Tag Archives for Rhode Island Health Care Association

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.

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Senior groups ask House leadership for an “Age-Friendly Rhode Island” budget

Will House Leadership’s Budget Proposal Create an “Age-Friendly” State?

Published in RINewsToday on February 6, 2023

Over two weeks ago, Gov. Dan McKee unveiled his $13.8 billion proposed FY 24 Budget. To members of the aging community, the reaction is that this budget shortchanges seniors.  In an e-blast sent to 1,800 seniors and aging advocates, the Senior Agenda Coalition of Rhode Island (SACRI) described the proposed budget as unfriendly to seniors.

“Governor McKee’s proposed FY2024 budget that would take effect on July 1, 2023, ignores the needs of Rhode Island’s rapidly-growing older population,” noted SACRI, which represents 21 organizations with allied concerns. The budget document will reflect what lawmaker’s value and “as it stands, this budget fails to value us,” states the email.

Calls for creating an “Age Friendly” budget  

The SACRI legislative alert highlights how McKee’s FY 24 budget proposal is “senior lite,” noting that it provides minimal increases in funding for senior centers and Meals on Wheels.  More concerning, “it does nothing to address the larger investments needed to enable a growing number of seniors to age in the community.”

SACRI says the budget proposal has ignored requests from advocates and the community, even some requests that came from the RI Office of Healthy Aging (RIOHA). Specifically, the Governor’s budget did not include funding for additional RIOHA staff, in particular for its Adult Protective Services that received over 6,000 calls last year.

“For fourteen years we’ve urged the state to invest in improving The Point, but our requests have fallen on deaf ears. At community meetings with seniors and their caregivers of all income levels, we found their most frequent and compelling complaints were about their great difficulties in finding reliable information about available support and service options,” says SACRI, noting that very few seniors, or their adult children caregivers, even know that The Point exists. “But they are very well aware that without reliable and timely information about home and community-based care, their least-desirable and most expensive choice – nursing home care – often becomes the default,” says the legislative alert email,” he stated.

According to SACRI, the FY 2024 budget didn’t include increased Medicaid reimbursements to homecare and nursing home providers to raise their direct care workers’ wages and reduce workforce turnover. Nor did it include financial aid to help low and moderate-income seniors pay their Medicare Part B premiums and co-pays, as many other states have done.

The Ask…

SACRI is calling on House Speaker Joe Shekarchi (D-Warwick) and Senate President Dominick Ruggerio (D-Providence, North Providence) to support an “Age Friendly Budget.”  Why not improve funding for aging programs and services that ultimately benefit everyone in their later years?

More older Rhode Islanders are going to need to access programs and services to allow them to age in place at home. “Seniors strongly desire to “age in the community,” but the services that allow them to do that are often hard to find or simply unavailable. SACRI’s budgetary wish list includes increasing the minimum salaries of senior home care and nursing home care workers to $20 per hour, that’s a 50% federal match.

SACRI also calls for allocating $500,000 in first-time state funding for major improvements to The Point to provide information and referral services for seniors and their caregivers. This increased funding never made it into the FY 2024 budget proposal outlined in Gov. McKee’s Jan. 17th State of the State Address.

“With Rhode Island’s aging population skyrocketing, why not add five staff persons requested by the RIOHA, two of whom will work in its Adult Protective Services Program,” says SACRI. 

Finally, SACRI says the House budget should also include a provision to raise the income level for seniors to qualify for the Medicare Premium Savings Plan to save seniors close to $2,000 per year. Older Rhode Islanders are becoming poorer with higher numbers falling below the 2023 federal poverty level of $14,580 for a single person and with 28% of older households trying to live on less than $28,000 per year.”

The Aging Network speaks…from the front lines

Maureen Maigret, Chairperson of the Aging in Community Subcommittee for the Long-Term Care Coordinating Council (LTCCC), says that the “Age-Friendly Budget” proposed by SACRI is right on target with the needs of Rhode Island’s older population.

“More than ever, we need to address and adequately fund the services and supports that keep older persons living at home as long as possible. It is especially important for those aged 75 and over as one-half may need supports to remain living at home at the same time that their incomes start to decrease while their healthcare costs increase,” she says.

“The ‘Age-Friendly’ Budget Plan also aligns nicely with the strategic objectives and actions of the Strategic Plan of the LTCCC:s Aging in Community Subcommittee yet to be accomplished,” says Maigret, noting that lawmakers should view funds requested as wise investments that will help older adults remain living at home – where most wish to be – and prevent the use of much higher costs for nursing home care.

