World issues pushed nursing home reform to the side in State of the Union. But it’s there

Published on March 7, 2022 in Rhode Island News Today

More than a week ago, President Joe Biden, with Vice President Kamala Harris and House Speaker Nancy Pelosi, sitting behind him in the House Chamber in the United States Capitol, delivered his first State of the Union Address. Harris and Pelosi made history marking the first time two women have been on the dais during a presidential address before the joint session and the American people

According to C-SPAN, Biden’s speech was the fourth-longest of the seven most recent presidents’ speeches, beating out Presidents George H.W. Bush, George H. Bush and Ronald Reagan. Amid frequent applause breaks, chanting from both sides of the aisle and heckling, Biden’s prepared remarks delivered Tuesday, March 1, 2022, totaled around 7,762 words, lasting over one hour and two minutes.

Biden spoke mostly on-script with his prepared remarks on a wide range of topics before lawmakers, Supreme Court Justices, guests, many waving small blue and yellow Ukraine flags or wearing the country’s colors to show solidarity with the people of Ukraine. While the first half touched on the Russian invasion of Ukraine and the need for a global coalition to respond, the second half addressed inflationCOVID-19 and the “new normal,” increasing domestic manufacturing, health care, prescription drugs, energy and taxes, voting rights legislation, and the nomination of Judge Ketanji Brown Jackson to the Supreme Court

Biden concluded his speech by proposing a “Unity agenda” calling for a fight against the opioid epidemic, pushing Congress to pass a mental health package, supporting Veterans returning from the battlegrounds of Iraq and Afghanistan and finding a cure for cancer.

The State of the Union and nursing homes

While Biden’s speech briefly touched on the quality of care in the nation’s nursing homes, his Administration is clearly making this a major domestic issue.  During the address, Biden expressed strong concerns about Wall Street firms that were taking over many nations’ nursing homes. “Quality in those homes has gone down and costs have gone up. That ends on my watch,” he told the packed chamber. “Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect and [they’ll be] looked at closely,” he said.

A day before the State of the Union address, the White house released a detailed document, entitled, “Fact Sheet: Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes,” outlining dozens of proposed changes on how U.S. nursing homes are regulated and operate, including a vow to adopt federal minimum staffing requirements for facilities, step up enforcement of regulations and to eliminate overcrowded patient rooms.

Amid the ongoing COVID-19 pandemic that continues to wreak havoc on the nation’s nursing homes, where 200,000 residents and workers have died from COVID-19, nearly a quarter of all COVID-19 deaths in the United States, the Biden Administration says that staffing shortages are getting worse, reducing the quality of care provided to residents

Poorly performing facilities will be held accountable for improper and unsafe care and must immediately improve their services or will be cut off from tax payor dollars. Biden calls for better information to be provided to the public to assist them in better understanding the conditions they will find in each facility and to assist them in choosing the best care options available.  

Centers for Medicare & Medicaid Services (CMS) will begin to explore ways to reduce resident room crowding in nursing homes by phasing out rooms with three or more residents and promoting private, single occupancy rooms. Multi-occupancy rooms increase the risk of the spread of infectious diseases, including COVID-19.  The agency will also establish a minimum nursing home staffing requirement, the adequacy of staffing is closely linked to quality of care provided.

Meanwhile, CMS also plans to strengthen the Medicare Skilled Nursing Facility Value-Based Purchasing Program and base payment on staffing adequacy (including over weekends) and retention and the resident experience.  Although the nation has seen a dramatic decrease in the use of antipsychotic drugs in nursing homes in recent years, CMS will continue its efforts to identify problematic diagnoses and bring down “inappropriate use” of such drugs.

Enhancing accountability and oversight

The Biden Administration calls for the enhancing and accountability and oversight of the nation’s nursing homes by adequately funding inspection activities, beefing up scrutiny on more of the poorest facility performers, expanding financial penalties and other enforcement sanctions, and increasing the accountability for chain owners whose facilities provide substandard care. CMS will work with nursing homes to improve care by providing technical assistance.

To enhance transparency, CMS will create a new database that will track and identify owners and operators across states to highlight previous problems with promoting resident health and safety.  The agency will also collect and publicly report data on corporate nursing home ownership and will enhance the Nursing Home Care website. Finally, CMS will examine the role that private equity investors play in the nursing home sector.

Biden’s nursing home reforms will ensure that every nursing home has a sufficient number of adequately trained staff to provide care to the 1.4 million residents residing in over 15,500 Medicare and Medicaid facilities across the nation.  Nursing home staff turnover can be reduced by creating pathways to good-paying jobs along with ensuring staff to join a union.  CMS calls for lowering financial barriers to Nurse Assistant Training, adequate compensation and access to a realistic career ladder. The agency launches a National Nursing Career Pathways Campaign with partners including the Department of Labor.

