Tag Archives for Office of Healthy Aging

Hoarding and seniors: “The Consequences of Clutter” Report 

Published in RINewsToday on July 22, 2024

With the number of seniors afflicted with a hoarding disorder expected to skyrocket to over 14 million, on July 2 U.S. Sen, Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, unveiled a report putting the spotlight on its impact on older hoarders and their communities.  For seniors those consequences include health and safety risks, social isolation, eviction, and homelessness. For communities, those consequences include public health concerns, increased risk of fire, and dangers to emergency responders.

According to the report, citing the Administration for Community Living’s 2020 Profile of Older Americans, the number of seniors in the U.S. is expected to increase from about 54 million in 2019 to over 94 million in 2060. “Because hoarding disorder disproportionately impacts older adults, experts worry that aging could fuel a rise in hoarding in the coming decades,” notes the report, quoting NPR Morning Edition’s Rose Conlon. 

According to the Majority Staff of the Senate Aging Committee who wrote the report (with a whopping 270 citations), it was developed for information purposes only and does not represent the findings or recommendations formally adopted by the Committee.

Hoarding is a chronic and progressive condition

The report notes that this chronic and progressive condition impacts roughly two percent of the general population, while it affects about six percent of those over the age of 70.

“Hoarding disorder is a heartbreaking condition that is posing challenges to older adults, their families, and their communities across the country,” said Chairman Casey (D-PA) in a July 2 statement announcing his report. “The federal government has an obligation to ensure that Americans can age with dignity and this report makes clear that obligation must include doing more to address hoarding disorder,” he says.

According to Casey, the new report, “The Consequences of Clutter: How Hoarding Disorder Affects America’s Older Adults, First Responders, and Their Communities,” demonstrates the scope and severity of the challenges of this complex mental health condition and offers a path forward for how we can help people, communities, and local governments contend with this condition. 

Local communities throughout the United States are already working to address cases of hoarding disorder, including through the formation of hoarding task forces to coordinate response efforts, says

Casey’s report, noting that the local resources  available often do not correspond with the level of challenge communities are facing. 

Casey’s report issued a series of nine recommendations for how the federal government can increase support to communities that are contending with hoarding disorder, including expanding access to treatment for the condition, providing local officials with more extensive guidance and training to support afflicted individuals, and expanding the scope of tracking and research about how hoarding disorder is affecting individuals and communities nationwide.

The report compiles 55 requests for information, responses, and stakeholder statements submitted by non-profits, social services organizations as well as state and local governments to gather information to better understand the impact of hoarding in local communities. 

“Overall, the report does a good job of outlining the importance of the topic and identifies the federal and state agencies that should be involved in assessment and intervention,” says Randy O. Frost, professor emeritus of psychology at Smith College and a leading researcher on hoarding and related topics.

“Hoarding Disorder is a relatively [recognized] new disorder, having just entered the DSM in 2013. Consequently, there are not identified agencies who can claim ownership of the problem and the potential solutions.” This report legitimizes this problem for attention from these agencies, says Frost, noting that this report also highlights the fact that the prevalence of hoarding is extremely high among the elderly.

“Severe cases are sometimes life threatening for the individual and those living nearby or those called in to provide help,” adds Frost.

An Expert’s take…

According to Frost, the report covers the important issues related to hoarding, including education of the general public as well as family, friends, and people suffering with the problem. It highlights the need to train professionals in best practices for intervention. An important assumption underlying the report is that this is a problem which touches many different social service disciplines, from first responders to assisted living facilities, adult protective services, animal control, mental health, public health, child health, elder services, etc. “When a local case is identified, in current practice, it is not unusual for 4 or 5 of these agencies to be involved, often not knowing what each other are doing. Integration among these agency professionals is crucial for dealing with hoarding efficiently,” he says.

“There is a lot more that could be said about this problem, and a lot more detail could have been included regarding specific recommendations,” he said, stressing that this was not the purpose of the report. “The report was to outline the problem and point different agencies in appropriate directions moving forward. It does so and is a welcome effort from a federal agency,” he says.

Spotlight on Rhode Island

“Hoarding is a serious problem that has apparently not been adequately addressed in Rhode Island as well as in the nation as a whole,” charges long-time advocate for vulnerable and marginalized populations Susan Sweet, former associate director of the Department of Elderly Affairs, and founder of the Rhode Island Minority Elder Task Force (RIMETF).  “While it is present in all age groups, adults over 60 years have the highest level of hoarding behavior and the most risk because of diminished physical and often cognitive abilities,” she says.

“This report outlines the difficult life circumstances that elders with the problem of hoarding face.  The Rhode Island network of aging programs and advocates for older adults do not have the resources to create and implement effective remedies,” warns Sweet. “I hope that shining a light on the issue will encourage policy, funding, and attention to what is a mental health issue and a complication in physical illnesses that create obstacles in attempts to help elders afflicted with the disorder,” she says.

According to Sweet, the Ocean State is one of the few areas and the only state that has organized a Hoarding Taskforce to point the way towards effective client management, education and training of eldercare healthcare, mental health programs and social work entities.  The health and well-being of individuals and communities is greatly impacted by the fire hazards, evictions, safety issues, and other self-neglect problems that occur with hoarding behavior.

“Awareness of the prevalence of hoarding and the danger to our communities and citizens should quicken the pace of funding and support to combat this growing threat,” says Sweet.

Like Sweet, Robin Covington, a member of Rhode Island’s Hoarding Task Force, sees the value of the released Senate Aging Committee’s report on hoarding and its recommendations. “As an adult protective services caseworker I saw firsthand the implications of hoarding,” said Covington, who serves as Coalition Director of Saint Elizabeth Haven for Elder Justice. “Hoarding creates health, fire hazard and safety risks, social isolation, eviction and homelessness,” she said. 

“Often times, people who hoard don’t think they have a problem because of their attachment to their possessions, which makes it difficult to deal with”, says Covington.  Because of its behavioral aspects a person with this behavior needs clinical assistance, she notes, not just decluttering of personal items. 

Covington believes that there is a lack of programs and clinical support in place in Rhode Island to address the increasing problem of hoarding. However, the state’s Hoarding Taskforce is working on helping support case managers and providers by developing a workforce initiative to support individuals with clutter or hoarding tendencies. 

Increase funding for Case Manager interventions

But more funding must be given to Community Action Programs who subcontract with OHA to oversee Adult Protective Services. “It’s pricey to cover the costs of visits, intervention and coordination of a clean-up company,” Covington says. 

A lot of times when it is someone over 60, a report to Adult Protective Services is provided and a CAP agency case manager goes out and visits the older adult to put eyes on them and to help with an intervention like the coordination of a clean-up company, but that can be expensive, notes Covington. 

As a Licensed Clinical Social Worker for over 23 years and RIMETF’s president  Lori Brennan-Almeida has seen the negative impact of hoarding up close.  For over 20 years, she has seen RIMETF provide emergency assistance to seniors age 55 and over to pay for services to clean their apartments to avoid eviction.

“Clinical intervention is necessary to stop seniors from hoarding”, says Almeida, stressing the importance of home-based therapy. “Grief counseling may be needed because a person often forms an attachment to compensate for a personal loss,” adds Brennan-Almeida.  

“Without counseling, hoarding may well continue after the debris is gone from their apartment and the senior will just collect more items”, says Brennan-Almeida.  

Keeping tabs on hoarding

“This is our first ever hoarding report,” says Misha Linnehan, Deputy Press Secretary for Sen. Casey.  When asked if there would be a follow-up report next year, she stated: “There are currently no plans for another but it is always a possibility.” 

