Tag Archives for Rhode Island Foundation

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

Regulatory approval can make a belated Christmas miracle happen

Published in RINewsToday on April 8, 2024

A belated Christmas miracle may truly happen, if state and federal agencies allow the Linn Health & Rehabilitation to convert one of its floors into affordable assisted living specializing in memory and dementia care. If this happens, says the facility’s management and its Board of Trustees it will keep the East Providence-based nonprofit facility from closing, preventing the displacement of residents and staff. 

Faced with rampant inflation, rising food and utility costs, high temporary staffing agency fees, and very low state Medicaid reimbursement rates that haven’t kept pace with increasing costs in over a decade, Linn Health, established over 52 years ago, publicized its financial troubles over four months ago.   

The Best of the Best 

When the news broke about Linn Health & Rehabilitation’s financial crisis over four months ago, the facility had just been named a 2024 ‘Best Nursing Home’ and ‘High-Performing’ short-term rehabilitation home in the nation by U.S. News & World Report, states Jamie L. Sanford, LNHA, LCSW, administrator of Linn Health & Rehabilitation.

“Here we are, one of the elite nursing homes in the United States, and we are finding it difficult to stay afloat like six other homes in our local market who have gone out of business, and three others who have declared bankruptcy, and one other who recently had to downsize by 50 beds,” says Sanford.

“It’s sad that Rhode Island families who deserve an affordable 5-star nursing home like ours don’t have the option because of inadequate Medicaid reimbursement. The struggle is real,” says Sanford.

Together with Aldersbridge Communities and its volunteer Board of Trustees, Linn leaders launched a savvy PR move, calling it a “Hail Mary” effort, to find its Christmas miracle donors and funding to prevent it from closing or forcing the displacement of 71 residents and the laying off of 150 staff members. A clever twist on the message resulted in a story on Rhode Island television stations, talk radio, and pick up by other media outlets.

“Our tireless pleas for funds to keep us afloat until a slight Medicaid reimbursement rate increase is expected to take place later this year were heard, but didn’t result in us receiving any emergency gap funding. We did receive charitable contributions from generous donors in earnest, but the amount was nowhere near enough to cover our losses of $100,000 per month,” states Richard Gamache, MS, FACHCA, chief executive officer of Aldersbridge Communities. With revenues dwindling, Linn leadership came up with a solution: convert one floor of the nursing home into affordable assisted living, specializing in memory and dementia care”, he notes. 

Submitting the Application

According to Gamache, its application for recertification was submitted last month and he expects the license to be approved by the RI Department of Health soon. “Obtaining our certification so that we can bill the Centers for Medicare & Medicaid Services is a bigger obstacle, because the federal government is involved,” he says. But, it could take “one or two months to get the facility’s licensing and certification approved by the RI Department of Health and Human Services (RIDHS) and CMS.  

If approved and certified, Linn Health & Rehabilitation will operate “The Loft at Linn” – a new assisted living memory care unit featuring 22 private studio apartments on the second floor of the building. The third floor will remain a licensed nursing home, albeit smaller now with 33 beds.

According to Gamache, the RIDHS has recertified Linn residents currently receiving long-term care to qualify for assisted living-level memory care, enabling them to continue to live at Linn and have the same caregivers they are used to and know. 

Meanwhile, grant funding from the Rhode Island Foundation, the Ruby Linn Foundation, and other sources are being used to pay for the apartment renovations; and to re-educate and train certified nursing assistants to become certified medical technicians so they can remain on staff working at the assisted living memory care program.

Shifting operations to assisted living and repurposing existing nursing home rooms will keep the facility’s doors open. “It’s not enough to solve our financial woes completely, as we expect the nursing home to continue to lose money – just not as much as we have been losing,” notes Gamache. “The irony is that we will save Rhode Island over $780,000 in a year because of the difference between what they will reimburse us for assisted living, versus a skilled level of care per Medicaid resident,” Gamache calculates. 

