Tag Archives for Medicare

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. 

Cicilline Pushes for House Aging Committee

Published in Pawtucket Times on January 4, 2021

Yesterday, the 116th Congress came to an end, with the new Congressional session convening that day with the swearing in of lawmakers elected on Nov. 3, 2020.   Some political observers say that legislative gridlock during this Congress made it the least productive in the last fifty years.  GovTrack.us, reported that of 16,587 bills thrown into the legislative hopper, 252 became enacted laws, and 712 resolutions were passed.

During a Fox interview last February, Senate Majority Leader Mitch McConnell (R-Kentucky) candidly admitted he prevented the consideration of hundreds of bills passed by the House that were sent over to the Senate for consideration.   McConnell’s “Legislative Graveyard” created by his controlling the legislative agenda by blocking debate, markup and refusing to allow a vote on House proposed legislation, was widely reported by the media and documented in a 33-page report, “2020 Democracy Score Card,” released last September by Common Cause, a watch dog advocacy group.

The results of tomorrow’s Georgia Senate runoff will determine if the GOP can maintain legislative control of the Senate. If Senate Democratic candidates win their seats, the Senate Democratic caucus will have the majority with 50 Senate seats, with Vice President Kamala Harris having a tie breaking vote. But if McConnell, called “the Grim Reaper” by his critics, continues to maintains political control of the upper chamber, Democratic legislative proposals introduced to improve the quality of life of America’s seniors and to help those struggling to financially make ends meet, would be rejected.  

Legislative Proposals to be Reconsidered by New Congress

During the116th Congress, Washington, DC-based aging advocacy groups, including the National Committee to Preserve Social Security and Medicare (NCPSSM) , AARP, Social Security Works, Leadership Council on Aging, and National Council on Aging, pushed for passage of legislative proposals to enhance the quality of life of America’s seniors and to strengthen and expand Social Security and Medicare, to keep these programs fiscally sound.  As the new Congress begins, lawmakers might consider bringing back legislative proposals that were not enacted in the previous Congressional session because of a Republican-controlled Senate.  Here are a few legislative proposals that have some merit and I hope to see reintroduced this year:

Congressman John Larson (D-Conn.) called on Congress to finally address the Social Security “Notch” issue. By ignoring this issue, workers born in 1960 and 1961, would likely see lower Social Security retirement benefits in the future, charged NCPSSM.  Last session, Larson, who chairs the House Ways and Means Social Security Subcommittee, introduced the “Social Security COVID Correction and Equity Act,” to increase benefits for those born in 1960 and 1961 without impacting the benefits for any other beneficiary. 

Larson also introduced the “Social Security 2100 Act” to strengthen and expand Social Security.  The landmark legislation would keep the program financially healthy for more than 75 years, while boosting benefits for all retirees. Congress must work during the 117th session to protect and expand the nation’s Social Security program.

The late Maryland Congressman Elijah E. Cummings, Chair of the House Oversight Committee, introduced the “Lower Drug Costs Now Act” which the House passed last session, would allow Medicare to negotiate prescription prices with Big Pharma, which would save the government and seniors nearly $350 billion in drug costs. The bill would also expand traditional Medicare by adding dental, vision, and hearing benefits. 

Additionally, a bipartisan crafted bill, the “Prescription Drug Pricing Reduction Act,” introduced by Senators Chuck Grassley (R-Iowa), and Ron Wyden (D-Ore.), was not allowed to be considered on the Senate floor by Senate Majority Leader McConnell.  According to the Congressional Budget Office, this legislation would save taxpayers $95 billion, reduce out-of-pocket spending by $72 billion and finally reduce premiums by $1 billion.

Almost three months ago, the Social Security Administration announced that approximately 70 million Americans would see a meager 1.3 percent cost of living adjustment (COLA) increase to Social Security benefits and Supplemental Security Income.  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. 

Following the announcing of the 2021 COLA, Congressman Peter DeFazio (D-Ore.), chair of the House Transportation Committee, introduced the “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. 

With COVID-19 quickly spreading throughout the nation’s nursing homes and intermediate care facilities, U.S. Senators Bob Casey (D-Pa) and Sheldon Whitehouse (D-R.I.), “The Nursing Home COVID-19 Protection and Prevention Act,” to provide needed resources to facilities to protect frail residents and staff. Residents in these facilities are among the most vulnerable because of their age and underlying medical conditions.  Days after the introduction of the Senate bill, Congressman David N. Cicilline (D-R.I.), signed on as a cosponsor of the House version.  