Kudos to Chairman Casey and the Majority Staff for putting resources, time and effort into crafting this report.  For those people in the trenches, future reports should be written and formal Senate Aging Committee hearings held to keep tabs on this growing problem and to determine if the recommendations from this first report are being implemented. 

Don’t drop the ball on this one.

RI Hoarding Task Force

Janet Spinelli and Kelly McHugh are co-chairs of the RI Hoarding Task Force which is convened through the RI Elder Mental Health and Addiction Coalition co-chaired by Chris Gadbois and Janet Spinelli. 

The RI Hoarding Task Force has two committees including the HD Task Force Toolkit Development Committee lead by Christopher Liu, an undergraduate at Brown University and the HD Task Force Website and Outreach Committee.  

Anyone interested in joining the Task Force can email RIEMHAC@gmail.com  More information and resources can be found at RIHoardingtf.ri.gov which is supported through the EOHHS Money Follows the Person Program.

For download a copy of the Senate Aging Committee’s hoarding report, go to chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.aging.senate.gov/imo/media/doc/the_consequences_of_clutter.pdf

Strengthening the Safety Net for Seniors Living in Poverty

Published in RINewsToday on July 15, 2023

A recently released U.S. Census Bureau report should send a message to Congress and spur the efforts of aging advocates to protect older Americans from financial hardship and poverty.  Some consider the “golden years” to be age 60, or 65, and over.  But it’s not so golden for millions of retirees.

According to a recently released U.S. Census Bureau’s report, “Profile of Older Adults by Poverty Status: 2021,” 8.3% of the nation’s population age 65 and over are living in poverty.    

The Census Report, released on June 25, 2024, uses data from the Survey of Income and Program Participation (SIPP), to draw a profile of the 4.7 million older adults who lived in poverty in 2021. This longitudinal survey provides comprehensive information on the dynamics of income, employment, household composition and government program participation.

Poverty in your later years

Here are a few data nuggets from the latest Census Report’s findings…

According to the report, two-thirds of older adults living in poverty in 2021 were women. Limited time in the workforce, raising children or serving as a caregiver, have decreased Social Security benefits, leading to income insecurity in their later years. Older adults living below the poverty line were more likely than those “non-poor” to have never married, says the report, noting that this limits the chance of these individuals to accumulate financial resources with a spouse or to obtain financial incentives (such as tax benefits) associated with being married.

And yes, living alone can be hazardous to your pocketbook, notes the Census report. In 2021, most older adults in poverty (62.9%) lived alone, compared to only 26.3% of those not in poverty.

In addition, among older adults in poverty who lived with at least one other person, 65.5% lived with a spouse, 29.9% lived with a child and 11.2 percent lived with a grandchild, noted the report’s findings.

A snapshot of poverty in Rhode Island

According to Maureen Maigret, Policy Advisor for the Senior Agenda Coalition of Rhode Island,” the Census Bureau released a “significant and must-read report.”  

“The data shows that almost five million older adults across the nation are living in poverty, and details how gender and social characteristics contribute to poverty status and wealth,” says Maigret. “Two-thirds of the nation’s older adults living in poverty are women, which is like the poverty profile of older adults in Rhode Island, as are the higher rates of poverty for older persons of color.

Maigret noted that a comprehensive 2014 report on RI Older Women she researched for The Women’s Fund of RI documented the high poverty rate of older women in the state – 9.7% for men and 11.3% for women. The Women’s Fund report also found about 20% of older RI adults living in poverty were more likely to be Hispanic or non-Hispanic Black. 

“Unfortunately, things have not improved,” she says, noting that the poverty rate for older Rhode Islanders has increased to 12.3% (US Census ACS 2022 estimates) which is higher than the 10.9% national poverty rate for older adults.

“Providing data on the poverty status of older adults is important for our state policymakers. It is also critical for them to understand the notable gender differences as women outnumber men in the state’s older population (56% vs 44%), have greater healthcare expenses, are more likely to live alone and need long term supports,” states the former Director of the state’s Department of Elderly Affairs (DEA), now referred to as the Office of Healthy Aging.  Older RI women also have lower Social Security benefits than men (about $5,000 less) and 37% less pension benefits, she says.

