Tag Archives for Rhode Island Health Care Association

Benefits for seniors from Rhode Island’s next budget

Published in RINewsToday on June 17, 2024 

With a 35-2 vote in the Senate early on Friday the Senate gave its approval for a $13.963 billion budget for the 2025 fiscal year, comprising 13 articles that direct additional funding toward education and children, raises Medicaid reimbursement rates, health care support, and includes a $120 million affordable housing bond. The 300-page budget bill – read here, 2024-H 7225Aaa has now gone to Gov. Dan McKee, who is scheduled to sign it at an event Monday, June 17, at 11:15 a.m. in the State Room on the second floor of the State House.

Rhode Island’s FY 2025 Budget and Seniors

House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick) reeled off specifics as to how this year’s budget proposal impacts senior programs and services, noting that it aims to lower the rising housing and health care costs that impact the quality of life of older Rhode Islanders. “We have asked the voters to approve an additional $120 million in funds to increase affordable housing production. The budget accelerates a commitment to raising Medicaid reimbursement rates for services to care for our most vulnerable seniors and people living with disabilities to stabilize our health care and human service provider networks,” noted Shekarchi. 

Under the budget proposal tax relief is provided to seniors who rely on retirement income, raising the exemption to $50,000 for qualified single filers and $100,000 for joint filers. It also repeals the suspension of annual cost of living (COLA) adjustments for retirees in the state pension system who retired before 2012 and moves up the timeline for resumption of COLA for other state retirees. 

Lawmakers changed the calculation for pension benefits to base it on the highest three consecutive years of earning instead of five. Finally, the House Speaker noted that this budget fully funds Medicaid rate increases for home care and other services that help seniors age with dignity in the community and stay in their homes if they so desire, and also increases support for services provided in nursing or assisted living settings. 

Adds Senate President Dominick J. Ruggerio(D-Dist. 4, North Providence, Providence), “I am pleased that the budget will invest in many Senate priorities, particularly in the areas of health care, child care, education and providing some needed relief to retirees,” says Ruggerio. “Specifically, the budget incorporates $2.7 million for primary care provider training sites, as well as $500,000 for tuition assistance for students who enter the primary care field and remain in Rhode Island. The budget also includes funding for purchasing medical debt for pennies on the dollar,” he says. 

But how does the aging network view this spending plan? 

According to Maureen Maigret, Policy Advisor with the Senior Agenda Coalition of RI (SACRI), under the spending plan approved by the Assembly $103.2 Million in all funds was added to the Governor’s proposed budget to fully fund the social and human service provider rate increases as recommended by the state’s Office Health of Insurance Commissioner (OHIC) based on the comprehensive legislatively mandated Rate Review Study performed in 2023. According to Maigret, who served as a member of the Advisory Task Force for the Rate Study, the full funding was especially important for those older adults and persons with disabilities seeking access to home and community services. 

“Too many persons on Medicaid have been waiting three months or longer to access needed home care supports which can cause health to deteriorate or to consider nursing home placement at far more expense to the state,” Maigret said. Maigret noted the increases would raise rates for providers of home care, assisted living, shared living and adult day services – all critical to helping persons with support needs to be able to stay at home where most persons with care needs prefer to live. 

Senior Agenda Coalition has worked for many years to promote better access to home and community-based services and to advocate for better wages for the direct care workers who provide this care,” she added, noting that these individuals are usually women, mostly women of color, and for too long have been undervalued and underpaid she noted. In 2022 the SACRI advocated with the legislature to set a minimum wage of at least $17/hour; however, the budget only called for a minimum of $15/hour. With full funding for the recommended home and community care provider rates, we would like to see these essential workers get a minimum starting wage of at least $25/hour in order to recruit and retain the necessary workers. 

SACRI also successfully pushed along with other housing advocates for the addition of $20 Million more to the Housing Bond to go on the November ballot for a total of $120 Million, Maigret added, noting that the coalition continues to advocate for paying adequate attention to the housing needs of older adults in the allocation of the bond funds. “Increasing affordable housing options for this population is critical,” says Maigret, stressing that census data shows that 53% of older RI renters pay more than 30% of their income on housing and studies show that 43% of extremely low-income RI renters are seniors. In the housing space, passage of bills to streamline development of Accessory Dwelling Units (ADUs) advanced by House Speaker Shekarchi along with most of his housing package was also a major win for expanding housing options and development. 

The legislature also addressed SACRI and its advocacy partners push to increase income eligibility for the Medicare Savings Program (MSP) that helps lower-income Medicare enrollees not on Medicaid afford needed healthcare and save dollars for other needed basic needs by covering Part B premiums ($176/month in 2024) as well as required co-payments for some with very low-incomes. “The budget includes a provision requiring the state to seek federal approval to increase the eligibility for the Medicare Savings Program for “qualified individuals” (currently persons with annual income between $18,312 and $20,331) up to 185% of the federal poverty level ($27,861),” says Maigret, adding that the Coalition plans to monitor the approval process and to seek additional legislation, if needed, next Legislative session to further expand the program. Maigret says that lawmakers expanded the Temporary Caregiver Insurance Program up to 8 weeks but SACRI was disappointed that siblings and grandchildren were not added to the list of persons for whom a worker could get paid leave.

“We will continue to advocate for these additions and to increase the number of weeks of leave up to 12 which is provided by most states that have such a program,” she says. And finally, SACRI will continue to advocate for additional funding for the Office of Healthy Aging to provide each of our communities with at least $10/per person age 65 and over to help support local senior centers and programs for older adults, says Maigret, as well as increasing the income cap to $50,000 for eligibility for the state Property Tax Relief Program (called the Circuit Breaker program) that provides a tax credit or refund for older homeowners and renters and those on Social Security Disability. 

FY 2025 Budget Helps State’s Nursing Homes  

James Nyberg, Executive Director  of LeadingAgeRI is pleased with the infusion of much-needed funds in the FY 2025 Budget to help support financially-distressed nursing homes as they continue to provide quality care in a very difficult environment.  “The providers are clearly in distress and we need to avoid any further closures to ensure access to care, resident choice and well-being, and support for the workforce,” he says.  “We also are grateful that the OHIC-recommended rate increases for various programs, including assisted living and adult day services, were expedited with full implementation this October.  Assisted living providers are scheduled for a 10.8% rate increase and adult day a 19.8% increase.  This will help support our home and community-based providers and those for whom they care, says Nyberg, who serves on the Advisory Task Force for the Rate Study. