Tag Archives for Rhode Island General Assembly

Nursing home workforce crisis deepens with minimum staffing standards

Published in RINewsToday on February 13, 2023

“The long-term care industry is enduring the worst workforce crisis in its history, in Rhode Island, and across the country. Although providers are committed to recruiting and retaining staff to provide quality care for residents, despite our best efforts, many nursing homes have fallen short of the staffing ratio set by the RI Department of Health,” notes James Nyberg, Executive Director of the East Providence-based Leading Age Rhode Island (LARI), representing nonprofit providers of aging services.

“We are extremely  concerned about the impending fines that will be imposed on nursing homes here in Rhode Island as a result of our state’s existing nursing home minimum staffing ratio statute,” said Nyberg. Because of staffing ratio mandates, “the industry would have faced fines of over $11 million, in just one sample quarter (April – June 2022), since over 70% of nursing homes are not in compliance,” he said.  

“While April-June was a sample, the fines go into effect for July-September and we will receive a similar notice in just a few weeks, with only 10 days to pay the fine,” says Nyberg, stressing that these fines will only increase going forward if nursing homes are unable to meet the minimum staffing ratio.

Nyberg calls on the Rhode Island General Assembly to rescue Rhode Island’s nursing homes and provide relief from these penalties by delaying them and exploring an alternative approach to support the efforts of nursing homes to meet the ratio.  He warns that the current fine-based approach is excessive and counterproductive and will lead to reduced access to care and threaten the survival of the state’s nursing homes.

Nyberg points out that the current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (five nursing homes have already closed since the COVID pandemic began).  These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes.  

“We are working with numerous stakeholders on various initiatives to develop a pipeline of workers, but the simple fact is that it will take time.  In addition, as you know, the industry has faced years of underfunding from Medicaid, which pays for the majority of nursing home care.  This has made recruiting and retaining workers more difficult than ever,” says Nyberg. 

John Gage, President of the Rhode Island Health Care Association (RIHCA) agrees with Nyberg’s assessment of the nursing home workforce.  “Nursing homes across the nation are facing an historic labor shortage as the direct result of chronic Medicaid underfunding and the devastating impact of the Covid-19 pandemic on the workforce, he says, noting that the state’s nursing home workforce is down 20% since the start of the pandemic, with 2,000 workers lost from Jan. 2020 to June 2022.  Nationwide, the nursing home workforce is down 210,000 workers.

According to Gage, Rhode Island’s staffing mandate, while well-intentioned, will siphon tens of millions of dollars from resident care. In the first year of full implementation of the state’s minimum staffing mandate, RIHCA estimates that facilities will be fined upwards of $60 million. “These fines will imperil care, not bolster it,” he warns.  

Without legislative action, Rhode Island nursing homes will be fined an estimated $11 million on or about February 28, 2023, because of their inability to attract workers to meet the mandate from July 1, 2022, through September 30, 2022, Gage charges. “There are simply not enough available workers to fill the open staff positions, and resources are scarce.  Nursing homes will be devastated by these fines.  Facilities will reduce admissions, backing up hospital referrals and clogging hospital beds.  More nursing facilities will close – five have already closed since the beginning of the pandemic,” he predicts.  

Gage asks, “Who will care for Rhode Island’s frailest elders?” To recreate a minimum staffing mandate in nursing homes on the federal level would be a huge mistake, especially given the historic workforce crisis here in Rhode Island and nationwide,” he says.  

Gage’s comments echo concerns expressed by another group of US Senators in Jan. 20 correspondence (https://www.tester.senate.gov/wp-content/uploads/1-20-23-Nursing-Home-Staffing-Mandate-Letter-FINAL.pdf) sent to CMS by Senators John Bourasso, Jon Tester, and eleven other US Senators.  They caution the agency that a one-size fits all mandate would undermine access to care for patients, and they encouraged CMS to work with Congress on tailored solutions that address the workforce challenges facing nursing facilities.

At the federal level

Just days ago, U.S. Senators Bob Casey (D-PA), Chairman of the Senate Committee on Aging, and Ron Wyden (D-OR), Chairman of the Senate Finance Committee, called on the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to encourage the federal agency to establish minimum staffing standards in nursing homes to ensure high-quality care for nursing home residents. In Feb. 10 correspondence, Casey and Wyden, along with Senators Sherrod Brown (D-OH), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Cory Booker (D-NJ), and Elizabeth Warren (D-MA) urged CMS to advance the agency’s ongoing study to determine adequate staffing requirements in nursing homes.