Maigret notes that most older Rhode Islanders are not wealthy with  many falling into what is termed the “forgotten middle.” A specifically, term used to describe those individuals with income not low-income enough to be on Medicaid but not enough to meet basic needs–estimated at $30,000/year for a single renter in good health (Elder Index). 

Twenty-seven percent of our older households have income below $25,000 (US Census) which is not sufficient to meet basic needs. This is why we must both improve some of the programs that can help them financially and better inform them of available benefits, she says. 

Tackling poverty in the Ocean State

According to Susan Sweet, founder of the Rhode Island Minority Elder Task Force (RIMETF) (riminorityeldertaskforce@gmail.com), a 501 © (3) nonprofit, established in 1992 after a survey found that elders from minority groups were not being serviced by aging network providers, “The survey revealed that Senior Centers, Adult Day Centers, and other state and local programs had almost no staff who were able to communicate with clients who had limited or no English language skills, and paid no attention to cultural differences in different populations,” she noted.

“While there has definitely been some improvement, most older Rhode Islanders of different cultures and/or languages must seek assistance from the few programs that are specifically directed to them,” says Sweet, a former state associate director of DEA, and advocate for seniors facing hardships and low-income difficulties.

“But they are not the majority of those who barely survive because of a lack of funds and support. Coming from all backgrounds, many poor elders are struggling to meet basic needs such as shelter, food, medicine, medical care, utilities and other necessities”, says Sweet.

“Older adult needs appear to be much worse than they were in the early 2000s. Inflation, Covid, lack of adequate housing options, as well as difficulty in accessing existing assistance programs are pushing these individuals to an existence that threatens their health and their life,” warns Sweet.

State programs that exist for the purpose of helping poor, older adults often have long application periods and stringent rules that create very little ability to respond to emergency situations,” according to Sweet.

Sweet says that RIMETF’s most extensive work is in direct assistance to poor elders for basic needs. “We provide mini-grants , generally in the range of $200 – $400, to low-income elders in dire circumstances by paying directly to providers of goods and services such as rental entities, utilities, fuel companies and gift cards for items such as food, clothing, medicine, and household goods. “Our members also assist to get people on payment plans, programs, services, and better situations that may prevent future emergencies and enable longer-term solutions,” she says.

RIMETF has no paid staff and its Board membership consists of a diverse group of health and social work representatives, program administrators, community members, Senior Center and Community Action staff members, housing specialists, and advocates from other aging programs. The older adults who need help are identified by the group’s membership and demographic information and records are kept by the organization.

The nonprofit group is funded by private foundations such as Nursing Placement Foundation, Rhode Island Foundation, Tufts, Harriet Boucher Foundation, Dexter Fund as well as municipalities including the Cities of Providence, East Providence and Pawtucket.

Both Maigret and Sweet call for more to be done by the Rhode Island lawmakers next session to strengthen the safety net for struggling older Rhode Islander’s to protect them from poverty.

“Yes, absolutely more work needs to be done,” says Maigret. ”Data from the national profile and corresponding state data provide strong evidence of the need to continue advocacy to fight for policies to ensure Rhode Islanders enjoy economic security in their older years.” 

“Policies are a necessary part of the work, but oversight and quality control of state and private programs and services is vital to ensure that actual help is available in a timely manner; currently, oversight is lacking,” says Sweet, calling for state programs and policies to be better monitored and evaluated by those who deal with poor older adults and know the hardships suffered by them.  

“The reality of increasing poverty among elders requires a grass roots understanding of the lack of support actually available to meet their needs,” says Sweet.