As a whole, because we’re going from a 42-bed skilled nursing floor to a 22-bed assisted living floor, the state is going to save $2.8 million per year in Medicaid dollars,” notes Gamache.

It is not surprising that Rick Gamache, who has years of experience managing nursing facilities, might have just found a way to keep his facility open,” says Kathleen Heren, Rhode Island’s Ombudsman. If the request of recertification is approved by state and federal regulators to offer assisted living with memory care, residents won’t be displaced and workers won’t lose their jobs, says Heren.

“It was never a viable option to sell Linn Health to an out-of-state nursing facility chain,” says Heren, noting that there is a need for assisted living facilities offering memory care. “There are high functioning people affected with dementia, with no medical conditions, who do not need to be placed in a nursing facility,” she adds.

Comments from the Sideline 

Like Heren, Maureen Maigret, policy advisor for the Senior Agenda Coalition and member of the RI Advisory Council on Alzheimer’s Disease Research and Treatment, holds Gamache in high regard. By converting a floor to needed assisted living with a memory care, staff will not be displaced, so residents with memory issues will not be losing staff who know them and who they are comfortable with.

According to Maigret, many assisted living residences strictly limit residents on Medicaid. A few years back, the state changed the Medicaid reimbursement for assisted living to one with three levels of reimbursement with a higher level of reimbursement to encourage more residences to accept persons with higher needs who are on Medicaid. ”We know that RI has many persons with diagnoses of Alzheimer’s and related dementias so such memory care programs are critical for those who cannot pay privately with monthly rates often over $6,000,” says Maigret.

Maigret notes that the state’s Health Department reports that 34 assisted living residences are licensed as Special Care/Alzheimer’s residences, but it is does not show which ones accept Medicaid. “And even those that do often limit the number of residents on Medicaid as they can get higher reimbursements from private paying persons,” she says.

According to Gage, in 2024, RI’s nursing homes are being paid rates by Medicaid that are based on their 2011 actual costs under the price-based reimbursement system that was implemented in 2013. Core principles of this reimbursement methodology are the statutory annual inflation adjustments and a Medicaid rate analysis every three years to determine whether rates are reasonable and adequate. “In the vast majority of years in the past decade, RI Medicaid has slashed or eliminated inflation adjustments, and they have never conducted a rate analysis/adjustment.  As a direct result, RI nursing homes are losing $50-75/day on each resident receiving care under Medicaid,” he says.

Gage predicts that Linn and Scandinavian Home will not be the last to make the difficult choice to downsize or close. “Just since the start of the pandemic, six RI nursing homes have closed and three were in receivership. Now, two nonprofit homes are forced to downsize their facilities,” he noted. “RI nursing homes must be adequately reimbursed by Medicaid under a stable and sustainable reimbursement system, and there needs to be bold action to recruit and retain frontline healthcare workers at competitive rates,” he warns, calling for the state to preserve nursing facilities. 

Demographics show a silver tsunami on the horizon. We need to ensure that there will be capacity for those who will need short-term or long-term care and services in the coming years,” states Gage.

As far as any potential Medicaid savings resulting from the planned conversion, Gage says that Linn would only be able to accommodate 33 nursing facility residents down from its former capacity of 87. By downsizing the nursing home by 54 beds and transitioning that floor into low-income memory care assisted living for just 22 residents, there will be a savings to the state, he says. due to the combined capacity of the facility decreasing by 32 residents, and those who remain in the memory care unit will be receiving a lower level of care and assistance than that provided in a skilled nursing home.

At press time, Gamache waits for the license from RIDOH and certification from the Centers for Medicare & Medicaid Services to be approved that enables the opening of the new assisted living memory care program. 

“There is no reason while this approval shouldn’t happen,” says Gamache. “We can comply with all the regulations, we’ve identified an overwhelming community need, and we are saving the state a lot of money,” he quipped. 

“After all, this is a win/win for the state, for residents, their families and staff to enable Aldersbridge Communities continue operating a full continuum of care,” states Gamache. 