“We appreciate the work that CMS has undertaken to promote safety and quality in nursing homes and applaud the Biden-Harris Administration’s commitment to protecting our nation’s seniors,” said the senators in Feb. 10 correspondence, urging CMS to “bring this work to completion.” 

“In our view, that means continuing the agency’s ongoing study to determine the level of staffing that is necessary to ensure safe and high-quality care for nursing home residents, developing an evidence-based and actionable proposal for mandatory minimum staffing levels, and a robust and transparent process—including direct stakeholder engagement— that will allow for further discussion and fine-tuning of requirements before the proposal is finalized,” wrote the senators.

The senators noted that studies have shown a correlation between inadequate staffing levels and lower quality of care. More recent studies have demonstrated that higher nurse staffing ratios mitigated the effect of COVID-19 outbreaks in nursing homes and resulted in fewer deaths. A recent Department of Health and Human Services Office of Inspector General report examining the high level of COVID-19 infections in nursing homes also pointed to the need for the establishment of minimum staffing requirements.  

In the correspondence, the senators cite the Social Security Act, which requires skilled nursing facilities to “provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents,” including the services of a registered nurse at least 8 consecutive hours per day, 7 days a week. The letter commends CMS for working to update this vague standard that has led to substantial variation in staffing levels and quality of patient care across facilities.

“Achieving the shared goal of ensuring quality care in nursing homes nationwide is a complex undertaking, says LeadingAge’s Ruth Katz, senior vice president, policy. LeadingAge is an association of nonprofit providers of aging services, including nursing homes.

“As our Get Real on Ratios proposal highlights, a number of conditions must be met in advance of any mandate implementation,” suggests Katz. “The senators correspondence to CMS is a promising development; it covers many of the same points as our Get Real on Ratios proposal – a recognition of the critical need for adequate reimbursement; that one size does not fit all, and that workforce shortages will need to be addressed with additional support. Without addressing these, staffing mandates are impossible. We look forward to continuing our discussions with Congressional leaders on this critical issue so that older adults and families can access much-needed care and services,” she says.

“The Senior Agenda Coalition of RI fully supports the need to develop national staffing standards to ensure quality care is provided to nursing home residents across our nation. It is important to note that Rhode Island has been a leader in this area. For many years our state has required 24/7 RN coverage in nursing homes and in 2021 the legislature passed the Nursing Home Staffing and Quality Care Act that includes staffing standards,” says Maureen Maigret, Policy Advisor to Senior Agenda Coalition of RI. “Now we must work to address workforce shortage issues and ensure that adequate government resources are provided especially through Medicaid payments so the standards can be met, and our critical direct care workers receive competitive living wages in order to keep them working in long term care,” she adds.

As the House Leadership hammers out the FY 2024 budget, it is crucial that adequate Medicaid funding is allocated to allow nursing homes to attract the necessary staff to meet the state’s minimum nursing standards that it codified into law. We must address this policy problem now rather than just kick the can down the road.

Lawmakers can do more for Seniors next year

Published in RINewstoday on July 11, 2022

Just days before July 1, 2022, Gov. Dan McKee was joined for the signing of the $13.6 billion state budget (2022-H7123aa) for fiscal year 2023 by Lt. Gov. Sabina Matos, House Speaker K. Joseph Shekarchi, Senate President Dominick J. Ruggerio, House Finance Committee Chairman Marvin L. Abney and Senate Finance Committee Chairman Ryan W. Pearson.

Taking a Look at the Budget’s Dollars and Cents

Let us take a look as ho the state’s FY2023 budget, signed by McKee on June 27, 2022, impacts older Rhode Islanders.

The budget doubled the funding for the Livable Homes Modification Program, from $500,000 to $1 million, which reimburses half the total retrofit costs, up to $4,000, to support home modifications and accessibility enhancements to allow individuals to remain in community settings. The increase is intended to address an anticipated surge in applications.

For retirees, the Assembly raised from $15,000 to $20,000 the amount of annual pension income that is exempt from state taxation.

The FY 2023 Budget also allocated an additional  $200,000 to the Office of Healthy Aging’s budget for senior centers, bringing total funding to $1 million. That is a 25% increase.

