Tag Archives for Rhode Island General Assembly

Confronting the Long-Term Care Dilemma in Uncertain Times

Published in the Pawtucket Times on January 14, 2002

 Aging advocates are about to find out how many slides you can cut the Rhode Island budgetary pie, especially when lawmakers are predicting that the state’s deficit could soar to hundreds of millions.

With the backdrop of a recession, pushing to keep funding at current levels for existing programs and services this legislative session may be their only hope as advocates for affordable health care and housing, education, disabled persons, seniors, and low-income families call for their fair share, too.

Meanwhile, CHOICES, a broad-based coalition of provider organizations and advocate organizations, will push this legislative session for more funding to keep Rhode Island seniors in their homes.

The coalition representing home care agencies, assisted-living facilities, adult day care, housing, senior center, disabled and senior advocates and Meals on Wheels, will continue its efforts to urge the General Assembly for reforms to Rhode Island’s long-term care system, said Paula Parker, Executive Director of Rhode Island Partnership of Home Care and a CHOICES member.

“Consumers must have options to choose programs and services that can provide them with greater independence in familiar surroundings,” Park told ALL About Seniors, adding that this is an underlying principle of CHOICE’S philosophy.

During the state’s prosperous years, Rhode Island’s allocation for home and community-based services slowly inched up from seven to eight percent of the state’s total long-term care budget.  Parker noted, however, that General Assembly funding for long-term care services continued to be heavily weighted toward funding institutional facility care.

“The challenge today is to continue the momentum of increasing state support for home and community-based services in less prosperous times,” Parker said, because the start’s rising elderly population creates a need to expand options in long-term care.

Susan Sweet, a consultant, long-time consumer advocate and CHOICES member, added that the seven-year-old coalition plans to continue its education efforts to inform legislators and the public about the cost savings of home and community care for elders as opposed to institutional care.

For example, Sweet stated that full-time adult day care five days a week may cost up to $ 10,000 annually as compared to an average $38,000 bill for nursing facility care.

Options in the state’s continuum of care include assistance with the costs of pharmaceutical drugs, community-based programs, rehabilitation facilities and nursing facility care. Sweet said, “A menu of available choices allows seniors and their families to seek out and receive the most appropriate and cost-effective care for their current situation. That’s what CHOICES is all about.”

Can long-term care options assist lawmakers in controlling the state budget while providing needed services for seniors?

Yes, said Sweet. “Not only is the quality of life greatly enhanced for elders and their families when institutionalization is delayed or eliminated, but also individual assets and state contributions to care through the Medicaid program are greatly reduced or eliminated,” she said.

Recognizing that lawmakers must work within severe budgetary constraints. Sweet said she believes it should be fiscally short-sided not to recognize the significant budgetary savings that home and community-based care- and preventative care- bring to situations that, without intervention, would lead to costly health care such as hospitalization and protracted institutional stays.

“The challenge for Rhode Island is to continue progress on creating less restrictive and less expensive community services while continuing funding for needed acute and long-term care,” Sweet said, stressing that in a tie of decreasing revenues, this will not be an easy task.

Lawmakers must either conform the long-term care crisis now for today’s seniors in the shadow of the state’s current budget deficit or in later years, when the state’s demographic time bomb I ready to explode. For today’s seniors and for the aging baby boomers who follow in their footsteps, lawmakers, state agencies, providers and seniors  must cooperate in crafting a seamless long-term care system with options that enhance quality of life and provide independence. This may take years.

But until then, amid competing interests for limited state dollars, advocates for better long-term care will have to roll up their shelves with the support of senior and disabled constituents to get this year’s slice of the state budget pie.

The Best of…Lifestyle Change is Effective Way to Fight Cancer

Published October 22, 2001

           Although cancer deaths in Rhode Island are among the highest in the nation, we ultimately do have control to reduce the incidence of this devastating disease, say state health experts.

           According to John Fulton, associate director of the Rhode Island’s Department of Health, cancer-related deaths last year in the Ocean State topped 2,500.  With its urban setting, Rhode Island’s listing as one of the top 10 states for cancer death was not a surprising to Fulton.  In an urban setting, he says a person’s lifestyle might include an unbalanced diet, little physical exercise, use of tobacco and a heavier use of alcohol, all contributing factors to the state having the higher incidence of cancer.