Calls for Rhode Island to become more “Age Friendly”

Published in Pawtucket Times on January 24, 2022

On Aug. 3, 2020, The Decade of Healthy Aging 2020-2030 proposal was endorsed by the 73rd World Health Assembly. It was presented to the U.N. General Assembly Dec. 14, 2020, (Resolution 75/131), leading to the proclamation of a U.N. Decade of Healthy Aging (2021-2030).

The four-page Resolution expressed concern that, despite the predictability of population aging and its accelerating pace, the world is not sufficiently prepared to respond to the rights and needs of older people. It acknowledges that the aging of the population impacts our health systems but also many other aspects of society, including labor and financial markets and the demand for goods and services, such as education, housing, long-term care, social protection and information. It thus requires a total whole-of-society approach to make changes.

The passed Resolution called on the World Health Organization (WHO) to lead the implementation of the decade, in collaboration with the other U.N. organizations. Governments, international and regional organizations, civil society, the private sector, academia and the media are urged to actively support the decade’s goals.

According to WHO,  the world’s population is aging at a swifter pace than any time in the past and this will have an impact on all aspects of society.  There are more than 1 billion people aged 60 years or older, most of these individuals living in low- and middle-income countries. “Many do not have access to even the basic resources necessary for a life of meaning and of dignity. Many others confront multiple barriers that prevent their full participation in society,” says WHO.  

In a December 14, 2020, statement announcing the passage of Resolution 75/131, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, stated that it “sends a clear signal that it is only by working as one, within the United Nations system and with governments, civil society and the private sector that we will be able to not only add years to life, but also life to years.”

“By adopting a U.N.-wide approach in support of healthy aging, we will be able to galvanize international action to improve the lives of older people, their families and communities, both during the COVID-19 pandemic and beyond,” Dr Etienne Krug, Director of the Department of Social Determinants of Health at added World Health Organization (WHO).

The WHO says that the ongoing COVID-19 pandemic highlights the seriousness of existing gaps in policies, systems and services and a decade of concerted global action is urgently needed to ensure that older people can fulfil their potential in dignity and equality and in a healthy environment.  

WHO’s worldwide initiatives would seek to change “how we think, feel and act toward age and aging; facilitate the ability of older people to participate in and contribute to their communities and society; deliver integrated care and primary health services that are responsive to the needs of the individual; and provide access to long-term care for older people who need it.” 

Healthy Aging Baseline Data Released

Just days ago, WHO released, “Decade of Healthy Ageing: Baseline Report,” in all official U.N. languages, to support member states, academia, civil society, U.N. partners and others to aid in evidence-based decision making on the policies, programmes and services needed to support all people, in particular older persons, to live long and healthy lives.

The Baseline report, released January 20, 2021, brings together data available for measuring healthy aging, defined by WHO as “the process of developing and maintaining the functional ability that enables well-being in older age.”

According to WHO, optimizing “functional ability” is the goal of the Decade of Healthy Aging, which began in 2021 and addresses five interrelated abilities that all older people should enjoy:  the ability to meet basic needs; to continue to learn and make decisions; to be mobile; to build and maintain relationships; and to contribute to society. The report also takes a look at people’s capacities (including physical and mental) and the environments (spanning attitudes, services, natural and built) in which people live, which contribute to functional ability.

The 203-page baseline report, now available in Arabic, Chinese, English, French, Russian and Spanish, introduces the concepts of health aging and strategies for achieving the initiatives goals by 2030. It provides a first-time baseline (in 2020) for healthy aging worldwide and takes a look at what improvements that can be made by 2030.  It documents progress and scenarios for improvement. The report addresses how stakeholders can work together and impact the functional abilities of older people. Finally, it outlines next steps detailing opportunities that can increase collaboration and impact by 2023, the next reporting period.

Is Rhode Island Becoming Age Friendly?   