The budget also makes significant investments in the quality of healthcare for seniors, providing rate increases to many kinds of providers of health care, nursing homes, home and community-based services for elderly (increase in starting pay to $15 hour), in addition to seeking a study by the Office of the Health Insurance Commissioner on appropriate reimbursement rate levels into the future.  The budget also includes substantial increase to reimbursement rates for Meals on Wheel meals ($400,000), ensuring that the program is able to provide high-quality therapeutic and culturally appropriate meals to participants.

Lawmakers also added $4 million to increase the “circuit breaker” tax credit available to qualifying elderly and disabled residents, raising the maximum credit from about $400 to $600 beginning in tax year 2022 and indexing that amount to inflation. They also made credit available to more Rhode Islanders by increasing the income threshold for eligibility from $30,000 to $ 35,000.

Those with military pensions will no longer have to pay any income taxes on them, beginning in the 2023 tax year. The governor had proposed phasing out military pension taxation over five years, but legislators instead made them tax-free in their entirety in one year.

Lawmakers also kept the Governor’s plan to invest $168 million in upgrades to Eleanor Slater Hospital, including $108 million to construct a new long-term care acute care hospital at the Zambarano campus in Burrillville.

The plan accelerates the six-year phase-out of Rhode Island’s motor vehicle excise tax, eliminating what would have been the final year of the tax next year.  The amended budget provides replacement license plates for free.

The state budget included a year-long pilot program to provide free service on the Rhode Island Public Transit Authority’s business route, the “R” line that runs from Pawtucket to Cranston.

It also added $11.5 million general revenue funds to launch a retail Supplemental Nutrition Assistance Program (SNAP) pilot program, beginning Jan. 1, 2023.  Eligible households would receive an incentive payment of 50-cents for every dollar spent on fruits and vegetables, subject to limits.  The state also requested a waiver from the Federal Nutrition Service to streamline the application process for elderly and disabled individuals seeking assistance from the SNAP program.

Lawmakers also allocated $10 million for rebalancing the state’s long-term care continuum, for funding home care agency workforce recruitment, retention and training.  Also, money in Rhode Island’s new budget includes $8.1 million to increase Medicaid Dental rates to increase access to dental services for older adults.

Finally, lawmakers kept in the $250 million total from the American Rescue Plan Act (ARPA) federal funds in the approved budget to address state’s affordable housing crisis.

Taking a peek at new state laws

The Rhode Island General Assembly passed H-7942/S-2623 which increases access and utilization of Accessory Dwelling Units (ADUs) and provides age-friendly housing options for older adults, family caregivers, and people of all ages and abilities.

McKee also signed the Let RI Vote Act into law. This new law makes voting safer, easier, and more accessible for all Rhode Islanders. Some of the major provisions of the bill include no-excuse mail ballots and emergency voting; online mail ballot applications; permanent absentee list opt-in for nursing home residents; no witness or notary requirement to vote by mail;  multilingual voter information hotline, community ballot; and voter registration list maintenance.

A new law also seeks to develop broadband in Rhode Island by creating a Broadband Advisory Committee. It’s director will be responsible for connecting with federal agencies to access funds for broadband infrastructure deployment pursuant to federal grants, facilitating broadband service adoptions, expanding digital literacy for residents (especially seniors), experiencing economic hardship, and for future economic development.

Following the passage of S-2228, the definition of an elderly person in regard to exploitation has changed from someone 65-years-old to someone who is 60 years old, making the definition of an elderly person consistent with state law.

Finally, the proposed Perry Sullivan one-year exemption has been eliminated. This preserves $38.6 million for home and community-based services for 2023.

Gearing up for next year’s legislative session

“Despite the lack of passage of H-7616 sponsored by Rep. Lauren Carson to elevate the Rhode Island Office of Healthy Aging to full Department status, I’m confident that it will be reintroduced early in 2023. I also anticipate broad community conversations to fine tune the design and identify the needed resources,” says Vin Marzullo, a well-known aging advocate who served as a federal civil rights and national service administrator.

“AARP Rhode Island worked hard on Smith Hill during the 2022 legislative session to achieve a number of important wins for the age 50 and over Rhode Islanders,” stated Catherine Taylor, AARP Rhode Island State Director. “We will find it easier to vote, have access to more housing options and assistance for accessibility modifications, see our direct care workforce better paid and better trained, and so much more. And, as always, AARP Rhode Island is committed to ensuring that those age 50 and our families know about these changes and how they will improve our lives,” she says.