To get a copy of the Census Bureau’s report,  “Profile of Older Adults by Poverty Status: 2021,” go to https://www2.census.gov/library/publications/2024/demo/p70-193.pdf

To read “Older Women in Rhode Island: A Portrait, Woman’s Fund Rhode Island 2014,” go to https://wfri.org/assets/older-woman-rhode-island.pdf

The legislative wish list of Rhode Island’s groups on aging

Published in RINewsToday on April 15, 2024

The Rhode Island General Assembly’s 2024 session kicked off on Jan. 2, 2024, scheduled to adjourn on June 30, 2024.  According to LegiScan, over the last three months 2,164 bills have been thrown into the legislative hopper.

“The state budget will likely be voted upon by the House Finance Committee in late May or early June.  Then a week later it is considered by the full House of Representatives, followed by votes by the Senate Finance Committee and the full Senate, and the final step would be consideration by the Governor. That process is usually completed  by mid-June to late June because the new fiscal year begins on July 1.” says Larry Berman, who has served as House Communication Director for 22 legislative sessions.“

According to Berman, the Senate and House both focus on their priorities within their own chambers first, and once those bills pass, then discussions take place between the leadership teams of both chambers to finalize bills for passage in both chambers before sending them to the Governor.  That time period will be May, and well into June. 

Legislative Wish List

Aging advocates are pushing for their legislative agenda’s to be included in the House budget.  They also are carefully monitoring the status of bills that have been introduced, specifically those that will have an impact on programs and services delivered to older Rhode Islanders.

Maureen Maigret, Policy Advisor, of Senior Agenda Coalition of RI (SACRI) puts the passage of H 7333 and S 2399 on ita priority legislative list to assist financially struggling seniors and persons with disabilities on Medicare. “As many older adults are struggling financially, SACRI is prioritizing H7333 (by Rep. Karen Alzate) and S2399 (by Senator Sandra Cano) to expand the Medicare Savings Program eligibility up to $28,000. These bills would put more money in the pockets of lower-income persons not on Medicaid by covering the Medicare Part B premiums that amount to $2,100 a year and also help them with prescription drug costs,” she says.

To provide financial help to our many unpaid caregivers we also support S2375 (by Rep. Linda L. Ujifusa) and H7490 (by Rep. Susan Donovan) to create a state tax credit up to $1,000 for half the costs incurred to care for an older family member needing supports and S2121 (by Sen. Valarie J. Lawson) and H 7171 (by (by Rep. Joshua J Giraldo) to increase the Temporary Caregiver Insurance program from six to 12 weeks.

According to Maigret, there are a number of bills addressing housing issues that SACRI also supports including those to promote ADU development, funding for affordable senior housing and incorporating accessibility features into new housing.

H. 7062, sponsored by Rep. June S. Speakman has passed the House. This bill would boost hosing production by helping Rhode Islanders to develop  ADUs has been identified by as a high priority this year for House Speaker K. Joseph Shekarchi (D-Dist. 13, Warwick).

“In looking at the Governor’s State FY2025 budget we are advocating to add about $660,000 to the Office of Healthy Aging budget to increase funding to local communities to support local senior centers/programs to reach a level of $10 per each person age 65 and older in the city or town,” notes Maigret. SACRI calls for increased funding to implement the recommended increases for social and human services providers beyond the one-third level proposed by the Governor to help address the long wait list for accessing homecare services and provide more livable homecare staff wages. This is critical as the average private cost of home health aide services in RI is $36/hour, she notes.

“ As our industry continues to fight off the existential threats of inadequate funding and staffing shortages, our Association is staying laser focused on our homes receiving sufficient and sustainable financial reimbursements and supporting all initiatives to improve staff availability. Without substantive help from the General Assembly, we will continue to lose more homes and our ability to care for our most fragile RI citizens,” states John E. Gage, MBA, NHA, president and CEO of the Rhode Island Health Care Association. 

At AARP Rhode Island’s 2024 Legislative reception, State Director Catherine Taylor called for passage of H 7127 to provide an optional, voluntary Roth-IRA plan to the 172,000 Rhode Island employees who do not have access to a convenient, low-cost voluntary retirement savings plan through their employer.

