Tag Archives for Rhode Island General Assembly

Time to resolve RI’s ongoing Nursing Home staffing crisis

Published in RINewsToday on April 18, 2021

The latest release of AARP’s Nursing Home COVID-19 Dashboard shows that both cases and deaths in nursing homes declined in the four weeks ending March 21. Although these rates are improving, chronic staffing problems in nursing homes—revealed during the COVID-19 pandemic—continue. In Rhode Island, 30% of nursing homes reported a shortage of nurses or aides, which is only fractionally better than the previous reporting period. 

AARP has come out swinging to fight for enhancing the quality of care in Rhode Island’s 104 nursing homes.

AARP Rhode Island, representing 131 members, calls for the General Assembly to ensure the quality of care for the state’s nursing home through minimum staffing standards, oversight, and access to in-person formal advocates, called long-term care Ombudsmen. The state’s the largest aging advocacy group has urged lawmakers to create a state task force on nursing home quality and safety and has pushed for rejecting immunity and holding facilities accountable when they fail to provide adequate care to residents.  It’s also crucial that Rhode Island ensures that increases in nursing homes’ reimbursement rates are spent on staff pay and to improve protections for residents, says AARP Rhode Island. 

Last December, AARP Rhode Island called on Governor Gina Raimondo to scrap Executive Order 20-21 and its subsequent reauthorizations to grant civil immunity related to COVID-19 for nursing homes and other long-term care facilities. The aging advocacy group warned that these facilities should be held responsible for providing the level of quality care that is required of them for which they are being compensated.

Rhode Island Lawmakers Attack Nursing Home Staffing Crisis

During the legislative session, the state’s nursing home staffing crisis caught the eye of Senate Majority Whip Maryellen Goodwin is a policy issue that needs to be addressed. They knew that Rhode Island ranked 41st in the nation in the number of the average hours of care nursing home residents receive, according to data from the Centers for Medicare and Medicaid Services.  The state also has the lowest average resident-care hours per day of any New England state.

On Feb. 2, the Rode Island Senate approved S 0002, “Nursing Home Staffing and Quality Care Act” sponsored by Goodwin and nine Democratic cosponsors to address an ongoing crisis in staffing nursing homes that has been exacerbated by the COVID-19 pandemic.  The bill had passed unanimously in the Health and Human Services Committee, and ultimately, the full Senate gave its thumbs up to the legislative proposal by a vote of 34 to 4.  Only one Republican senator crossed the aisle and voted with the Democratic senators.

“There is a resident care crisis in our state. Staffing shortages and low wages lead to seniors and people with disabilities not receiving the care they desperately need. The pandemic, of course, has exponentially increased the demands of the job and exacerbated patients’ needs. We must confront this problem head-on before our nursing home system collapses,” said Sponsor Senator Goodwin (D-Dist. 1, Providence).

The legislation would establish a minimum standard of 4.1 hours of resident care per day, the federal recommendation for quality care long endorsed by health care experts including the American Nurses Association, the Coalition of Geriatric Nursing Organizations, and the National Consumer Voice for Quality Long-Term Care. The bill, which the Senate also approved last year, has been backed by Raise the Bar on Resident Care, a coalition of advocates for patient care, and the Rhode Island’s Department of Health (RIDOH).

The bill would also secure funding to raise wages for caregivers to recruit and retain a stable and qualified workforce. Short staffing drives high turnover in nursing homes. Not only does high turnover create undue stress and burnout for remaining staff, but it also diverts valuable resources to recruit, orient, and train new employees and increases reliance on overtime and agency staff.  Low wages are a significant driver of the staffing crisis. The median wage for a CNA in Rhode Island is less than $15, and $1/hour lower than the median wage in both Massachusetts and Connecticut.

The legislation would also invest in needed training and skills enhancement for caregivers to provide care for patients with increasing acuity and complex health care needs.

At press time, the companion bill (2021-H-5012), sponsored by Reps. Scott A. Slater (D-Dist.10, Providence) and William W. O’Brien (D-Dist. 54) was considered by House Finance Committee and recommended for further study.

RIDOH’s Director Nicole Alexander-Scott, MD, MPH says the state agency “supports the thoughtfulness of the provisions included in the legislation and welcomes dialogue with its sponsors, advocates, and the nursing home facility industry regarding methods to sustain the necessary conditions associated with the intent of the bill.”

Alexander-Scott states that “RIDOH takes its charge seriously to keep nursing home residents and is supportive of efforts to update standards of care to better serve Rhode Islanders in nursing facilities, as well as increase resident and staff satisfaction within nursing facilities.”