 “Although there was some very good news for seniors coming out of the 2022 legislative session, overall, the results were modest when we think about the projected growth of our older population, that 42% of older Rhode Island households have income less than $ 40,000 and that our Office of Healthy Aging is under resourced. So much advocacy work remains,” warns Maureen Maigret, chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council and Policy Advisor for the Senior Agenda of Rhode Island, representing 21 organizations to mobilize people to enhance the quality of life of older Rhode Islanders.

However, Maigret sees a big win in the state budget language calling for rate review for state contracted providers as far too many services important for all ages have become so difficult to access due to poor payment rates to providers for many years. One example is that dental rates under Medicaid have not increased since the early 1990’s so older adults have had an extraordinarily hard time getting detail care, she says.

“Another big win that the Senior Agenda worked tirelessly for was removing the suspension of the $38.6 millions of “Perry-Sullivan” funds for FY 2023 that was in Gov. McKee’s proposal,” says Maigret.

However, Maigret expressed disappointment that the state’s budget only calls for minimum wage for home care direct care staff of $15 per hour. “Advocates tried to get this up to at least $17 to address the homecare workforce crisis that leaves some seniors waiting months for service,” she says.

According to Maigret, other items that will help older adults and persons with disabilities with rising housing costs are the expansion of the Property Tax Relief program sponsored by Rep. Ruggiero and Sen. Coyle.

“While we are appreciative overall for the gains that have been made for Rhode Island’s seniors in this legislative session, it is just a start toward what our state needs to do to meet the needs of our aging population,” says Bernie Beaudreau, Executive Director of Senior Agenda Coalition of Rhode Island. “I am disappointed that the minimum wage of $15 per hour was set so low.  This wage level will not do much to attract workers and solve the severe workforce shortages that home care agencies are facing. We also have to be vigilant about the administration of this new law as we have already seen a draft regulation suggesting that $15 will be the “average wage,” not the “minimum wage” of home care workers.

Senior Agenda Coalition of RI zeros in on key aging legislation 

Published in RINewsToday on May 30, 2022

As the General Assembly winds down, the Senior Agenda Coalition of Rhode Island (SACRI) is tracking 16 House and Senate Bills along with FY 24 Budget Articles that have an impact on the state’s senior population. In a legislative alert, SACRI details a listing of 16 House and Senate bills and FY23 Budget Articles relating to care givers, mobile dental services, supplemental nutrition, housing, tax relief and home care worker wages. 

The state’s largest organization of aging groups is focusing and pushing for passage of the following four bills during the upcoming weeks.

SCARI puts on its radar screen S-2200/H-7489 to push for passage. The legislation (prime sponsors Senator Louis DiPalma (D-District 12) and Representative Julie Casimiro (D-District 31), establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24-member advisory committee, to provide review and recommendations for rate setting, and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.  

Meanwhile, DiPalma and Casimiro have also introduced S-2311/H-7180 to require a 24-member advisory committee to provide review/recommendations for rate setting/ongoing review of social service programs licensed by state departments/agencies and Medicaid. The House and Senate Finance Committees have recommended these measures be held for further study.

Ratcheting Up the Pay for Rhode Island’s Home Care Workers

In testimony on April 28th, SACRI’s Executive Director Bernard J. Beaudreau says, “Because payment levels for services have not been updated in years, especially in our current inflation ,levels, the low-pay level of direct care workers has created workforce shortages, impoverished workers and has put at risk our ability to provide proper care for our aging elder population.”

“Shamefully, an estimated 1 in 5 Rhode Island home care workers live in poverty and most have insufficient incomes to meet their basic needs,” says Beaudreau, calling for enactment of this bill to raise the wages of the lowest paid care workers as a top priority. 

S-2200 was referred to the Senate Finance Committee and companion measure, H 7489, was referred to the House Finance committees for review.  After hearings in their respective chambers, both bills are being held for further study. 

At press time, the Rhode Island General Assembly is hammering out its state budget for Fiscal Year 2023, taking effect July 1, 2022, to June 30, 2023.  SACARI calls on the state to make it a budgetary priority to address Rhode Island’s home care crisis.