The Secure Choice program, endorsed by Gov. Dan McKee and AARP Rhode Island, would be administered by the office of the General Treasurer, would see retirement savings accumulated in individual accounts for the exclusive benefit of the participants or their beneficiaries.  

The legislation has been referred to the House Finance Committee. A similar measure (S 2045) has been introduced in the upper chamber by Sen. Meghan E. Kallman.

According to Taylor, Secure Choice has been enacted in 18 states to date. In Connecticut, the program led to over 25,0000 workers saving over $19 million dollars in the first year of operation. These savings would not have been realized without Secure Choice.

Taylor also noted that Rhode Island is one of only 8 states that tax hard-earned Social Security benefits. “Our state tax on Social Security undermines the purpose of Social Security, which was designed to lift older adults out of poverty – not to fund state government,” she says.

AARP Rhode Island supports the efforts of Sen. Elaine Morgan (S 84) to completely eliminate the state tax on Social Security income and Sen. Walter Felag (S 246) to increase the thresholds to $ 110,000 for single, and $ 140,000 got joint filers, says Taylor.

“We would like to see the passage of S. 2556 [by Senators Lou Dipalma, Bridget Valverde, John Burke, and Pam Lauria] and H. 7493, sponsored by Rep. Scott Slater and Rep. Grace Diaz, that would establish a 20% add-on to the Medicaid per diem rate for nursing homes that have single-occupancy rooms and bathrooms,” says James Nyberg, executive director of LeadingAge RI.

According to Nyberg, there is a growing body of research that shows the benefits of single rooms on residents’ physical ad mental health and well-being, which was clearly exposed by the COVID-19 pandemic.  “There is also the simple fact that it promotes human dignity. Older Rhode Islanders should not have to share a bathroom and shower with strangers during a frail time of life,” he says.

“As for the budget, we want to ensure that the nursing home funding included in the Governor’s budget is maintained, and the Office of the Health Insurance Commissioner recommended rate increases be expedited, if possible, as well,” says Nyberg.

Just a Few More to Watch

Here is a sampling of other bills, of interest to aging advocates, thrown into the legislative hopper this legislative session:

Sen. Linda L. Ujifusa and Rep. Megan Cotter are sponsoring a bill (H 7208, S 2063) to provide relief to some of the state’s most vulnerable households by raising the eligibility limit and the maximum credit for the “circuit breaker” tax credit, which benefits low-income seniors and individuals with disabilities. The bills have been referred to their chamber’s Finance Committee.

The circuit breaker credit program provides an income tax credit to low-income Rhode Island homeowners and renters who are over 65 or disabled, equal to the amount that their property tax exceeds a certain percent of their income. That percent ranges from 3 to 6 percent, based on household income. In the case of renters, a figure representing 20 percent of their annual rent is used in the place of property tax in the calculation.   

The Senate approved S 2082, sponsored by Sen. Melissa A. Murray, to limit insured patients’ co-pays for supplies and equipment used to treat diabetes to $25 for a 30-day supply.

The legislation would apply to private insurers, health maintenance organizations, nonprofit hospital service or medical service corporations and the state employee health insurance plans that cover such supplies. Under the bill, beginning Jan. 1 (or, for state employees, the next time the health plan contract is purchased or renewed by the state), co-pays for insulin administration and glucose monitoring supplies shall be capped at $25 for a 30-day supply, or per item when an item is intended to be used for longer than 30 days.

During this legislative session, S 0089 and H 5417 were introduced by Senator Meghan Kallman and Rep. Evan P. Shanley and take their savings with them when they change jobs. The legislative proposals have been referred to the House Finance and Senate Committees for consideration.

For more details about legislation being considered by the Rhode Island General Assembly, go to https://legiscan.com/RI/legislation/2024.

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