Finally, Biden puts together his strategy to ensure emergency preparedness in nursing homes during the ongoing pandemic.  He calls for continued COVID-19 testing in nursing homes and continued COVID-19 vaccinations and boosters to be provided to residents and staff. CMS will strengthen requirements for on-site infection prevention, and make changes to its emergency preparedness requirements,   Finally, the agency will take what it has learned during the pandemic and integrate new lessons on standards of care into nursing home requirements around fire safety, infection control, and other areas, using an equity lens.

Point/Counter Point

In a released statement after Biden’s State of the Union address, AARP CEO Jo Ann Jenkins stated: We were also encouraged to hear the President describe new actions to ensure that residents in nursing homes will receive the safe, high-quality care they deserve. For yearsAARP and AARP Foundation have sounded the alarm about problems in America’s nursing homes. The COVID-19 pandemic exposed the chronic, ongoing issues with our long-term care system and emphasized the need for reform. It is a national disgrace that more than 200,000 residents and staff in nursing homes and other long-term care facilities died. AARP urges the federal government to act swiftly to ensure minimum staffing standards, increase transparency, and hold nursing homes accountable when they do not provide quality care.”

On the other hand, the nursing home industry had its views as to Biden’s call for nursing home reforms.  “The nursing home profession has always been committed to improving the quality of care our residents receive, and we appreciate the Biden Administration joining us in this ongoing effort. Over the last decade and prior to the pandemic, the sector made dramatic improvements. Fewer people were returning to the hospital, staff were providing more one-on-one care than ever before, and the unnecessary use of antipsychotic medications significantly declined,” said Mark Parkinson president and CEO of AHCA, in a released statement.

“Those who continue to criticize the nursing home sector are the same people who refuse to prioritize our residents and staff for resources that will help save and improve lives,” noted Parkinson, whose Washington, DC-based nonprofit organization represents more than 14,000 nursing homes and long-term care facilities across the nation. “Additional oversight without corresponding assistance will not improve resident care. To make real improvements, we need policymakers to prioritize investing in this chronically underfunded health care sector and support providers’ improvement on the metrics that matter for residents,” he said.

It’s time to stop blaming nursing homes for a once-in-a-century pandemic that uniquely targeted our residents and vilifying the heroic caregivers who did everything they could to protect the residents they have come to know as family,” said Parkinson. ““Long term care was already dealing with a workforce shortage prior to COVID, and the pandemic exacerbated the crisis. We would love to hire more nurses and nurse aides to support the increasing needs of our residents. However, we cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers,” he said.  

To read the White House Fact Sheet to improving the quality of care in the nation’s nursing homes, go to:

https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/

On Monday, March 7th at 9am, AARP Rhode Island and US Senators Reed and Whitehouse will speak on the need for lower prescription drug prices in a virtual press conference.

AARP Rhode Island State Director Catherine Taylor, Volunteer State President Marcus Mitchell and Volunteer Lead Federal Liaison Dr. Phil Zarlengo will join Rhode Island US Senators Jack Reed and Sheldon Whitehouse for a virtual news conference highlighting the need for Congress to lower prescription drug prices. AARP Rhode Island will present the Senators with a petition signed by more than16,000 Rhode Islanders calling for Congress to act now and stop unfair drug prices.

You can listen in via ZOOM at:  

https://aarp-org.zoom.us/j/98668832992?pwd=bktuTjJBMUZhUDRaVDkvN2dCSXZqUT09

Passcode: 618357

Participants will respond to on-topic media questions posted in chat.

More information about AARP’s Fair Drug Prices campaign can be found at aarp.org/rx.

Senator Bob Dole’s legacy – putting nation over politics

Politician, War Hero, Senator Bob Dole Dies at 98

Published on December 7, 2021 in RINewsToday

Bob Dole a seriously wounded World War II hero, a Kansas politician who served in the House from 1961 to 1969 and the U.S. Senate from 1969 until 1996, who unsuccessfully ran as the Republican candidate against Bill Clinton for President in 1996, dies at age 98, after a long illness.  

According to the Elizabeth Dole Foundation, Senator Robert J. Dole died in his sleep on early Sunday morning.  While no cause of death was reported the former Senator was diagnosed with stage 4 lung cancer last February.  While funeral arrangements have not been announced, House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer announced that Dole, one of the longest serving Republicans in the Senate’s history who served as Senate Majority leader from 1985 to 1987 and from 1995 to 1996, will lie in state in the United States Rotunda on Thursday, Dec. 9, 2021.  A formal arrival and departure ceremony will be held on Thursday morning.  Dole will join just 34 others, including government officials and military officers, who have had this honor in the U.S. Capitol since 1852.

