA. Approvals of Moderna, Johnson & Johnson and booster shots are expected to follow soon.

According to CMS, the new mandate is a key component of protecting the health and safety of nursing home residents and staff by ensuring that all nursing home staff receive COVID-19 vaccinations. Over the past several months, millions of vaccinations have been administered to nursing home residents and staff, and these vaccines have shown to help prevent COVID-19 and have proven to be effective against the Delta variant.

“Keeping nursing home residents and staff safe is our priority. The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death,” said CMS Administrator Chiquita Brooks-LaSure in a statement announcing the new vaccine mandate.  “We will continue to work closely with our partners at the CDC, long-term care associations, unions, and other stakeholders to advance policies that keep residents and staff safe. As we advance these new requirements, we’ll work with nursing homes to address staff and resident concerns with compassion and by following the science,” she said.

CMS says that it’s requiring all nursing home staff to be vaccinated is in keeping with the federal agency’s authority to establish requirements to ensure the health and safety of individuals receiving care from all providers and suppliers participating in the Medicare and Medicaid programs. About 62% of nursing home staff are currently vaccinated as of August 8 nationally, and vaccination among staff at the state level ranges from a high of 88% to a low of 44%. The emergence of the Delta variant in the United States has driven a rise in cases among nursing home residents from a low of 319 cases on June 27, to 2,696 cases on August 8, with many of the recent outbreaks occurring in facilities located in areas of the United States with the lowest staff vaccination rates.

Last May, CMS issued new regulations that require Long-Term Care (LTC) facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) to educate residents, clients, and staff about COVID-19 vaccination and, when available, offer a COVID-19 vaccine to these individuals. These regulations also mandate that LTC facilities report weekly COVID-19 vaccination data for residents and staff to the CDC’s National Healthcare Safety Network (NHSN).

CMS will continue to analyze vaccination data for residents and staff from the CDC’s National Healthcare Safety Network (NHSN) data as an additional method of compliance monitoring and in keeping with current practice, as well as deploy the Quality Improvement Organizations (QIOs)—operated under the Medicare Quality Improvement Program—to educate and engage nursing homes with low rates of vaccinations.

CMS strongly encourages nursing home residents and staff members to get vaccinated as the Agency undergoes the necessary steps in the rule-making process over the course of the next several weeks. CMS expects nursing home operators to act in the best interest of residents and their staff by complying with these new rules, which the Agency expects to issue next month.  CMS also expects nursing home operators to use all available resources to support employees in getting vaccinated, including employee education and vaccination clinics, as they work to meet this staff vaccination requirement.

Rhode Island Long Term Care Facilities with new cases in the last 14 days (as of 8/14/2020):

These RI nursing homes are on the RI Dept. of Health list with increased cases –

Alpine – Coventry – 5-9 cases

Avalone – Warwick – less than 5

St. Antoine – North Smithfield – less than 5

Woonsocket Health – Woonsocket – less than 5

All America Assisted Living – Warwick – less than 5

Anchor Bay – Johnston – less than 5

Smithfield Woods – Smithfield – less than 5

Sunrise House – Providence – less than 5

Bridge at Cherry Hill – Johnston – 5-9

Tockwotton – Providence – less than 5

AARP Strongly Supports Biden’s Vaccine Mandate in Nursing Homes 

In response to the Biden Administration directing all nursing homes that receive Medicare or Medicaid funds to require vaccinations for all staff, Nancy A. LeaMond, AARP Executive Vice President and Chief Advocacy & Engagement Officer, stated:  

“The Administration’s announcement today requiring vaccinations for nursing home staff is a significant step in the fight against this pandemic. Around 30% of COVID deaths have been among residents and staff in nursing homes and other long-term care facilities, even though they represent less than 1% of the population. As the new variants are emerging, facilities cannot let preventable problems be repeated. Increasing vaccination rates in nursing homes is one of the most common sense and powerful actions we can take to protect the lives of vulnerable older adults.”

The AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

Don’t Just Single Out Nursing Homes 

“We appreciate the Administration’s efforts to increase COVID-19 vaccinations in long term care. Unfortunately, this action does not go far enough. The government should not single out one provider group for mandatory vaccinations. Vaccination mandates for health care personnel should be applied to all health care settings. Without this, nursing homes face a disastrous workforce challenge,” warns Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) 

“Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents. It will make an already difficult workforce shortage even worse. The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents. We look forward to working with the Administration in the coming days to develop solutions to overcome this challenge,” says Parkinson.

The full Nursing Home COVID-19 Dashboard is available at www.aarp.org/nursinghomedashboard. For more information on how COVID is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes.