Tag Archives for Nursing Homes

Seniors Held Their Ground During Legislative Session

Published in Pawtucket Times on July 16, 2001

As the dust settles with the aftermath of the 2001 General Assembly session, senior advocates and providers held their ground with the state legislature allocating small funding increases in some existing programs, but no major expansions or new programs were implemented.

More than 2,500 bills were introduced during the 2001 General Assembly session, with lawmakers considering a small handful of proposals that specifically targeted senior programs and services.

Pawtucket Rep. Antonio J. Pires, who heads the House Finance Committee, gives his take to The Times on the session as it related to older Rhode Islanders.

During this year’s legislative session senior advocates called on the General Assembly to consider increased funding for Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE).

Recognizing the high cost of prescription drugs and its adverse impact on the elderly, lawmakers ratcheted up the $10.3 million RIPAE program by $ 2 million. With the passage of the state’s Fiscal Year 2002 budget, the size of a large phone book, lawmakers appropriated a 20 percent increase to support the RIPAE program, stated Pires.

The General Assembly expanded the drug formulary lists of drugs to include prescription drugs to treat osteoporosis,” Rep. Pires noted. Additionally, he added that the state’s budget now provides 100 percent of covered drug costs incurred once the program’s poorest clients spend more than $ 1,500 in coo-payments in a year.

While senior advocates had pushed for more drugs to be covered by RIPAE drug formulary, Pires stated, “We can’t afford to pay for an o pen formulary program yet because of budgetary limitations.” In next year’s legislative session, when more state monies are available, coverage for gastrointestinal drugs will seriously be considered, he added.

“It’s a trade-off,” Pires said, in explaining why lawmakers choose not to add drugs to the RIPAE formulary list but rather to increase the eligibility income limits to allow an estimated 3,l50 seniors and disabled persons to participate in the state’s Medical Assistance Program. This program pays for nursing home care for low-income eligible seniors. The enacted state budget included $ 1.8 million from all sources of funds, including $ 857,485 in general revenues to increase the eligibility income for those who are 65 years old or disabled. Now individual income limits increased from $ 576 to $  686 per month, he said, noting that income limits for couples also increased from $ 889 to $ 921 per month.

According to Pires, the Fiscal 2002 State budget also includes $ 85,000 to continue funding the state’s elder guardianship program enacted last year. “The program brings volunteer guardians to assist frail elderly who are cognitively impaired and without families or friends in decision making,” he said. This year’s funding would allow a full-tie coordinator to be hired who will recruit and train the volunteer guardians. Ultimately, the funding would also allow the program to be phased in statewide over a three-year period, he said.

“We also continue to fund the state’s Elder Information Network Program,” Pires added, noting that the FY 2002 budget includes $ 425,000, a $ 12,300 increase over last year’s budget. Funding for this program provides grants to 15 community-based agencies to employe specialists to link information and services across the state.

This session Rhode Island lawmakers also moved to soften the blow of federal cutbacks to RIPTA by providing an additional $ 2.5 million to the state’s transportation agency. “RIPTA found itself in need of cutting routes to balance it’s budget,” Pires stated, noting that the General Assembly responded to the federal cuts by appropriating one-half cent of the state’s gasoline tax to help the agency keep its exiting bus routes.

“RIPTA may have to make some adjustments to their bus routs but not to the extent that they had fared,” Pires said. Ensuring that buses continue to run throughout the state are important because this mode of transportation provides older riders their mobility and independence, he said.

Finally, on the heel of calls by the nursing home industry and senior advocates, Pires noted that the General Assembly allocated $ 4.5 million with a $ 4.5 million federal match, to provide higher salaries for certified nursing assistants to keep them in their profession.

While nursing home providers did not get the $ 14.1 million, they requested, the 2002 state budget called for a funded study to develop a new plan on how nursing homes would be funded, Pires said. “We anticipate that the modern payment principles that will be developed will ensure continued quality of care for the elders in facilities,” he added.

But the funding allocated by the General Assembly to alleviate the direct care staff shortage and a study to develop a new payment methodology still leaves many nursing home providers and senior advocates seriously concerned about the direction of quality care with the inadequate paid to a shrinking work force.

Based on an independent study, providers found that last year health care worker turnover approached 92 percent in Rhode Island facilities due to low wages in relation to the work performed, stated Hugh Hall, chair of the  Direct Care Staffing Coalition and administrator of Cherry Hill Manor.

