Rhode Island General Assembly Tackles Senior Issues

Published in Pawtucket Times, July 19, 2013

At the end of June, Rhode Island lawmakers passed the state’s $8.2-billion FY 2014 state budget bill, sending it to Governor Lincoln D. Chafee’s desk for his signature. Even with $ 30 million ultimately slashed from the state’s fiscal blueprint because of lower-than-anticipated revenues, cash strapped taxpayers were happy to learn that they will not see any state tax or fee increases.

            Political correspondents in print, electronic media and in web site blogs zeroed in on specific items in the state’s enacted budget plan, those that they judged as weighty and newsworthy to be detailed to their audience.  Like the phoenix rising from the ashes, the FY 2014 state budget brought back to life the state’s historic tax credit (through the efforts of Executive Director Scott Wolf, of Grow Smart and a broad based coalition of over 100 groups), also putting dollars into workforce development, even helping the Ocean State’s burgeoning artist community by enacting a state-wide sales tax exemption on specific types of art purchased.  With the budget now signed into law, Rhode Island liquor retailers are able to compete against competitors in nearby Massachusetts because of a new 16-month trial period for tax-free wine and liquor sales.  

            One of the more controversial items in the FY 2014 state budget that fueled heated discussions on WPRO and WHJJ radio talk shows was putting funds in the state budget to pay the first installment payment of $2.5 million on the bonds issued to the now bankrupt 38 Studios. 

 

Funding Programs and Services for Seniors

            Although not widely reported in many media outlets, Rhode Island lawmakers did not turn their back on aging baby boomers or seniors.   

            The FY 2014 budget provides $1.0 million in Community Service Grants to organizations serving the elderly, including $200,000 for meals on wheels, $25,000 for Home and Hospice Care and level funding for Senior Centers across the state.

            It also consolidates funding for care for the elderly, consistent with the Integrated Care Initiative.  This initiative will coordinate care of the elderly, many of whom are eligible for both Medicare and Medicaid and who navigate disjointed payment and delivery systems.  With the state’s enacted budget, there will be a single funding and delivery system that integrates long term, acute and primary care to dually-eligible individuals.

            Also, the state’s budget plan maintains the Rhode Island Pharmaceutical Assistance to the Elderly program (RIPAE), coordinating with benefits provided through the Affordable Care Act and ensuring no gaps in coverage for low income seniors.

            It also directs funding for programs and personnel within the state’s Office of Health and Human Services to combat waste, fraud and abuse, including the new Medicaid Fraud Control Unit, to ensure Medicaid dollars return as much value for participants as possible.

            The enacted budget also establishes $80,000 for the Emergency and Public Communications Access Fund to improve emergency communication and to support emergency responder training for the deaf and hard of hearing population in the State.

TDI Expansion Becomes Law

            Meanwhile, on July 3rd, Rhode Island lawmakers approved legislation (S 231 B, 5889A), sponsored by Sen. Gayle Goldin (D-District 3, Providence) and Rep. Elaine Coderre, (D-District 60, Pawtucket) to expand temporary disability insurance to employees who must take time out of work to care for a family member or bond with a new child in their home (see my May 17 issue of the Pawtucket Times, May 19 issue of Woonsocket Call).

            Women’s Fund of Rhode Island CEO Marcia Conė and the WE Care for RI coalition, consisting of over 40 groups, brought in national politico operative, Steve Gerencser, who consulted and developed the game plan and messaging needed to get the TDI legislation passed and onto the Governor’s desk for signature.  Rhode Island becomes the third state in the nation to pass a paid family leave law.

            Signed by Democratic Governor Chafee, the new law will increase the state’s TDI program to cover up to four weeks of wage replacement for workers who take time off to care for a seriously ill child, spouse, domestic partner, parent, parent-in-law or grandparent or to bond with a new child, whether through birth, adoption or foster care. Temporary caregiver benefits would be limited to those who are the caregiver of their sick or injured family member, and the program would require documentation from a licensed health care provider.

            “The most important reason for this legislation is to provide support to help families in times of need, but it has many good ripple effects for Rhode Islanders,” noted Coderre. This includes saving on avoidable medical costs for people who will be able to stay home with a family member instead of needing to admit their family member to an expensive medical facility. It can mean that someone keeps their job.

            Adds Senator Goldin, unpaid leave isn’t always an option, and it’s a very difficult option for most families. “Paid caregiver leave is a cost-effective way to keep people from losing their jobs, jeopardizing their financial security or risking their family’s well-being when a family member needs care,” she said.