This legislative proposal would help states implement strategies to reduce the spread of COVID-19 in congregate settings, including through the purchase of personal protective equipment (PPE) and testing and to support nursing home workers with premium pay, overtime and other essential benefits.

New Push to Reestablish House Aging Committee

“After a lifetime of hard work, seniors should be able to enjoy their retirement years with dignity and peace of mind,” says Rhode Island’s Cicilline. “It’s the best way to secure the future of Medicare and Social Security, bring down the cost of prescription drugs, and find solutions for housing, transportation and long-term care issues that are especially important to Rhode Island seniors,” he says.

A long-time advocate for seniors, Cicilline announces in this weekly commentary his intentions of reintroducing a House resolution in the 117th Congress to reestablish the House Aging Committee

During the previous three Congressional sessions, Cicilline, representing the state’s first legislative district, introduced a House Resolution (just 245 words) to reestablish a House Permanent Select Committee on Aging. Two of the times a Republican-controlled House blocked consideration of the House Resolution. 

According to Cicilline, the House can easily create an ad hoc (temporary) select committee by just approving a simple resolution that contains language establishing the committee—giving a purpose, defining membership, and detailing other aspects.  Funding would be up to the Appropriations Committee. Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill.

The previous House Aging Committee was active from 1974 to 1993 (until it was disbanded because of budgetary issues) put the spot light on an array of senior issues including elder abuse, helped increase home care benefits for older adults and helped establish research and care centers for Alzheimer’s disease.  

Cicilline noted that a House Aging Committee would perform comprehensive studies on aging policy issues, funding priorities, and trends.  Like its predecessor, its efforts would not be limited by narrow jurisdictional boundaries of the standing committee but broadly at targeted aging policy issues, he notes.

“I look forward to working with my colleagues on both sides of the aisle to get the job done,” says Cicilline.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Updated on Jan. 4, 2021

Older Georgian Voters Key to Winning Senate Runoff Election

Published in the Pawtucket Times on December 21, 2020

Weiss Both Democrats and Republicans know that the proverbial clock is ticking.  It’s 15 days before the Georgia’s Senate runoff election scheduled for Jan. 15.   At press time, 1,336,136 registered Georgia voters have gone to the polls, says the U.S. Election Project.   The percent turnout of registered voters is 17.5 percent.    

Although Democrat presidential candidate Joe Biden beat President Trump to take the White House and the House Democrats maintain a very slim majority in their chamber, GOP Senate Majority Leader Mitch McConnell can still block Democratic legislative proposals by controlling the upper chamber’s agenda.  He must keep two GOP Senate seats up for grabs in next month’s U.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 the Democrat candidates Jon Ossoff and Raphael Warnoc. 

Capturing Georgia’s Senior Vote 

A new poll, released on Dec. 11 by AARP Georgia, predicts that age 50 and over voters may well bring the two Democratic Senate candidates to Capitol Hill.  Social Security, Medicare and Nursing home protections are key issues for these older voters, says the pollsters.

 The survey of 1,250 2020 Georgia voters, including 857 age 50-plus voters and an oversample of 358 Black voters age 50-plus, was conducted on behalf of AARP by the bipartisan team of Fabrizio Ward and Hart Research Associates between Nov. 30 and Dec. 4, 2020.  The telephone/cell phone poll results were published in a 11-page report, “50+ Voters and the Georgia State Runoff Elections.”   

According to AARP Georgia’s bipartisan poll, both U.S. Senate races are statistically tied, with Democrat Jon Ossoff (48 precent) narrowly leading Republican incumbent David Perdue (46 percent) and Democrat Raphael Warnock (47 percent) edging out Republican incumbent Kelly Loeffler (46 percent). But among voters age 50 and over, the poll shows both the Republican candidates lead their Democratic challenger by identical margins, 53 percent for Perdue and Loeffler versus 42 percent for Ossoff and Warnock. Just percent of the voters are undecided.