Scott Fraser, President and CEO of the Rhode Island Health Care Association (RIHCA), a nonprofit group representing 80 percent of Rhode Island’s nursing homes, says that “staffing shortages are directly traceable to the chronic lack of Medicaid funding from past governors. Period.” 

According to Fraser, state law requires Medicaid to be funded at a national inflation index, usually averaging around 3%. “Up until this year, previous governors have slashed this amount resulting in millions of dollars in losses to our homes.  Thankfully, Governor McKee is proposing to fully fund the Medicaid Inflation Index this year,” he says.

RIHCA opposes the mandatory minimum staffing the legislation now being considered by the Rhode Island General Assembly, says Fraser, warning that its passage would result in facilities closing throughout the state. “No other state has adopted such a high standard,” he says, noting that the Washington, DC-based American Health Care Association estimates that this legislation would cost Rhode Island facilities at least $75 million to meet this standard and the need to hire more than 800 employees. 

Fraser calls for the “Nursing Home Staffing and Quality Care Act” to be defeated, noting that the legislation does not contain any provisions for funding.  “Medically, there is no proof that mandating a certain number of hours of direct care results in any better health outcomes.  This is an unfunded legislative mandate. If homes are forced to close, not only would residents be forced to find a new place for their care, but hundreds of workers would also be forced out of work,” he says.

Goodwin does not believe that mandating minimum staffing requirements in nursing homes will force nursing homes to close. She noted that the legislation is aimed at ensuring nursing home residents receive adequate care and that Rhode Island is the only state in the northeast without such a standard.

“There is an un-level playing field in nursing home staffing in Rhode Island,” charges Goodwin, noting that many facilities staff 4.1 hours per day, or close to it, while others only provide two hours of care per day. “In either case, the overwhelming majority of well-staffed and poorly-staffed nursing homes remain highly profitable,” she says. 

According to Goodwin, the lack of staffing and certified nursing assistants (CNAs) is due to unreasonable workloads and low pay. “RIDOH’s CAN registry makes it clear that retention of these workers is a big issue. This is in part because they can make as much money – or more – in a minimum wage profession with much less stress,” she adds, stressing that “The Nursing Home Staffing and Quality Care Act” directly addresses these staffing challenges.

One quick policy fix is to provide nursing home operators with adequate Medicaid reimbursement to pay for increased staffing.  Lawmakers must keep McKee’s proposed increase of nursing home rates pursuant to statute, requiring a market-based increase on Oct. 2021, in the state’s FY 2020 budget. The cost is estimated to be $9.6 million.

With the House panel recommending that Slater’s companion measure ((2021-H-5012) to be held for further study, Goodwin’s chances of seeing her legislation becoming law dwindles as the Rhode Island Assembly’s summer adjournment begins to loom ever closer. There’s probably no reason to insist that a bill be passed in order to have a study commission, so this could be appointed right away if there is serious intent to solve this problem.

Slater’s legislation may well be resurrected in the final days of the Rhode Island General Assembly, behind the closed doors when “horse-trading” takes place between House and Senate leadership.  If this doesn’t occur, either the House or Senate might consider creating a Task Force, bringing together nursing home operators, health care professionals and staff officials, to resolve the state’s nursing home staffing crisis. 

RI Senate Tackles High Cost of Prescription Drugs – Herb Weiss

Published in RINewsToday.com on March 15, 2021

In the shadow of the COVID-19 pandemic, as Governor Dan McKee and the Rhode Island General Assembly move to hammer out their Fiscal Year 2022 budget, Senate lawmakers push a package of eight legislative proposals to put the brakes on skyrocketing cost of prescription drugs.

The Senate resolution (2021-S 0560) sponsored by Senate Majority Whip Maryellen Goodwin (D-District 1, Providence), has already been passed and complements the prescription drug affordability package that will be considered next week that would require health insurers to provide coverage, without cost sharing, for colorectal screenings and follow-up colonoscopies when necessary.

The package of legislation aims to protect Rhode Islanders by limiting copays for insulin, capping out-of-pocket expenses for high deductible plans, requiring health insurers to cover preventive colorectal cancer screening, eliminating clauses hidden in pharmacy contracts that prevent a pharmacist from talking about more affordable options, requiring transparent pricing information, importing wholesale prescription drugs from Canada, and creating a board responsible for evaluating and ensuring drug prices are affordable. 

According to Greg Paré, the state Senate director of communications, this package of legislative proposals was developed in conjunction with AARP during the off session before the 2020 Senate session and first submitted last year, but legislation considered last session was limited due to the pandemic and so it did not pass. The legislation has been resubmitted this year with some small modifications and remains a Senate priority.