According to Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, who also serves SACRI as a volunteer policy adviser and Board Member, says that the Governor’s budget calls for suspending use of an estimated $38.6 million in state funds which, by law, should be used to enhance home and community-based services. This law, says Maigret, is referred to as the “Perry-Sullivan” law after its sponsors.

Maigret calls for these funds to be used to increase home care provider rates so they may be fair and competitive to home care workers and increase rates for independent providers.  Many of these workers are low-income, women, and women of color, she says.

Lowering the property taxes for Rhode Island’s low-income seniors

SACRI also calls for the Rhode Island General Assembly to provide property tax relief for low-income seniors and Social Security Disability Income (SSDI) recipients. As housing costs rise and property taxes increase, more older Rhode Islanders with limited or fixed incomes and those on SSDI are becoming housing tax burdened, says the Providence-based the aging advocacy coalition. 

In SACRI’s legislative alert, Maigret calls for the passage of H-7127 and S-2192, with primary sponsors Representative Deborah Ruggiero (D-District 74) and Senator Cynthia Armour Coyne (D-32), charging that Rhode Island’s property tax relief law needs urgent updating.

Rhode Island’s Property Tax Review Law, sometimes referred to as the Circuit Breaker Law, needs serious updating. Initially the law was enacted to help provide property tax relief for persons aged 65 and over and to those on SSDI, says Maigret.  It is currently available to those with incomes up to $30,000 (set in 1999) and provides a credit or refund up to $415 against a person’s state taxes owed.  Both homeowners and renters are eligible to a apply. 

H-7127 and S-2192 would make hundreds of older Rhode Islanders eligible to participate by increasing the income cap from $30,000 to $ 50,000. Maigret notes that if these bills pass, a person with household incomes of $35,000 who is not eligible now could be eligible to get a refund of up to $850 next year. “These changes would provide direct relief against high property taxes and make Rhode Island more in line with our neighboring states of Connecticut and Massachusetts,” she says.

Finally, Executive Director Beaudreau testified on May 17th before the House Finance Committee, calling for the passage of H-7616, Reinstating the Department of Healthy Aging. “The time is long overdue for the state to re-invest in serving the needs of aging population,” he says, noting that “the state’s total population of 65 years and older has grown by 20% from 152,283 in 2010 to 182,486 today.”

Beaudreau testified that the “data clearly indicates that Rhode Island should be increasing plans, resources and services to meet the need of the state’s aging population, not cutting back.” The state’s budget has not kept up with the growth needed in the Office of Healthy Aging, charged with overseeing the state’s programs and services for older Rhode Islanders. “Additional funding is needed for increasing the Department’s staffing capacity and increasing financial support of Senior Centers serving thousands of older Rhode Islanders every say,” he adds.

But do not forget oral health of seniors, says SACRI.  According to the aging coalition, the importance of accessing quality oral health care in nursing homes is key to a nursing facility resident’s health, well-being and quality of life. Poor oral health care results in a higher incidence of, pneumonia cardiovascular disease diabetes, bone loss and cancer; all situations increasing the frequency of accessing medical care resulting in higher costs. 

Improving oral health care to Rhode Island’s seniors and special populations

SACRI calls for the passage of S-2588 and H-7756, bills that would provide for reimbursement for patient site encounter mobility dentistry visits to be increased to $180 per visit. The state’s reimbursement for mobile dentistry site visits began in 2008, only in nursing homes, but failed to provide funding for dental care in other settings. 

These bills would also expand the availability of this service to additional community-based group homes, assisted living facilities, adult day health and intellectual and developmental disability day programs. Passage of these bills will increase access to special populations who have difficulty in accessing basic dental services.

S-2588, referred to the Senate Finance Committee, was held for further study.  The House companion measure is scheduled to be heard on May 28th at a House Finance Committee hearing. 

Reimbursement for this service has not increased since it was initially funded over 14 years ago and does not cover the cost of delivering this critical service, says SACRI.

SACRI says “Make your voice heard!  Call House Speaker Joseph Shekarchi (401 222-2466) and Senate President Dominick J. Ruggerio (401 222-6555) and your legislative delegation to urge supporting SACRI’s priority legislation. 

To see a listing of SACRI’s 2022 Priority Legislation, go to https://img1.wsimg.com/blobby/go/049a7960-1c2a-4880-afdd-8d1e0e283acc/downloads/SACRI%20Bill%20Tracker%202022.pdf?ver=1653052514912.

For more details about SACRI, go to https://senioragendari.org/