Hall noted that certified nursing assistants must complete 125 hours of training followed by a state licensing exam, both written and practical, to perform this type of work. These workers have found they can make as much or more working in local retail establishments than in nursing facilities, he says.

While nursing home providers appreciate the funding that the legislature has approved, it doesn’t go far enough, says Hugh, to address the inadequate wages that the state is funding for direct care workers. “The state continues to cut the same size of the pie for an ever-increasing aging population,” he noted.

In response to those seeking better funded programs this year, Pires stated, “We had limited resources to expend so there wasn’t a lot of new programming this year but quality of life and independence remains my top priority as chairman of the House Finance Committee.” The eight-term Democrat noted that this year’s focus was to ensure that the existing level of senior services would not be cut but maintained with some incremental expansion.

Medical Staff Shortage Hits Nursing Homes

Published in the Pawtucket Times on April 2, 2001

In 2001, a crisis is looming in how we care for the frail elderly in nursing homes throughout the state.

Both nursing home providers and long-term care advocates are working together to publicize this tragic crisis, a shortage and turnover of certified nursing assistants in the state.

High job turnover rate of certified nursing assistants is drastically impacting the quality of care provided in both nursing homes and home health agencies.

And this direct care staffing shortage is also financially hurting facilities, too, reducing their financial stability.

According to Hugh Hall, nursing home administrator and Chairman of the Nursing Home direct Care Staffing Task Force, testifying at the hearing at the General Assembly, vacancy rates for certified nursing assistants, in nursing facilities has reached 21 percent with turnover skyrocketing to over 82 percent.

With these startling statistics, this staffing problem must be on the radar screen of Governor Almond’s policy staff, state legislators and state officials. If not, we’re edging closer to a quality care disaster in nursing homes.

Nursing home administrators live with a staffing shortage every day, most are forced to temporarily hire certified nursing assistants from nursing pools at the rate of $ 23.50 an hour.

Quick fixes, like relying on nursing pools, are quickly chipping away at the facility’s financial stability. And the state’s Medicaid program drastically under reimburses for these staffing costs.

Every day, it takes compassion, ongoing training and continuing education, physical and emotional endurance and perhaps a sense of humor for certified nursing assistants to care for frail elderly nursing home residents.

But, like in many professions, money talks.  With an average starting wage of $ 7.69, large numbers are now beginning to walk away from the long-term care field. Yes, its obviously easier and less stressful to work at a fast-food restaurant. One has employment options especially when the local newspapers are filled with help wanted ads. This is reflected by the testimony of a concerned Hugh Hall who recently stated at the members budget hearing of the Department of Human Services that only half of the 26,000 licensed certified nursing assistants in Rhode Island are currently working in the long-term care field.

Like other states, the percentage of Rhode Islanders who are over 65, age 75, and even age 85, who require increased skilled nursing and medical are rapidly growing.

The number of Rhode Island centenarians, now numbering over 200 is expected to dramatically increase too. Moreover, the growth of the over 85 population, who will require more services and supports from certified nursing assistants, will drastically strain the existing long-term care delivery system.

The certified nursing aide crisis impacts on family members too, states Roberta Hawkins, Rhode Island’s Ombudsman and Executive Director of the Alliance for Better Nursing Home Care.

Hawkins says, “Children, grandchildren, and aging spouses, are all worn out from making daily “feeding visits” to help short-staffed facilities ensure that loved ones receive (and eat) hot meals.” The informal helping hand is now an unpaid, but very necessary part of the facilities daily care team, she says.

With the demographic time bomb ready to explode, its time to get serious to fix this problem. Governor Almond’s proposed FY 2002 budget which allocates $ 10 million dollars across the health care continuum to address this critical shortage is an inadequate response.

Both nursing home providers and the Alliance for Better Long-Term Care, the state’s Ombudsman for the frail elderly, call for an infusion of $ 14.1 million of state funds to leverage $16 million in federal dollars to pay a living wage for direct care workers.

Increased funding is only the first step to fix this problem. Both consumer advocates and nursing home providers also see a need for a career ladder for certified nursing assistants, and increased funding for training sites for individuals to become certified nursing assistants. Some have said that a society is judged by how well it takes care of its elderly. If so, let’s  hold up states to that high standard, too. The Rhode Island General Assembly must make a commitment today’s commitment to today’s home residents for their families, and to the growing number of baby boomers who might require nursing home care in the upcoming years.