Tag Archives for Raise the Bar on Resident Care

When the dust settles. Looking back at 2024’s legislative days

Published in RINewsToday on June 24, 2024

Over a week ago, after being in session for 49 legislative days (opening day was Jan. 2, 2024), the Rhode Island General Assembly held its final session at 4pm on June 13, 2024, and ended at about 1:30am on June 14, 2024. During this year’s legislative session 1,167 bills and resolutions were introduced in the Senate, and 1,369 in the House. This total does not include Resolutions, which were  congratulatory in nature or noted prominent Rhode Island residents who have passed away.

With the dust settling at the end of this year’s session, there were 249 bills that passed both the House and Senate, and that are now sitting on Gov. Dan McKee’s desk for his signature to enact, or to pass without signature, or to be rejected.

“This was an outstanding legislative year for Rhode Island’s seniors,” observes House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick). “In addition to all the investments for seniors made in the state budget that has been signed by Governor McKee, there were excellent bills that will be of great benefit to our aging population, he says. 

Attacking the housing crisis head on

In a joint statement, the House Speaker and Senate President Dominick Ruggerio said, “It is critical to attack our housing crisis from many different angles. Allowing ADUs in other states has been proven to make a significant impact by immediately increasing available housing supply.  We are confident that ADUs will be beneficial for the many Rhode Islanders who need flexibility in housing options, particularly seniors wishing to age in place in their communities,” they say.

Shekarchi points out the enactment of ADU legislation sponsored by House Commission on Housing Affordability Chairwoman June S. Speakman (D-Dist. 68, Warren Bristol) and Sen. Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingston) that would boost the development of accessory dwelling units (ADUs), which are also known as in-law apartments. The House Speaker is the House bill’s top co-sponsor.

“I have heard from so many seniors who would like to downsize and continue to live independently, but would enjoy the extra assurance of living on the property of their children,” he noted, thanking AARP Rhode Island and housing advocates, including Rhode Island Housing, Grow Smart RI and Housing Network RI, who pushed this “significant legislation” across the finish line. 

The bills (2024-H 7062A, 2024-S 2998A) would provide homeowners statewide the right to develop a single ADU on an owner-occupied property or within the existing footprint of their structures or on any lot larger than 20,000 square feet, provided that the ADU’s design satisfies building code, size limits and infrastructure requirements.

The purpose of the bill is to encourage the development of rental units that are likely to be more affordable than many other apartments, and also to provide opportunities for homeowners with extra space to generate income that helps them maintain ownership of that property.

To ensure that the bill achieves its goal of housing Rhode Islanders, the legislation prohibits ADUs constructed under this provision from being used as short-term rentals, and streamlines the permitting process.

In the HEALTH arena

According to Senate President Dominick J. Ruggerio, several legislative proposals in the Senate’s health care package passed the General Assembly.

“Few issues are as important as health care, and right now, our health care system is in critical condition. Health care absolutely must be accessible and affordable for all Rhode Islanders,” says Ruggerio, noting that for too many people in the Ocean State is too expensive or too difficult to get. “And we know that many health care providers are feeling enormous strain due to many factors,” he adds.

“Like providers and consumers, our community hospitals, including Fatima in my district, are facing difficult circumstances,” said the Senate President, who recognized his Senate colleagues in the development of this package of legislation.

“As we celebrate our victories in the 2024 session, we are committed to continuing our work on this issue and accomplishing all the objectives of the HEALTH initiative. “

According to Ruggerio, several legislative proposals in the Senate leadership’s HEALTH (Holistic Enhancement and Access Legislation for Total Health) initiative include legislative proposals to join five interstate licensing compacts to make it easier for Rhode Islanders to access the care they need and budget provisions to use $1 million of general revenue to purchase debts of struggling Rhode Islanders and incentivize providers to enter primary care fields.

Advocates on aging give their recap of the 2024 Legislative Session

“The Senior Agenda Coalition of RI supported several housing-related bills (that did not pass) that would benefit older adults including those sponsored by Rep. Meghan Cotter (D-Dist. 39, Exeter, Richmond, and Hopkinton)  and Sen. Linda Ujifusa (D-Dist. 11, Portsmouth, Bristol) to increase the income cap for the Property Tax Relief program to $50,000 and the credit or refund to $850 to help offset the cost, of property taxes and rents for older adults and persons with disabilities,” says Maureen Maigret, Policy Advisor for the Senior Agenda Coalition of RI (SACRI), noting the Coalition plan to continue to advocate for them next year.

Maigret warned that with a growing older population the need for more accessible housing will increase and the Coalition supported and will continue to support bills to create greater accessibility in new housing.  

Maigret stated that SACRI will also continue to support legislation to create a caregiver tax credit as provided for in 2024 legislation sponsored this year by Rep. Susan Donovan and Sen. Linda Ujifusa. “Our caregivers are valued and deserve our support. A caregiver tax credit will help the many R.I. family caregivers who provide thousands of hours of care for spouses and parents often spending thousands of dollars of their own money to give their loved ones a better, more comfortable life,” she says.

She noted that SACRI also plans to build on its efforts to further expand the Medicare Savings Program to help more lower-income persons on Medicare afford needed healthcare by covering required co-pays and deductibles and to continue its work to promote quality long term care through support for staffing standards, worker training programs and Medicaid enhanced reimbursement for private rooms to help with infection control issues that became so apparent during the Covid pandemic.