Last year, AARP along with 14 groups including, the Alzheimer’s Association, the American Cancer Society Action Network, and Aging in Community, urged lawmakers to pass the package of legislative proposals.  Expect to see some of these groups again call for passage of either the total package or specific bills at a Senate Health and Human Services Committee’s virtual hearing, chaired by Sen. Joshua Miller, on Thursday, at 5:00 p.m. For the hearing’s agenda, go to: For hearing details go to: https://bit.ly/3ezofmJ.

Passage of this legislative package would require action by both the Senate and House. At press time, not all of the Senate bills have companion measures in the House.   

Controlling the Skyrocketing Increase of Prescription Drugs

Here are specifics about the Senate’s prescription drug affordability legislative package that will be considered next week by the Rhode Island’s Senate Health and Human Services Committee:  

Legislation (2021-S-0170 sponsored by Sen. Melissa A. Murray (D–Dist. 24, Woonsocket, North Smithfield), would limit the copay for prescription insulin to $50 for a 30-day supply for health plans that provide coverage for insulin. Additionally, the bill mandates that coverage for prescription insulin would not be subject to a deductible.  

Legislation (2021-S 0381)sponsored by Senate Majority Leader Michael J. McCaffrey (D–Dist. 29, Warwick), would cap out-of-pocket expenses for prescription drugs at the federal minimum dollar amount for high-deductible health plans, currently $1,400 for individual plans and $2,800 for family plans.    

The bill (2021-S-0383), sponsored by Senator Goodwin (D–Dist. 1, Providence), would save lives by requiring health insurers cover preventive colorectal cancer screening in accordance with American Cancer Society (ACA) guidelines. This coverage must be provided without cost-sharing and includes an initial screening and follow-up colonoscopy if screening results are abnormal. The ACA recommends people at average risk of colorectal cancer start regular screening at age 45.  

A bill (2021-S -497) sponsored by Sen. Walter S. Felag Jr. (D–Dist. 10, Warren, Bristol, Tiverton) would allow consumers to pay less for their prescription drugs by banning gag clauses sometimes found in pharmacy contracts that prevent a pharmacist from talking to a customer about more affordable options.   

This bill (2021-S-0494) would require pharmaceutical drug manufacturers, pharmacy benefit managers, health insurers, and hospitals to disclose certain drug pricing information. Such transparency would help payers determine whether high prescription costs are justified. This bill is sponsored by Senate President Dominick J. Ruggerio (D – Dist. 4, North Providence, Providence).  

This bill (2021-S-0499), sponsored by Sen. Louis P. DiPalma (D–Dist. 12, Middletown, Little Compton, Newport, Tiverton), would create a state-administered program to import wholesale prescription drugs from Canada, which has drug safety regulations similar to those of the United States. Such programs are allowed under federal rules, with approval from the U.S. Department of Health and Human Services. 

This legislation (2021-S0498) would create a prescription drug affordability board tasked with investigating and comprehensively evaluating drug prices for Rhode Islanders and possible ways to reduce them to make them more affordable. The bill is sponsored by Sen. Cynthia A. Coyne (D–Dist. 32, Barrington, Bristol, East Providence). 

The bill (2021-S 0496) introduced by Sen. Felag (D-District 12, Bristol, Tiverton, Warren) aims to protect consumers from unexpected changes in their health plan’s formularies (list of covered drugs). Under the legislation, formulary changes can only be made at the time of health plan renewal, if the formulary change is made uniformly across all identical or substantially identical health plans, and if written notice is provided 60 days or more before the change. 

Seniors Hit Hard by High Price of Prescriptions

“The high price of prescriptions is having a severe impact on Rhode Islanders, particularly older residents,” said Ruggerio, noting the state’s population is one of the oldest in the nation.  “Many older Rhode Islanders have limited means, and the high cost of prescriptions means people are 

Ruggerio warns that the pharmaceutical industry is not going to address this on its own, so it’s up to the state and federal governments to take action.”

Maureen Maigret, Co-Chair, Long Term Care Coordinating Council, observes that with Medicare paying the tab for costly pharmaceuticals, controlling rising drug costs is a federal issue.  “But this is a big issue to address for those with low and moderate incomes under-insured for prescription drugs,” she says. “I applaud the Senate legislative package aimed at controlling the cost of prescription drugs for Rhode Islanders, says Maigret, who cites the findings of a Kaiser Family Foundation survey that shows one out of four persons take four or more prescription drugs and more than one-third say that have difficulty taking their medication properly due to cost.  “Seniors may fail to get prescriptions filled, resort to pill splitting or skipping doses. Some may end up with costly hospital Emergency Rooms or inpatient visits as health conditions worsen due to the inability to afford their medications, notes Maigret, calling for lawmakers to make necessary prescription drugs affordable for all who need them. Maigret says, “It is time to make necessary prescription drugs available for all who need them.”

“AARP Rhode Island is eager to work with both the Senate and the House of Representatives to pass this important legislation designed to lower prescription drug costs,” said AARP State Director Kathleen Connell. “The high cost of drugs leads families – and particularly older Rhode Islanders on fixed and limited incomes — to often make impossible decisions. No one should have to choose between paying rent, providing food for themselves or their family and vital prescription medications that keep them healthy,” she says.

We look forward to working with legislators from across the state to help improve the health and financial stability of everyone by lowering the cost of prescription drugs. We thank Senate President Ruggerio for once again bringing forth this very important legislation,” adds Connell.

It’s mid-March. Lawmakers turn their attention now to passing the state budget.  Even if the Senate passes every bill in the prescription drug affordability package, the lower chamber must pass companion measures for these bills.  When passed, Governor Dan McKee must sign the legislation to become law.  Right now, it’s an uphill battle and Rhode Islanders must call on their state lawmakers to get on board to support bills to reduce the high cost of pharmaceuticals.  It’s the right thing to do. 

Things that You Should Know 

This meeting will be streamed live online through Capitol TV:

http://www.rilegislature.gov/CapTV/Pages/default.aspx

Written testimony is encouraged and can be submitted prior to 2:00 PM on Thursday, March 18, 2021, in order for it to be provided to the members of the committee at the hearing and to be included in the meeting records. Finally, if you are interested in providing verbal testimony to the committee at this hearing, please go to the following link and make your request by 4:00 p.m., on Wednesday, March 17, 2021:  https://bit.ly/3bIJAs2

Never forgetting will help us keep the promise of “never again.”

Published in RINewsToday.com on February 1, 2021

During a Pro-Trump rally, as thousands of rioters swarmed the US Capitol on Jan. 6, Robert Keith Packer, sporting an unkempt beard, came wearing a black hoodie sweatshirt emblazoned with the phrase “Camp Auschwitz,” in white letters, the name of the most infamous of the many Nazi concentration camps where 1.1 million people were murdered during World War II.  Under a skull and bones at the bottom of his shirt was the phrase, “Work brings Freedom,” a loose translation of the phrase “Arbeit macht frei” that was inscribed above the main entrance gate at Auschwitz and other concentration camps’ gates. 

Packer’s image, 56, a former welder and pipefitter, was circulated widely on social media and by newspapers, evoking shock and disbelief.

Packer, a resident of Newport News, Virginia, was not the only anti-Semitic rioter that day, according to a report released by the Miller Center for Community Protection and Resilience at Rutgers University-New Brunswick and the Network Contagion Research Institute. The report identified at least half a dozen neo-Nazi or white supremacist groups involved in the failed Capitol Insurrection who had also attended President Trump’s “Save America” rally speech. 

In recent years, anti-Semitic incidents have become more common in the Ocean State.

In 2017, the Providence Journal reported that the New England chapter of the Anti-Defamation League recorded 13 incidents of anti-Semitism in Rhode Island. Nazi swastikas were painted on a Providence building, at Broad Rock Middle School in North Kingstown, and even at a Pawtucket synagogue.

Anti-Semitism is Nothing New

But, anti-Semitism, exhibited at the “Save America” rally, has been in our country since its founding, and in fact, has been around western societies for centuries.  Over three years ago, torch marchers, some wearing Nazi-style helmets, carrying clubs, sticks and round makeshift shields emblazoned with swastikas and other Fascist symbols, and others entered the one-block square in downtown Charlottesville, Virginia, to protect a controversial Confederate monument, chanting “Jews will not replace us” and “Blood and Soil” (a Nazi rallying cry).  

The Anti-Defamation League’s (ADL) 2014 Global Index of Anti-Semitism documented world-wide anti-Semitism. The survey found that more than 1 billion people – nearly one in eight – around the world harbor anti-Semitic attitudes. Carried out by First International Resources and commissioned by the ADL, this landmark survey included 53,100 adults in 102 countries representing 88 percent of the world’s adult population.

Over 30 percent of those surveyed said it was ‘probably true’ that Jews have too much control over financial markets, that Jews think they are better than other people, that Jews are disloyal to their country, and that people hate Jews because of the way that Jews behave. 

Most troubling, the ADL study found a large gap between seniors who know and lived through the horrendous events of World War II, and younger adults who, some 75 years after the Holocaust, are more likely to have heard of or learned that six million Jews were exterminated by the Nazis’ “Final Solution.” Nearly half of those surveyed claim to have never heard of the Holocaust and only a third believe historical accounts are accurate.