            The expansion would be funded through employee contributions, just as the rest of the TDI program is currently funded. In order to support the expanded benefits, employees would contribute another 0.075 percent of their income to TDI. For a worker earning about $40,000 a year, this would mean he or she would pay an additional 64 cents a week for the expanded benefit.

Also Becoming Law…

            Governor Chafee has also signed the Family Caregivers Support Act of 2013 passed by the Rhode Island General Assembly.    

            Aiming to improve the quality of life for the elderly and the disabled in the comfort of their own homes, an approved  legislative proposal requires the Executive Office of Health and Human Services to develop evidence-based caregiver assessments and referral tools for family caregivers providing long-term care services.

            Sponsored by Rep. Eileen S. Naughton (D-Dist. 21, Warwick) and Senate Majority Whip Maryellen Goodwin (D-Dist.1, Providence), the legislation calls for an assessment that would identify specific problems caregivers or recipients might have, carefully evaluate how those situations should be handled and come up with effective solutions.

            The legislation defines “family caregiver” as “any relative, partner, friend or neighbor who has a significant relationship with, and who provides a broad range of assistance for, an older adult” or an adult or child “with chronic or disabling conditions.” Rep. Naughton said people should be aware that there are support systems and an abundance of resources available for home care before deciding to put an elderly person in a nursing home or an expensive facility.

            Senator Goodwin added that without the proper support, the current system can place an unnecessary burden on both facilities and caregivers.

            “We want fewer individuals going into nursing homes and similar facilities if we can help it,” says Rep. Naughton. “It’s upsetting for an elderly or disabled individual to have to trade the comfort of his or her home for an unfamiliar place. Family caregivers not only know the medical needs of these individuals, but are often aware of their emotional needs, too,” she said.

            The comprehensive assessment required as part of Medicaid long-term service reform is meant to provide assistance with activities of daily living needs and would serve as a basis for development and provision of an appropriate plan for caregiver information, referral and support services. Information about available respite programs, caregiver training, education programs, support groups and community support services is required to be included as part of the plan for each family caregiver.

Addressing Long Term Care Needs

            Other approved legislative proposals, supported by the state’s nursing facility industry, were also signed by Governor Chafee.  

            Lawmakers passed and the Governor signed legislation to permit pharmacies that sell medications to nursing homes to buy them back, with a “restocking” fee.  Under the new law, medications that are individually packaged, unopened, and meet other safety requirements as determined by a pharmacist can be used rather than being discarded.

            Also signed into law were measures that promote “aging in place” and direct the state’s Department of Health to review regulations to permit this.

            Finally, the Governor signed the Palliative Care and Quality of Life Act, which establishes an advisory council and program within the Department of Health. Also, beginning in 2015, every health care facility must establish a system for identifying patients or residents who would benefit from palliative care and provide information and assistance to access such care.

             Virginia Burke, CEO and President of the Rhode Island Health Care Association (RIHCA), observed that this year’s legislative session had mixed results for nursing home residents.  Most of the bills that the group supported did pass, which “should lead to enhanced care for our residents,” she says. 

            According to Burke, “Unfortunately, providers were anticipating an adjustment to their rates this fall to address price increases in things like insurance, food, and utilities and that was taken away due to the budget deficit.  We’re very lucky that Rhode Island providers are known throughout the nation for their delivery of quality care, but quality begins to suffer when providers don’t have adequate resources to do the job.”

            This year difficult budgetary choices were made to balance the state’s budget.  Although aging advocates did not get everything they pushed for, Governor Chafee and the Rhode Island General Assembly did fund programs and services that are sorely needed by the state’s growing senior population.  I urge lawmakers to continue these efforts in the next legislative session.  

            Herb Weiss LRI ’12 is a Pawtucket-based writer who covers aging, health care and medical issues.  He can be reached at hweissri@aol.com

 

Rhode Island Families Can Benefit from Expanding State’s TDI Program

Published in Pawtucket Times, May 17, 2013

In the 2012 legislative session, it was very easy for Pawtucket Rep. Elaine A. Coderre to say yes to Sen. Rhoda E. Perry, when the Providence lawmaker came looking for a House sponsor of S 2734. Perry’s legislative proposal would amend the State’s existing Temporary Disability Insurance (TDI) program to include coverage for caregivers who care for loved ones during a health care emergency or to take time off to bond with a child.

Years before, unexpectedly being pushed into the role of caregiver would bring Coderre to become the primary sponsor of H 7862, the companion bill to S 2734. To the disappointment of the Pawtucket lawmaker and her Senate colleague, their legislative proposal would be held for further study, effectively killing it.
Understanding a Caregivers Needs

In 1997, taking care of her dying mother became time-consuming for Coderre, a part-time lawmaker who served full-time as Executive Director of the Emergency Shelter of Pawtucket. Before the onset of the terminal illness, Coderre’s 78-year-old mother had lived independently on the second floor of her daughter’s three floor tenement.