Maureen Maigret, policy consultant and chair of the Aging in Community Subcommittee of Rhode Island’s Long-Term Care Coordinating Council, says that many Rhode Island communities are involved to 1 degree or another in what we consider age-friendly activities. “The initiative is usually led by the local senior center and in some instances volunteer programs such as RSVP and AARP and The Village Common of RI,” she says.

According to Maigret, over the last five years the state’s Long-Term Care Coordinating Council Aging (LTCCC) in Community Subcommittee has adopted and continues to work to support WHO’s decadelong initiative, adding the domains of Food & Nutrition and Economic Security and Supports to Remain at Home.

Maigret noted that Newport was the first community to join the AARP age-friendly network; Cranston, Providence and Westerly following. The state’s Office of Healthy Aging has adopted its State Plan on Aging, calling for Rhode Island to become an age-friendly state.

Governor Dan McKee’s proposed budget for FY2023 includes an additional $200,000 for local senior programs increasing the total amount to $1 million. Maigret calls for adding an additional  $800,000 so each municipality would be allocated $10 per person aged 65 and over to support local senior programs. Advocates had promoted this since at least 2018 to make up for prior budget cuts and inflation, she says.

Don’t forget improving and expanding the state’s transportation options for older Rhode Islanders who have mobility needs and are no longer able to drive. “This could be accomplished by adding trip types to the state funded Elderly Transportation Program,” she says, noting that trips are now limited for trips to medical appointments, adult day care services, meal sites and Insight. Why not provide trips for older adults to access volunteer activities, she adds.

“We also need to adequately fund our subsidized home care programs by providing realistic reimbursement to address the huge workforce challenges we face,” warns Maigret, noting that seniors are waiting over two months to get service. “This is a travesty,” she says.

“It is tragic that the state’s Office of Healthy Aging is so under resourced in so many areas,” says Maigret, putting the spotlight on the lack of affordable home maintenance and chore services to keep people in their homes. “There is also a need to provide greater supports for our family caregivers who provide the vast majority of caregiving in our state and nation,” she adds. 

Getting Municipalities Involved

Maigret suggests that Rhode Island’s cities and towns review their community’s Comprehensive Plans to see how age-friendliness is addressed. “This is what Newport did. They can also form local Steering Committees to identify local needs and develop recommendations to address them both at the local and state level,” she says.

Governor Dan McKee can also issue an Executive Order directing all state departments and agencies to review programs and policies for age-friendliness and provide incentive funding for local communities to assess their communities. Several states have done this. NY, MA, CO, FL, MI, ME, CA, she says. 

While aging advocates pushed for McKee and lawmakers to allocate ARPA COVID-19 federal funds to make Rhode Island a more age friendly, it’s gotten little attention, says West Warwick resident Vin Marzullo. “Quite frankly its shocking — that there is yet an explicit acknowledgement that the aging community needs resources, support, more collaborative arrangements, to extend living in-place. There seems not to be any sensitivity to the fact that 90% of the COVID deaths were adults 60 and over – and 53% were in congregate care,” says Marzullo, a  well-known aging advocate who served as a federal civil rights and national service administrator.

“The ARPA funds were authorized to be used to ameliorate the impact on the populations, communities, sectors, etc. that were adversely impacted. Our older adults must be in the conversation and not neglected,” says Marzullo.

Maigret agrees. “It is tragic that neither the McKee-Matos’ “Rhode Island 2030 Plan” nor the Rhode Island Foundation report outlining the use of ARPA funds gave sufficient attention to the needs of our state’s older population, she says, warning that this population is increasing, and getting more economically insecure and diverse,” she says.

“When we look at the exceedingly high cost of residential institutional care,  much of which is paid for taxpayers through government programs, we can make a strong case that funding programs helping older persons remain healthy and living in their homes and communities are important investments,” says Maigret. 

To obtain a copy of WHO’s “Decade of Healthy Ageing: Baseline Report,” go to:

https://www.who.int/publications/i/item/9789240017900.