Gearing Up to Fight Antisemitism

On Jan. 14, the American Jewish Congress (AJC), a global Jewish advocacy organization, briefed the FBI on the continuing threats of anti-Semitism to the nation. 

“Antisemitism fundamentally is not only a Jewish problem; it is a societal one. It is a reflection on the declining health of our society,” Holly Huffnagle, AJC’s U.S. Director for Combating Antisemitism, told the FBI officials on a video conference briefing. “Education is essential, to clarify what constitutes antisemitism, the various sources of this hatred, and what effective tools are available for law enforcement to fight antisemitism,” she said.

The presentation of AJC’s second annual report on antisemitism in the U.S. took place in the wake of the January 6 assault on Capitol Hill, where anti-Semitic images and threats were openly conveyed by some of the rioters.

AJC’s 2020 report, based on parallel surveys of the American Jewish and general populations, revealed that 88 percent of Jews considered antisemitism a problem today in the U.S., 37 percent had personally been victims of antisemitism over the past five years and 31 percent had taken measures to conceal their Jewishness in public.

In the first-ever survey of the general U.S. population on antisemitism, AJC found a stunning lack of awareness of antisemitism. Nearly half of all Americans said they had either never heard the term “antisemitism” (21 percent) or are familiar with the word but not sure what it means (25 percent).

The AJC experts praised the FBI for its annual Hate Crimes Statistics report, which provides vital data on antisemitism. The latest report found 60.2 percent of religious bias hate crimes targeted Jews in 2019. But the report historically has not provided a full picture of the extent of hate crimes, since reporting by local law enforcement agencies is not mandatory.

To improve the monitoring and reporting of hate crimes, AJC continues to advocate for passage of the Jabara-Heyer National Opposition to Hate, Assaults, and Threats to Equality (NO HATE) Act. This measure will incentivize state and local law enforcement authorities to improve hate crime reporting by making grants available and managed through the Department of Justice.

In addition, AJC is asking the FBI to use the International Holocaust Remembrance Alliance (IHRA) Working Definition of Antisemitism as an educational tool. The definition offers a clear and comprehensive description of antisemitism in its various forms, including hatred and discrimination against Jews, and Holocaust denial. 

FBI officials in the Bureau’s Civil Rights Unit, Intelligence Division, and Community Outreach Program, among others, participated in the AJC briefing.

Keeping the memory alive about the Holocaust is key to fighting antisemitism, says Andy Hollinger, Director of Communications, for the United States Holocaust Memorial Museum (USHMM). “”We are seeing a disturbing trend in the rise of antisemitism and the open display of neo-Nazi symbols, most recently at the attack on the U.S. Capitol. This is a long-time problem requiring a long-time solution. We must remember. Education is key. We must learn from this history-learn about the dangers of unchecked hatred and antisemitism. And we must not be silent,” he says.

Adds Bill Benson, who has interviewed Holocaust Survivors before live audiences at the USHMM’s First Person program for more than 2 decades, observes that the majority of those visiting the museum are not Jewish and many of have little familiarity with the Holocaust, and as a result of their visit are profoundly affected by their experience. “The USHMM provides an extraordinary avenue for educating the general public about the Holocaust and anti-Semitism for those millions who visit it, but it is essential that many millions more learn the truth about anti-Semitism and that must done through our educational systems,” he notes.

“The USHMM does an incredible job of educating and assisting teachers who want to teach about the Holocaust, but far too many school systems do not teach about the Holocaust, without which the gulf in knowledge and awareness may only grow as we lose those first-hand knowledge of the Holocaust,” says Benson.

A 2009 report, “Jewish Survivors of the Holocaust Residing in the United States Estimates & Projections: 2010 – 2030,” prepared by the Berman Institute-North American Jewish Data Bank, for the Conference on Jewish Material Claims Against Germany, estimated that 36,800 Holocaust survivors would still be living by 2025. As the number of survivors who witnessed the horrors of Genocide and the Holocaust during World War II continues to dwindle, a growing number of states, including Alabama, Florida, Georgia, Illinois, New Jersey, Ohio, and Texas, and have established Commissions to keep this knowledge alive to millennials, GenZ and  younger generations through educational programming and raise awareness through public education and community events to provide appropriate memorialization of the Holocaust on a regular basis throughout the state.

If the Rhode Island General Assembly legislates the establishment of a Rhode Island Genocide and Holocaust Education Commission, its motto might just be, “Never forgetting” will help us keep the promise of “Never Again.”