“Putting his life on the line to defend our nation, he was awarded two Purple Hearts for his valor and sacrifice on the battlefield – and, when he came home, served as an inspiration to millions of Americans living with disabilities.  From the Well of the House to the Floor of the Senate, as a presidential candidate and as an elder statesman, he was one of the foremost advocates for our servicemembers, veterans and military families,” stated Pelosi, in a statement announcing Dole being given the nation’s highest honor to lie in state in the Capitol.   

“Senator Dole exemplified the Greatest Generation, and while I never had the pleasure of serving in the Senate with him, his reputation and his achievements, and most of all his character proceeded him, said Senate Majority Leader Chuck Schumer. “I always admired his steadfast advocacy for Americans with disabilities, and his love for this country,” he added.

Adds Senate Republican Leader Mitch McConnell, “Whatever their politics, anyone who saw Bob Dole in action had to admire his character and his profound patriotism. Those of us who were lucky to know Bob well ourselves admired him even more. A bright light of patriotic good cheer burned all the way from Bob’s teenage combat heroics, through his whole career in Washington, and through the years since.”

Fixing Social Security

Back in the late 1970s, President Ronald Reagan reacted to Social Security’s short-and long-term financing crisis funding crisis by charging the National Commission on Social Security Reform (NCSSR), chaired by Alan Greenspan, by making recommendations on strengthening the program’s financial viability to Congress.

There were NCSSR members of the bipartisan Commission who did not believe there was an impending fiscal crisis, believing that it was being politically blown out of proportion.  Like today, there were philosophical differences in how to keep Social Security solvent.  

The political polarization that resulted in hammering out recommendations kept the NCSSR from making its original deadline to issue its report. Reagan was forced to extend the life of the Commission, and this ultimately gave time for the 15 members to reach a compromise.

However, even with the NCSSR compromise, there was still political gridlock in Congress as to how to fix Social Security. But a chance reading of Dole’s article on Social Security published in the January 3, 1983 issue of the New York Times, brought Senator Patrick Moynihan (D-NY) together on the Senate floor with the Kansas Senator. Ultimately it was these two seasoned Senators who put political differences aside to draft a bipartisan compromise to allow the passage of NCSSR’s recommendations, including taxation of Social Security benefits and increasing the retirement age for receiving full benefits.

Dole and Moynihan’s “Gang of Seven”, including three NCSSR members and two Reagan advisors, came up with a politically acceptable time frame of payroll tax increases and spending reforms that both the Democrats and Republicans could accept. Meeting outside the halls of Congress, the so-called “Gang of Seven,” Dole, Moynihan, three other members of the Greenspan Commission and two Reagan advisors, came up with a timetable of payroll tax increases and spending reforms that legislators of both parties could accept. On April 20, 1983, President Reagan signed the Social Security reform into law. 

Reaching Across the Aisle

In a statement, President Joe Biden noted that even though he and Dole often disagreed on issues during his time in the Senate, “he never hesitated to work with me or other Democrats when it mattered most.”

“He and Ted Kennedy came together to turn Bob’s lifelong cause into the Americans with Disabilities Act — granting tens of millions of Americans lives of greater dignity,” said Biden.

“When he managed the bill to create a federal holiday in the name of Martin Luther King, Jr. — a bill that many in his own caucus opposed — I will never forget what he said to our colleagues: “No first-class democracy can treat people like second-class citizens,” noted Biden.

Finally, Biden noted Dole’s support of  another bipartisan effort, the McGovern-Dole International Food for Education and Child Nutrition Program. This initiative provided school meals and food for nursing mothers and young children. “It saved the lives of countless young people who would otherwise have died in infancy — and brought dignity to tens of millions of families at home and abroad. This work, for Bob, was about more than passing laws. It was written on his heart,” said Biden.

Known for his integrity and trustworthiness, this statesman, war veteran, patriot, knew how to work across the aisle to pass Senate bills that would help seniors, the disabled, and the needy, oftentimes in opposition to his caucus. He put the nation first above politics.

Hopefully, Congress can clearly see Dole’s political legacy of being bipartisan in legislating.  It’s not too late.   

House Bill to Expand, Strengthen Social Security

Published in Woosocket Call on February 3, 2019

With the 116th Congress kicking off on January 3, 2019 and the Democrats seizing control of the House, it did not take long for a bill to emerge that would strengthen and expand the nation’s Social Security program. Seven years ago, when U.S. Congressman John Larson (D-CT) first introduced the Social Security 2100 Act during the 113th Congress, the GOP controlled Congress blocked a fair hearing and vote. Now, with a Democratic majority in the House Larson’s Social Security proposal will finally get a thorough review as Democrats take control of the House Ways and Means, Energy and Commerce, and Education and Labor. These committees have oversight of Social Security.