With her elderly mother quickly losing her ability to live independently, being diagnosed with fourth stage Alzheimer’s disease and fourth stage colon cancer, the fifty-year old Coderre instantly became a very stressed caregiver

For over ten months, Coderre skillfully juggled the responsibilities of working two very challenging jobs, meeting family demands, and becoming the primary caregiver to her frail mother. To provide care seven days a week, 24 hours a day, Coderre would rely on her husband, three adult children, sister and her husband, to assist.

“It was a scheduling nightmare, remembered Coderre, referring to the complexity of making sure each family member was inked in the schedule and were notified when to report for duty. “We were committed to making my mother, in her final days, feel safe, secure and to have a quality of life,” she said, noting that her family did work well together, making the care giving schedule work

Looking back, Coderre considers herself extremely fortunate because she had her immediate family and was able to hire a homemaker, to provide more of the physical care, from 9:00 a.m. to 4:00 p.m.
Supporting Temporary Caregiver Insurance

But, Coderre realized from this experience and calls from constituents that not everyone has a large network of family and friends, or adequate finances to take care of a very sick loved one, even to know where to find caregiver support services. Becoming a care giver to a frail family member, an experience that many Rhode Islanders will face during their adult life, pushed Coderre to again become the primary sponsor of House legislation to create a Temporary Caregiver Insurance Program (TCIP), for the second time around.

During the 2013 legislative session, Coderre has joined Sen. Gayle Goldin, who represents areas in Providence’s Eastside, to reintroduce companion measures in the Rhode Island General Assembly (H 5889 and S 231) to create a TCIP. The legislative proposal, modified to address opponent concerns from the last session over the length of the benefit, would expand TDI to employees who must take time out of work to care for a family member or bond with a new child in their home.

If enacted, employees would be eligible to receive up to 8 weeks of replacement income while providing care for a seriously ill family member or new child. The law would provide employees with job security by allowing them to return to work when their caregiver responsibilities have concluded. The average weekly benefit for an employee would be $408.

Like Coderre, Goldin, a first-term Senator, had her own life experience as a caregiver. Over the years she, as a family advocate, she has also talked with many parents who told her of their own children’s health needs and financial and emotional stress it created and how important this program was for them.

“Paid family leave is a cost-effective way to give employees the time to balance family and work responsibilities without jeopardizing their economic security,” said Goldin.

In the early 2000s, Goldin’s interest in research on TCIPs was piqued when the program was implemented in California. Last year, as a member of the Providence-based Women’s Fund of Rhode Island’s Policy Institute, she brought this knowledge to the table when working with seven women to get legislation introduced on Smith Hill.

At that time, out of five state’s nationwide that had TDI, like Rhode Island, identified two (California and New Jersey) allowed the program to be used by caregivers, not just those who are suffering the illness or injury themselves.

The research findings gathered from the Women’s Fund of Rhode Island’s Policy Institute would give ammunition to Sen. Perry and Coderre to push for the TDI program expansion in 2012. When Goldin took over Perry’s Senatorial seat when the long-time Providence Senator retired, she picked up the TDI cause, bringing Coderre back to the plate this legislative session, to assist her in the House.
Advocates Rally to Support

On April 11, eleven groups, including AARP Rhode
Island, the Senior Agenda coalition, Woman’s Fund of Rhode Island, the Economic Progress Institute, Rhode Island Kids Count, and the Rhode Island SEIU State Council, came before the House Finance Committee, to push for passage of H 5889.

Dr. Marcia Conè, Ph.D., CEO, of the Woman’s Fund of Rhode Island, told lawmakers that the TCIP is just an updated extension of the current TDI program that “best addresses the new health and lifestyle changes of today’s society, giving “everyone the flexibility of needed to balance the new realities of family and work responsibilities.”

To put the brakes to a “brain drain” out of the Ocean State, due to higher salaries available in bordering states, Dr. Conè stressed that H 5889 would offer what all employees need, time off to care of family business in a crisis. “The prestige of having the most family friendly work environment in New England is a very strong incentive for families to stay in the state to make Rhode Island their home,” she told the panel.

In her testimony, Executive Director Kate Brewster, of The Economic Progress Institute, stated that the state’s Parental and Family Medical Leave Act of 1987, and the Federal Family Medical Leave Act of 1993, give employees up to 13 weeks of “unpaid leave” to care for a family member or new child. “These laws protect employees’ jobs, but not their wages,” she said, observing that low-income Rhode Islanders can not afford to take unpaid time off from work, they need their wages.