          Seniors can take more control of their health and well-being to reduce the probability of being afflicted with cancer.  By just avoiding many of the high-risk factors for cancer and by living a healthier lifestyle, or through early detection by screening and treatment, Rhode Islanders of all ages can stave off or successfully survive cancer’s devastating effects, says Fulton.

          He recommends all older persons schedule a check up every year with their primary care physician. Balanced diets are important, too, he says especially with meals including large portions of fresh fruits and vegetables.  Don’t forget regular physical activity, such as walking for at least 20 to 30 minutes.  At annual checkups, always ask your physician if it’s time for your mammogram, pap test, or sigmoidoscopy or colonoscopy.  Finally, do not use any type of tobacco because it causes at least four out of 10 cancers in Rhode Island.

           Being diagnosed with cancer does not always translate into a death sentence, says Dr. Arvin S. Glicksman, who serves as the executive director of the Rhode Island Cancer Council.  The private nonprofit group, funded by the Rhode Island General Assembly, serves as an information and referral source for those needing cancer-related information, along with providing educational programming to the public and health care professionals.

         “Breast cancer incidence is much higher for women age 65 and over than for younger women,” he states. “While 80 percent of women of all ages get      mammograms, less than 50 percent of those age 65 and over have regular mammograms.”

         “When detected earl breast cancer is over 90 percent curable,” Glicksman says.  But somehow older woman do not avail themselves of this important test, even with Medicare paying  for the annual mammograms in women age 65 and over and with 45 mammography centers located throughout the state, he adds.

       According to Dr. Glicksman, colorectal cancer kills more men and women in Rhode Island than either breast cancer or prostate cancer.  Again, preventative screening is important because even if early cancer has already developed , it is 90 percent curable too, if caught early,” he adds.

       “With testing we do for cervix cancer and colon rectum cancer we can actually detect the problems before the cells become cancerous,” Dr. Glicksman says.  “In these cancers we are actually preventing the cancer before it even starts by removing precancerous lesions.”

          Meanwhile, only a few of the 39 municipalities in Rhode Island have created Cancer Task Forces to bring cancer-related educational, screening programs and activities to their residents.

          “The City of Pawtucket has the most well-developed program,” Glicksman says.  Recognizing the important of early preventative screenings, he notes that the city allowed all full-time employees up to four hours of paid time away from work for one preventative cancer screening appointment performed by a licensed physician.  Those requiring additional time for cancer screenings are allowed to use their sick time for this purpose.

         No miraculous wonder drugs or startling medical techniques are necessary to combat cancer, Dr. Glicksman states.  The cancer care rate can rise to more than 75 percent by using the medical techniques, treatments and medications now available, combined with early prevention screenings and lifestyle changes.

        Herb Weiss is a Pawtucket-based  freelance writer covering aging, health care and medical issues. The article was published in the October 22, 2001 issue of the Pawtucket Times.  He can be reached at hweissri@aol.com.

Congressional report spotlights nursing home abuse

Published in The Times dated August 6, 2001

Congressional investigators have recently released a scathing report charging that within the last two years more than 30 percent of the nation’s nursing homes – about 5,285 facilities – were cited by state inspectors for at least one abuse violation that had the potential to cause harm.

These facilities were cited for almost 9,000 violations during the two-year congressional study, the report said.

Citing information gleaned from a sampling of state inspection reports or formal complaints, the 15-page report released last week at a hearing called by Henry Waxman (D-Calif), Minority Chairman of the House Committee of Government Reform, found that in more than 1,600 nursing facilities, approximately one out of every 10, the abuse violations were serious enough to cause significant harm to residents or to place them in immediate jeopardy of death or serious injury.

Abused residents were punched, choked or kicked by staff members or other residents, the report said, stating that the attacks frequently caused serious injuries such as fractured bones and lacerations.  In other instances, residents were being groped or sexually molested.

Although the report, “Abuse of Residents is a Major Problem in U.S. Nursing Homes,” prepared by Minority Staff of the Committee’s Special Investigation Division, found that the percentage of nursing facilities with abuse violations is increasing, it noted that the reasons for this increase are unclear.