Larson chose to throw the bill into legislative hopper on the 137th anniversary of President Franklin D. Roosevelt’s birth, who signed Social Security into law in 1935.

On January 30, 2019, Larson, recently appointed to chair of the House Ways and Means subcommittee on Social Security, introduced H.R.860, the Social Security Act 2100 Act, with over 202 House Democrats cosponsors (including Rhode Island Representatives David N. Cicilline and James R. Langevin), to ensure the retirement security of working Americans for another century.

Passage of the Social Security 2100 Act only requires a simple majority vote of 218 lawmakers. With 235 Democratic lawmakers sitting in this chamber, it is expected to pass. But, with the Senate-controlled by Republican Majority Leader Mitch McConnell of Kentucky and his GOP caucus, it will be difficult for Senators Chris Van Hollen (D-MD) and Richard Blumenthal (D-CT) to see their companion measure make it to the Senate floor for a vote.

H.R. 860’s eight provisions expand benefits for 62 million Social Security beneficiaries. It would provide an across-the-board benefit increase for current and new beneficiaries that is the equivalent of 2 percent of the average benefit. It also calls for an improved cost-of-living adjustment (COLA), through adopting a CPI-E formula, that takes into account the true costs (include health care expenses) incurred by seniors and a stronger minimum benefit set at 25 percent above the poverty line, tied to their wage levels to ensure that the minimum benefit does not fall behind. Finally, the bill would ensure that any increase in benefits from the bill do not result in a reduction in SSI benefits or loss of eligibility for Medicaid or Children’s Health Insurance Program. Finally, 12 million Social Security recipients will receive a tax cut through the eliminating the tax on their benefits.

Increasing the Financial Solvency of Social Security

According to an independent analysis of the Social Security’s Office of the Chief Actuary, H.R. 860 proposal would also strengthen and protect the Trust Funds by 75 years.

H.R. 860 would have wealthy individuals pay the same rate as everyone else. Presently, payroll taxes are not collected on wages over $132,900.
Larson’s legislation would apply the payroll tax to wages of $400,000, affecting the top 0.4% of wage earners. The bill gradually phases in an increase in the pay roll contribution rate beginning in 2020, of 50 cents per week, so that by 2043 workers and employers would pay 7.4 percent instead of 6.2 percent. Finally, the bill’s provisions would combine the Old-Age and Survivors, called Social Security, and the Disability Insurance trust funds into one Social Security Trust Fund, to ensure that all benefits will be paid.

“Social Security is a promise that after a lifetime of hard work, you should be able to retire with dignity and economic security. It’s critical that Congress preserve and strengthen this promise for years to come,” said Cicilline, who serves as Chair of the Democratic Policy and Communications Committee, representing Rhode Island’s 1st congressional district.

Larson, recently appointed chair of the House Ways and Means Subcommittee on Social Security, noted, “With 10,000 baby boomers becoming eligible for Social Security every day, the time to act is now. The Social Security 2100 Act will provide economic security not just for today’s seniors but for future generations too,” said Larson, as the bill was thrown into the legislative hopper.”

There have not been any significant adjustments to Social Security since 1983, when Tip O’Neill was Speaker and Ronald Reagan was President, said Larson. “It’s time for Congress and the President to come together again, just like Speaker O’Neill and President Reagan did to make this a reality, he said.

“For years, fiscal hawks have told us that the only way to ‘save’ Social Security is to cut benefits for future retirees. Congressman Larson’s bill is a resounding rebuke to those claims. The Social Security Act 2100 keeps the program financially sound for most of this century while boosting benefits for millions of beneficiaries,” said Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare.

Richtman says, “Congressman Larson has promised that, for the first time, this legislation will receive thorough consideration in the U.S. House, including hearings with testimony from experts and the public. We applaud him for his vision, persistence, and advocacy on behalf of America’s current and future retirees in moving this bill forward.”

Today, more than 222,000 Rhode Islanders receive Social Security benefits today. It is the most important retirement income for 4 out of 5 seniors and provides financial protections to disabled workers and families who have lost a breadwinner.

For decades, GOP lawmakers pushed its Social Security reforms by privatization, raising the retirement eligibility age and imposing stingier COLA formulas. But, national poll after poll, across party lines and age groups, revealed the public’s strong support for the nation’s retirement program.

Washington Insiders expect Larson’s Social Security bill to pass the House. While GOP Senate leadership keeps the companion measure at arms-length, the upcoming 2020 elections may well grease the legislative wheels for passage. Over 20 Republican Senate, whose seats are at serious risk, may well vote for passage with Democratic Senators.
Stay tuned…