Tag Archives for Rhode Island General Assembly

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.

Many Seniors Struggle with High Cost of Medications

Published in the Pawtucket Times on June 18, 2001

Many seniors are struggling to pay the spiraling cost of prescription drugs as a politically divided Congress seeks a solution by crafting a bipartisan prescription drug benefit tied to Medicare.

Until this issue is addressed, a tragedy occurs in many communities across the nation.

Often, the high cost of prescription drugs has forced seniors on fixed incomes into not taking their medications at all or using only partial doses.

Noncompliance in taking medication can lead to hospitalization, nursing home admission or premature death.

According to the Families USA study released in June 2001, costly prescriptions continue to hit seniors hard in their pocketbook.

The report found that 50 of the most heavily prescribed drugs for seniors on average rose more than twice the rate of inflation in the year ending January 2001.

On average, the researchers found that prices increased by 6.1 percent from January 2000 to January 2001, though the rate of inflation excluding energy in that time period was 2.7 percent.

Furthermore, the 18-page report stated that seniors are most affected by any prescription drug price  increase.

Although older persons represent just 13 percent of the total nation’s population, they account for 34 percent of all prescribed medications dispensed and 42 percent of all prescription drug spending.

Of the 50 drugs used more frequently by seniors, the average annual cost per prescription as of January 2001 was $ 956, the report noted.

Drug prices rose significantly over the one-year period of the study.

The report findings revealed that the cost of Synthroid, a synthetic thyroid agent, rose by 22.6 percent; 22.5 percent for Alphagan, commonly used to treat glaucoma; 15.5 percent for Glucophage, prescribed for treating diabetes; and 12.8 percent for Premarin, used estrogen replacement.

While rising drug costs are national, Rhode Island fiscal nets are in place to make prescription drugs more affordable to low-to-moderate income seniors, says Susan Sweet, consultant and advocate for a variety of nonprofit agencies and minority groups.

Many aging advocates and state legislators know Sweet as “the mother of the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE).”

“Rhode Island is one of a handful of states that has responded to senior’s concerns and anxieties about the high cost of prescription drugs,” Sweet says.

In 1985, the Rhode Island General Assembly moved to assist elders with rising prescription drug costs by enacting RIPAE.

Initially, the RIPAE program covered only medications purchased by low-income seniors to treat hypertension, cardiac conditions and diabetes.

In the past fifteen years, the General Assembly has expanded the program,” Sweet adds, to over the cost of prescription drugs to treat glaucoma, Parkinson’s disease, high cholesterol, cancer, circulatory insufficiency, asthma, chronic respiratory conditions, Alzheimer’s disease, depression, incontinence, infections, arthritic conditions and prescription vitamins and mineral supplements for renal patients.

Additionally, the RIPAE Plus Program, proposed by Lt. Governor  Charles Fogarty with House and Senate leadership, allowed moderate income seniors to purchase prescription drugs at a lower rate that is negotiated by the state.

The state also pays a portion of the remaining cost of the drug based on the senior’s income level.

“The innovations in RIPAE have made Rhode Island a leader in assisting seniors to stay healthy and independently,” Sweet says.

With the end approaching to this year’s session of the General Assembly, lawmakers are considering legislation to again expand the RIPAE Program, states Fogarty, who authored the legislation.

Fogarty’s RIPAE Next Step would cover all FDA-approved prescribed drugs, excluding cosmetic and experimental drugs, cap out-of-pocket expenses at $ 1,500 annually, and open up the program to people age 55 and over who are receiving Social Security Disability Insurance.

While no one really opposes the passage of RIPAE expansion this year, ultimate passage of the entire legislative proposal is really a question of competing budget needs and limited state dollars, Sweet comments.

House Finance Chair Tony Pires (D-Pawtucket) remembers a time in the mid-1990s when Governors Bruce Sundlun and Linc Almond attempted to roll back the RIPAE program by calling for an increase in the senior’s co-pay and limiting access to benefits.

“The General Assembly made it very clear that it did not want to reduce state support, but rather moved to increase benefits,” Rep. Pires said.

“This year we’ll be expanding the list of drugs to include prescription drugs used to treat osteoporosis,” Rep Pires tells The Times, adding that House leadership also supports an out-of-pocket prescription drug cap of $ 1,500 annually.

With the RIPAE Next Step’s price tag of $ 3.5 million dollars. “We can’t afford to pay for an open formulary program yet because of budgetary limitations,” Rep. Pires states.

In upcoming legislative sessions, coverage for gastrointestinal drugs will seriously be considered, he adds.

“In the upcoming years the state’s pharmaceutical assistance program will remain a top priority to the General Assembly, Rep. Pires says. “There will be an expansion of coverage to a full formulary when more state monies become available, he adds.

Currently, Lt. Governor Fogarty estimates that more than 170,000 Medicare beneficiaries in Rhode Island, who do not meet the state’s pharmaceutical assistance program’s income eligibility requirements, lack comprehensive prescription drug coverage.

With an aging population, Congress and state lawmakers must roll up their sleeves to find innovative ways of making prescription drugs affordable.