In his opening remarks, Waxman stated that it had been unwise for Congress to repeal the Boren Amendment in 1997, a federal law which mandated that states provide nursing facilities with adequate funding to operate.  Because of this, he said, Medicaid funding for nursing facility care has not kept pace with the rising costs of providing care.

Waxman’s legislative prescription for attacking the growing abuse in the nation’s nursing facilities is to introduce a legislative proposal that would reestablish the abolished Boren Amendment, mandating minimum nurse staffing requirements, imposing tougher regulatory sanctions on poorly performing facilities, and instituting criminal background checks for nursing facility employees, or increasing internet disclosures on nursing facility care.

What’s playing out in Rhode Island?

According to Wayne Farrington, Chief of Facilities Regulation at the state’s Department of Health, the reporting of Rhode Island abuse complaints has risen by 10 percent.  The statewide increase in reports of abuse, neglect and mistreatment probably mirrors the tragic national problem, he tells All About Seniors, but is smaller because the Rhode Island 1987 statute has made it a misdemeanor for health care professionals or public safety officials not to report suspected abuse, neglect, mistreatment.  The size of the national increase is partially due to abuse reporting being a new requirement in some states.  Farrington added. 

Farrington states that the biggest factor that increases the number of reported calls of abuse, neglect and mistreatment is the severe statewide staffing shortage in Rhode Island’s nursing facilities.

“Overworked staff may become short tempered and this can result in abuse.  Not enough staff in the facility may also result in resident’s needs not being met,” he added.

Administrator Hugh Hall, of Cherry Hill Manor, also feels that the state’s critical staffing crisis contributes to the possibility of increased abuse and that crisis also affects the quality of care provided in the state’s 104 nursing facilities.

“Today’s nursing facility employees are underpaid, overworked creating an environment in which even the best employee may falter,” Hall said.

The administrator urges the General Assembly to increase Medicaid payments to more adequately cover the nursing facility’s actual cost of care, allowing for greater increases in direct care provider salaries.

“While last year’s average cost of care in a Rhode Island facility was $140 per day the state’s Medicaid program only reimbursed facilities $116 for the care provided, creating a serious shortage of funds in many facilities, Hall added.

“There are not enough certified nursing assistants in the system to deliver the care,” Hall said noting that opportunities must be created and a fair wage paid to attract people into this profession.

Meanwhile, Hall believes that the overwhelming majority of nursing facilities in Rhode Island provide quality care.  These facilities do criminal background checks and provide staff training.  They educate their staff about the facility’s expectation on quality patient care, he said.

Hall says facilities that have on going problems with abuse should be prosecuted to “the fullest extent of the law.”

Although Roberta Hawkins, the state’s Long-Term Care Ombudsman and Executive Director of the Alliance for Better Long-Term Care sides with Farrington and Hall about the critical need to directly confront the adverse impact of the staffing shortage in facilities, “it’s not to excuse to provide bad care,” she says.  “If facilities can’t care for residents then they should not admit them.”

A mandated continuing education program for both professional nurses and certified nursing assistants can be an effective strategy for reducing the incidence of abuse while enabling the better trained worker to care for more medically complex residents.

Additionally, Hawkins and long-term care providers are pushing for more state and federal Medicaid dollars to be allocated to provide a living wage for direct care workers.

Although lawmakers this year gave a small increase, “it’s not what was needed but it’s a start,” she acknowledges.

A divided Congress and a conservative Bush White House may well keep Waxman’s legislative proposal that addresses the problem of rising abuse in the nation’s more than 17,000 nursing facilities from every being enabled.

So, change must begin in the Ocean State.

When the Rhode Island General Assembly comes back into session next year, it becomes critical that the serious direct care staffing shortage in Rhode Island’s nursing facilities become a top legislative priority.

As the Republican and Democratic Gubernatorial candidates gear up their political campaigns and dream of becoming the state’s top elected policy official, they might well consider taking up the just cause of improving the care provided in the state’s nursing facilities.

Lawmakers can gubernatorial candidates can ill afford to ignore this key policy issue, one that puts the state’s 10,000 frail nursing facility residents in continued jeopardy of abuse, neglect or mistreatment.

On a political note, hundred of thousands of families and friends of these residents, who are voters, are watching.