SACRI will also push next legislative session to enact legislation to establish a formula for state funding to support local senior centers and programs based on a community’s population of those 65 years and over.  

Raise the Bar on Resident Care and other advocates successfully pushed the passage of H 7733 and S 2621 legislation sponsored by Rep. Scott Slater (D-Dist. 10, Providence) and Sen. Bridget Valverde (D-Dist. 35, (East Greenwich, North Kingstown, South Kingstown) that would establish the Nursing Home Work Standards Board (NWSB). According to Raise the Bar, NWSB will help stabilize the nursing home system by establishing training standards, promoting caregiver rights, depoliticizing funding allocations and implementing financial oversight of nursing homes.  A 13-member board (including frontline staff, nursing home management representatives, state government and community organizations will work with Medicaid to ensure comprehensive and informed decision-making.

“In 2023, Minnesota passed its own Nursing Home Workforce Standards Board and just voted to raise wages for caregivers to over $23 an hour in 2027 while guaranteeing 11 paid holidays. Here in Rhode Island, the Workforce Standards Board is a critical step toward transforming nursing home jobs into sustainable careers that can support a family and provide quality resident care. Now we need Governor McKee to show his support and sign this bill into law,” said Jesse Martin, Executive Vice President of SEIU 1199 New England, member of Raise the Bar on Resident Care.

Raise the Bar also advocated for the passage of the Financial Transparency Act (S 2604 | H 8204) but ultimately pulled the bill in order to re-adjust some of its language. This legislative proposal, S 2604, sponsored by Sen. Dawn Euer (D-Dist.13, Newport, Jamestown) and its companion measure, H 8204, sponsored by Rep. Matthew Dawson (D-Dist.65, East Providence) would require nursing homes to provide annual, audited financial statements that include detailed income, expenses, and cash flow, alongside transparent ownership information to prevent for-profit owners from misusing Medicaid and Medicare dollars. “We look forward to advocating for its passage in next year’s legislative session to ensure all for-profit nursing homeowners are held accountable to investing public dollars appropriately in direct care,” continued Jesse Martin. 

Advocates for Better Care in Rhode Island, a grassroots community organization founded to advocate for the rights and interests of residents of long-term care facilities in RI, celebrates the passage of S. 2263. The Long-Term Care Residents Rights Camera Bill, notes Director Kathleen Gerard. 

“The legislation gives residents of nursing homes and assisted living facilities and their legal representatives the right to install a monitoring device in their room provided all residents in the room consent. The consent can be withdrawn at any time, and a variety of safeguards exist to protect resident privacy,” says Gerard.

The legislation, S 2263 A, sponsored by Sen. Dawn Euer (D-Dist. 13, Newport, Jamestown, who chairs the Senate Committee on Judiciary and H 7969 A, sponsored by Deputy Majority Leader Jason Knight (D-Dist. 67, Barrington and Warren) has been signed by the governor and will take effect Jan. 1, 2025.  

According to Gerard, the legislation was first introduced in this form in 2021, but the care staffing crisis and massive 138% increase in serious deficiencies cited in RI long-term care facilities since 2022 made it even more urgent to finally pass it this year.

“Speaker Shekarchi worked tirelessly to reach a compromise that was acceptable to the various parties supporting and opposing the bill, and long-term care residents will consequently soon be able to have their care and condition monitored remotely by loved ones and care-partners, resulting in more peace of mind for everyone,” she says. 

“A legislative proposal we backed this year and that we hope to see enacted next year was introduced by the Rhode Island Department of Health.  The legislation, (S 2818 sponsored by Sen. Joshua Miller (D-Dist. 28, Cranston, Providence and H. 7819 sponsored by Rep. June S. Speakman), would improve financial transparency in nursing home ownership and prevent the rapid extraction of equity from facilities that we see with many private equity firms, real estate investment trusts, and investor groups,” says Gerard.

Next legislative session, Gerard says Advocates for Better Care in Rhode Island will also continue to advocate for legislation requiring assisted living facilities to support family councils.   This requirement already applies to nursing homes, she notes.

“We’ve Only Just Begun, says Sandra Paquette, representing Advocates for COLA Restoration and Pension Reform, a non-profit representing 4,700 retirees. “Our group numbers continue to increase, along with our determination and commitment, to fight for the justice which was so unnecessarily and ruthlessly taken away,” she says. .

According to Paquette, there were legislative proposals pertaining to current and future state and teaching retirees, which did not reach the floor of the House or Senate. One legislative proposal applied to those active employees whose retirement is based upon an arbitrary “rule of 95”. This translates into a calculation where the years of service and the age of those wishing to retire must add up to 95. The law would have changed this total to 90. Another one for which we strongly advocated, and for which we provided thousands of letters, verbal testimony and volunteer lobbying sessions was Pat Serpa’s (D-Dist. 27, West Warwick, Coventry and Warwick), H-8193, would have restored a compounded Cost of Living Adjustment (COLA) to all current and future retirees, and would have been enacted as of July of this year.

“Our goals for next year will remain— to advocate through testimony, letters, media and lobbying–for the passage of the two bills which will provide the now essential support to the victims of the 2011 Rhode Island Retirement Security Act,” says Paquette.

And here are specifics about other bills that impact seniors:

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.