Further, the poll found majorities of Republicans and Democrats age 50 and over are more likely to vote for a candidate advocating for policies that protect older Americans, like using Medicare’s buying power to help lower drug prices. “These results show that both races are a dead heat and time is running out for candidates to address the concerns of 50-plus voters,” said AARP Georgia State Director Debra Tyler-Horton in a statement announcing the release of the poll’s results. “To win, candidates must discuss the issues that matter to 50-plus Georgians now – like preventing cuts to Social Security and Medicare, lowering drug prices and protecting seniors in nursing homes,” she says.  

Georgia’s Republican and Democratic 50-plus voters told the pollsters that they are much more or somewhat more likely to support a Senate candidate who advocates to protect Medicare (Republicans 83 percent, Democrats 96 percent) and to allow the national health insurance program to negotiate with drug companies (Republicans 93 percent, Democrats 94 percent).  The survey’s respondents also wanted Congress to protect Social Security (Republicans 90 percent. Democrats 93 percent). 

Additionally, the older survey respondents call for more protections for nursing home residents during COVID-19 (Republicans 79 percent, Democrats 95 percent).  They want Congress for providing tax credits for family caregivers to help offset costs (Republicans 69 percent, Democrats 90 percent), and support the strengthening of federal age discrimination laws (Republicans 53 percent, Democrats 81 precent). 

As to today’s COVID-19, pandemic, the AARP Georgia survey findings indicate that older Georgian’s willingness to get vaccinated against COVID-19 has increased a substantial 14 points—from 41 percent to 55 percent—since September, when over half said they would not agree to be vaccinated.  And two in five 50-plus voters told pollsters that nursing home safety is “extremely important” to them in 2020.  It’s especially important to Black voters (53 percent), people who know someone who died from COVID-19 (51 percent), and to those who worry a lot about getting COVID-19 (48 percent). 

NCPSSM to Encourage Turnout of Older Georgia Voters

Recognizing the importance of mobilizing Georgia’s older voters, the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM) announced the launching of a voter outreach campaign in the Peach State to encourage turnout and promote Democratic Senate candidates Warnock and Ossof as advocates for the state’s seniors. The campaign includes radio ads in the Atlanta market, postcard mailings to thousands of National Committee members and supporters throughout the state, and social media outreach to the Georgia’s voters.The National Committee has made a five-figure advertising buy on three Atlanta radio stations beginning December 15th through the runoff election on January 5th. 

“Only two candidates are ready to put Georgia seniors’ health and economic well-being first, Jon Ossoff and Rev. Raphael Warnock,” the radio ad tells voters.  Postcards are being mailed to more than 7,000 National Committee members in Georgia, bearing the message, “Your best future starts with your vote for John Ossoff and Raphael Warnock.”

“We need the leadership, vision and determination of Raphael Warnock and Jon Ossoff to fight for seniors in the U.S. Senate. They will work to protect Social Security and Medicare from harmful proposals to cut the benefits Georgians have earned.  They will be voices to strengthen the critical lifelines of Social Security and Medicare during the COVID pandemic, when older Georgians are counting on their earned benefits more than ever,” said Max Richtman, NCPSSM’s president and CEO.  “Georgia has 1.3 million Social Security beneficiaries and 1.8 million Medicare enrollees.  The average Social Security benefit in Georgia is $1,500 per month.  Those benefits provide $45.3 billion in annual economic stimulus to communities across the state, he notes.

While Warnock and Ossoff earned the National Committee’s endorsement by making it clear that they will standup to protect and strengthen Social Security, the incumbent GOP Senators David Perdue and Kelly Loeffler have paid lip service to protecting Social Security, says Richtman.  As U.S. Senators, they have supported GOP positions of cutting the benefits of future beneficiaries and deferring Social Security’s payroll tax last August that will force workers to repay those funds back in early 2021, he says.

Controlling the Senate’s Legislative Agenda

“Wins by Warnock and Ossoff would not only be a victory for Georgians. It would give President-elect Biden and his party the power in the U.S. Senate to actually get things done for seniors after four years of obstruction, says Richtman.

For a copy of AARP Georgia’s poll findings, go to:
https://www.aarp.org/content/dam/aarp/research/surveys_statistics/politics/2020/2020-election-battleground-states-senate-georgia-runoff-election.doi.10.26419-2Fres.00401.029.pdf