“Apparently, the Governor and his staff haven’t fully understood nor been sensitive to the struggles that the aging community has faced since the pandemic – more than 90% of the deaths in RI were individuals over 60, and 52% of the overall deaths were congregate care residents. Many are still frightened, isolated, hungry, and need community homecare or a caregiver,” says Vin Marzullo, who served 31 years as a career federal civil rights & social justice administrator at the National Service Agency.

Marzullo adds, “The Governor’s budget doesn’t provide any vision for an Age Friendly RI – which was to begin in FY2023 according to a 2019 RI OHA Strategic Plan,” adds Marzullo. “We have no coordinated path/strategy to build greater local capacity & support services for our growing aging population.”

“The McKee administration has yet to develop a Comprehensive Master Plan for Aging in RI despite a series of community conversations (Rhode Island 2030) during the Fall of 2021 and commitments made to the elderly during the 2022 Gubernatorial campaign,” charges Marzullo.

Other aging advocates had their views of McKee’s budget proposal

While they are appreciative that the Governor’s budget proposal fully funds the statutory nursing home inflation index of 5.4% plus a 1.5% labor add-on effective October 1, 2023, John Gage, President and CEO of Rhode Island Health Care Association (RIHCA) warns about a major issue facing Rhode Island nursing facilities. “The minimum staffing mandate that was passed in 2021 is largely an unfunded mandate and is impossible to comply with given the 20% reduction in the Rhode Island nursing facility workforce just since the start of the pandemic,” he says.

“RIHCA will work together with the Governor, the House Speaker, and the Senate President for short-term relief from the staggering penalty provisions of the minimum staffing mandate statute – fines estimated at $55-60 million in the first year of full implementation and nearly two-thirds of facilities being prevented from admitting residents after three quarters of their inability to comply by automatic admissions freezes,” he says. There are simply not enough workers to employ to meet the mandate, and fines of this magnitude would devastate the industry and lead to further facility closures,” he adds.

“The Rhode Island Senior Center Director’s Association (RISCDA) is focused on gaining funding requested by RIOHA Director Cimini for increased staffing, fully funding the Point, and supporting senior centers more fully with a funding formula that gets us to the rate of $10/person for non-institutionalized individuals 65 and over residing in each municipality,” says Robert Robillard, RISCDA’s president. “Shoring up services with funding will benefit not just our elders, but their families and caregiver’s alike,” he noted.

According to Robillard, the Governor’s presented budget includes a $200,000 increase for senior centers across our state. This is split between 39 communities based on the number of seniors living in each of the municipalities. “As we are pleased to see this movement to support senior centers more fully, [even with the additional funding] there are gaps within the system of care for our elders here in Rhode Island,” he says.

James Burke Connell, Executive Director, Age-Friendly Rhode Island, agrees with Robillard’s assessment of the key role senior centers play in Rhode Island’s long-term care continuum and the need for increased funding. “No, there isn’t sufficient funding toward the goal of making Rhode Island a great state in which to age, and I’m particularly concerned that the RIOHA will be under resourced to meet the needs of senior centers and older adult Rhode Islanders in general. Senior centers are the hubs of services and programs in every community, and they need greater support from our state, principally through significant increases in RIOHA’s capacity to support our aging population,” he says.

The McKee administration responds…

In responding to SACRI’s charges that McKee’s proposed budget was not “Age Friendly,” Derek Gomes, spokesperson for the state’s Pandemic Recovery Office says, “a single budget cannot address everything that the Administration is committed to accomplishing.” He noted that the Administration will work every year to make meaningful progress toward improving the quality of life for older Rhode Islanders and all the goals in RI 2030.

According to Gomes, the Governor’s proposed budget invests in older Rhode Islanders by including an additional $200,000 for senior centers, an additional $100,000 for Meals on Wheels, and $250,000 to digitalize an essential record of service that military veterans use to receive their benefits. The 2022 November Caseload Estimating Conference increased funding for long-term care by approximately $40 million in all, across Fiscal Year 2023 and Fiscal Year 2024, including a 6.9% rate increase for nursing facilities.

The battle of Rhode Island’s Fiscal Year 2024 budget moves to the House Finance Committee and ultimately for a vote on the House and Senate floor. It’s crucial that House Leadership begin the process of increasing funding for aging programs and services to move Rhode Island closer to becoming an “Age Friendly” state. Every taxpayer will ultimately benefit, because each one will ultimately have to access programs and services to allow them to age in place at home in their community.  