Countering Brewster’s comments, submitted testimony by R. Kelly Sheridan, representing The Greater Providence Chamber of Commerce, warned that H 5889 would expand the State’s existing TDI program to allow employees time off to care for family members, when most states do not even have a TDI system. This expansion “would make Rhode Island’s business climate an outlier compared to our neighboring states and would send the wrong message to the business community regarding improving the business climate in our state,” he said.

While Matt Weldon, Assistant Director, of the State’s Department of Labor and Training, took no position on the TCIP legislative proposal, he came to answer questions. Weldon noted that there could be a .2 increase to the rate an employee is mandated to pay into TDI. Currently, the state program takes 1.2% of the first $61,400 out of an employee’s paycheck.

Maureen Maigret, Policy Consultant for the Senior Agenda Coalition of Rhode Island, told the House panel that nobody can predict when a family crisis will come, specifically “the critical illness of a child or spouse, an older person’s fall and subsequent need for care.”

Maigret estimated, for just pennies per week paid by workers – the cost of a cup of coffee — passage of H 5889, would allow workers to take temporary leave to deal with sudden critical family needs and still have some income.

With the Rhode Island General Assembly gearing up to finish the people’s legislative business by the middle of June, We Care for Rhode Island (WCRI), a grass roots coalition consisting of 32 organizations, including small business owners, workers, policy centers and family and health care advocates, was established at the end of April, to push for the passage of a Rhode Island TCIP.

Last Saturday, visiting local retail stores on Hope Street, Steve Gerencser, of WCRI, passed out literature, calling on owners to support his group’s attempts to create a TCIP in the Ocean State. “It can be a boon for businesses,” he says, citing a 2011 research study detailed on his Legislative Fact Sheet, supporting the passage of H 5889 and S 231. Gerencser notes that the findings estimate that program would save employers $89 million a year by improving employee retention and reducing turnover costs.

Goldin agrees with WCRI’s assessment a TCIP’s benefit to businesses. Moreover, she claims that there is really no impact on the State’s budget, to start up this new program. “It’s revenue-neutral and is solely funded by the employee, business owners and taxpayers do not contribute.”

With a negligible expense to implement, with no cost to the taxpayer or even the business community, it’s penny-wise and pound foolish for state lawmakers to not create a Temporary Care Giver Insurance Program, to financially assist Rhode Island employees when they take off time to help seriously ill family members or to care for newly adopted child.

Sound public policy, like this legislative proposal, can only send a clear message across the United States, that the Ocean State is finally taking steps to become more family-friendly, a great way to competitively attract large corporations and even smaller businesses into our borders.

Herb Weiss, LRI ’12, is a writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

Complete Streets Legislation Stalled in House Committee

Published May 19. 2012, Pawtucket Times

            A properly designed road system helpsolder Rhode Islanders to successfully “age in place” and stay safely and comfortably in their homes for as long as they choose. But the benefits of so-called Complete Streets design benefits people regardless of age, abilities or mode of transportation.  AARP Rhode Island has joined a broad-based coalition of 17 aging, health and transportation groups and smart growth advocates to push state policy makers into making the Ocean State’s streets, highways and byways more accessible and safer for all users. Out of 2,111 legislative proposals submitted this year for consideration by the Rhode Island General Assembly, H 7352 and S 2131, its companion measure in the Senate, would accomplish this lofty goal.

          Coalition members fear that their efforts to make sure that the state’s transportation infrastructure becomes more user friendly for all ages and abilities is in jeopardy with the House Committee on Municipal Government which has held H 7352 for further study.  While the Senate passed the companion measure (for the second year in a row) last month, this House Committee might just kill the legislation unless it can be resuscitated. 

The Details of H 7352

            The legislationwould require that whenever the state is building or modifying a road, planners and designers must consider Complete Streets design conceptsthat is, considering safe travel by all users, current and projected, particularly pedestrians and bicyclists of all ages and mobility capabilities.  Features of Complete Streetsdesign include sidewalks, paved shoulders suitable for use by bicyclists, lane striping, bicycle lanes, “share the road” signage, “road diets” (narrower lanes to discourage speeding and leave room  for pedestrians and bicyclists), roundabouts, crosswalks, pedestrian control signalization, bus pull-outs, curb cuts, raised crosswalks and ramps and traffic-calming measures.