SACRI is planning a Legislative Leadership Forum scheduled for March 22, 2023, at Warwick’s Crowne Plaza. Save the Date. Stay tuned for details. https://senioragendari.org/

Aging groups gear up to support candidates in primaries, mid-terms

Published in RINewsToday on June 20, 2022

In just 140 days, seniors will go to the polls to cast ballots for candidates who they believe will lead the nation in the right direction.  Over three months ago, the Washington, DC based AARP, the nation’s largest senior advocacy group announced the kick-off of its Voter Engagement Campaign, designed to maximize the influence that older voters have on who controls the House and Senate. Whoever controls the majority of each chamber sets the legislative agenda for the next two years. So, it is appropriate that this election cycle’s theme is “Our Voices Decide.”

“As they do in every election cycle, voters 50-plus will decide who will hold power in state capitals and in Washington, DC in this year’s midterms,” says Khelan Bhatia, AARP’s director of voter engagement, in a March 1, 2022 blog article, “AARP Voter Engagement Campaign Underway,” penned by AARP’s Dena Brunis, who covers health care, health policy and Congress.

According to AARP, voters will be faced with new voting rules and may have to vote at a different polling place because of the results of the 2020 census that has led to redistricting for both state legislative and congressional districts in different states.

AARP’s Voter Engagement Campaign will also “remind candidates from both sides of the aisle that voters 50-plus are the most important and reliable voting bloc,” Bhatia says in the AARP Blog Posting, “Government and Elections.”

The blog post notes that the voter education campaign website is designed to serve as a one-stop portal for voters to get pertinent details and news about the upcoming election. This website will provide key dates of primaries along with individualized state election guides detailing methods and rules for voting at polling places for all 50 states, the District of Columbia, Puerto Rico and the Virgin Island.

AARP will also disseminate voting information and poll results of 50-plus voters in key states through the AARP website, direct mail, email, social media and digital and radio advertising.  The aging organization will also make sure that this information is also communicated with communities of color across the nation in multiple languages.

Finally, AARP will keep its 35 million members updated on all election issues and news, alerting them to local events, tele-town halls and candidate forums, too.

Taking a look at the upcoming Rhode Island gubernatorial primary

In less than 5 months, Rhode Islanders will go to the polls to elect the state’s next Governor for a 4-year term. Who that person will be and what they promise to deliver to benefit older Rhode Islanders is an essential question for the state’s 275,000 voters, ages 60 and older, says Executive Director, Bernie Beaudreau, of the Senior Agenda Coalition of Rhode Island (SACRI) in a statement announcing their gubernatorial forum on senior issues to take place in August.

Rhode Island seniors 60 and older represent 34% of all registered voters and accounted for 42% of the vote in the 2020 general election. Rhode Island seniors have higher voter participation rates than the rest of the population: 77% compared to 57% for voters under 60 years of age, he says, suggesting that this voting bloc can influence the primaries outcome.

SACRI announces the scheduling of a forum for the 2022 gubernatorial candidates to speak at on Wednesday, August 3, 2022, from 9:30 a.m. to 11:30 a.m. at East Providence High School Auditorium, to address issues that will impact Rhode Island’s aging population. 

SACRI’s co-sponsors, organizations that actively advocate on behalf of Rhode Island’s seniors, include: 

Alzheimer’s Association Rhode Island Chapter, A Community Together, Carelink, Community Provider Network of Rhode Island, Economic Progress Institute, Leading Age Rhode Island, NAACP Providence Branch, Ocean State Center for Independent Living, PACE, Rhode Island Assisted Living Association, RI Elder Info, Rhode Island Health Care Association, Rhode Island Organizing Project, Rhode Island Senior Centers Directors Association, SEIU Health Care 1199 and The Village Common of Rhode Island.

Beaudreau says that the candidates will be given questions in advance on aging issues impacting the Ocean State.  Each candidate will have the opportunity to answer the questions, chosen in random order by a moderator. The questions will be asked by practitioners from each topic area and the candidates are expected to respond by presenting their own policy platform for addressing senior concerns.  

According to Beaudreau, the forum’s overarching question is,What will our next governor do to ensure the well-being of seniors considering the forecasted population growth of older Rhode Islanders? Many more seniors will need services ranging from affordable housing, transportation, supports for aging at home, and long-term care, he said.

Seating for the forum is limited to 450 people, leaving space for social distancing in the high school’s new 900-seat capacity auditorium. The event will also be live-streamed for attending virtually. To register go to www.SeniorAgendaRI.org.  RINewsToday is planning to attend to inform those who can’t attend in person.

Get the latest information on how to and where to cast your ballots at the upcoming mid-term elections.  Go to www.aarp.org/politics-society/government-elections/info-2022/state-voting-guides.html Here are some key senior issues that may well influence the upcoming mid-term elections.  Go to www.aarp.org/politics-society/government-elections/info-2022/older-voters-midterm-issues.html