            Meanwhile, this legislation allows common-sense exceptions, such as on interstate highways, where pedestrians and bicyclists are prohibited, and on projects where the space is too limited or costs would be disproportionate to the use such features would likely get.

            Furthermore, this legislation also requires the State’s Department of Transportation to issue a report within two years detailing what it has done to comply with the law, how it has changed its guidelines on such features as lane width, design speed and more, and what best practices the agency has employed.  It would also be required to include information on exceptions made, and why they were made.

            In a press release touting the passage of S 2131, bill sponsor, Senator Louis P. DiPalma, noted that the legislation’s goal is to plan streets that encourage people to use healthy, greener, transportation modes whenever possible, contributing in their own health as well as the wellbeing of the environment.

            “Cars shouldn’t be the only consideration when public roads are being built.  The health and environmental benefits of walking, bicycling and other active modes of transportation are well know, and we should be building our roads in ways that are safe for those activities and encourage people to choose them,” said Senator DiPalma.

Pushing for Safer Roads, Highways and Byways

            In her testimony before the House Committee on Municipal Government, AARP State Director Kathleen Connellsaid the goal of H 7352 is to direct the Department of Transportation  to plan with all users in mind.  “Making it easier for older people to get around is an obvious reason we’re involved, but Complete Streets design promotes public safety, helps revive our towns and cities and increases property value,” she said.

            Molly Clark, Manager, Health Promotion and Public Advocacy for the American Lung Association, also testifying to support H 7352, predicted that Complete Streets design that would promote walking and bicycling and this would ultimately improve the health of Rhode Islanders.

             Also attending the Committee Hearing, Co-Chair John Flaherty, of the Coalition for Transportation Choices, advocated for 21st century transportation system “that’s good for the economy, good for the environment and that provides clean, healthy and affordable transportation choices for all Rhode Islanders.”

            There is no fiscal note estimating the true costs of H 7352 due to the multitude of factors that must be considered.  However, bill supporters believe that this legislative proposal does not necessarily add costs to the road construction project.

            Addressing concerns about the legislative proposals “possible” fiscal impact on the State’s budget, Senator DiPalma notes that H 7352 has been crafted in such a way to reduce the fears of fellow lawmakers that there could be initial and future costs if the legislation is enacted.  Provisions would protect the state’s coffers by requiring common sense exceptions to take effect if a road construction design project incurs a cost that is disproportional to its benefits, he says.

It’s All About the Economy

            Doing it right the first time makes economic sense,” says AARP Associate Director for Advocacy Deanna Casey.

             Enacting H 7352 is just good economic policy, adds Scott Wolf, Executive Director of Grow Smart Rhode Island.  According to Wolf, “forRhode Islandto thrive economically it needs to attract and retain talented young people. These people, research shows, are looking for places that are vibrant, user friendly and possess an abundant natural and architectural beauty.” 

            Wolf stated “Rhode Island has many of these ingredients but we need to be much more user friendly with regard to transit, walk ability and bike ability to maximize our appeal to this new segment of workers. He added, “Adopting an aggressive complete street strategy that requires all roads built to accommodate bikes, pedestrians, and mass transit as well as autos could do a lot to increase our appeal to this critical cadre of mobile young talented workers.”   

             In these tough economic times usually a price tag on a legislative proposal is just enough for General Assembly leadership to doom a legislative proposal’s passage by not taking action on it.  Just refer it for further study.  Complete Street supporters are puzzled by the inaction in the House panel because of the protections built into the measure to rein in initial or future costs of a project.  At press time, the City of Pawtucket along with eight other cities and towns, have already passed resolutions supporting the Complete Street legislation being considered by the Rhode Island General Assembly and another eight communities are also considering supporting this legislation by enacting  resolutions.  Most important, the State’s Department of Transportation is not even blocking passage but endorsing it.

           According to the National Complete Streets Coalition, in 2011 alone “over 140 jurisdictions adopted a policy, up from 80 that committed to Complete Streets in 2010. In total, 352 regional and local jurisdictions, 26 states, the Commonwealth of Puerto Rico, and the District of Columbia have adopted policies or have made written commitment to do so.”

           Elections are looming and House and Senate leadership are looking to adjourn in early June.  The Rhode Island General Assembly must move quickly in the waning days of the 2012 legislative session to join 26 states that get it.  House leadership must do the right thing to make streets, highways and byways more accessible and safer for all Rhode Islanders, regardless of age, abilities or modes of transportation.   That is to pass H 7352.    

             Herb Weiss is a Pawtucket-based writer covering aging and health care issues.  His Commentaries are published in two Rhode Island Daily’s The Pawtucket Times and Woonsocket Call.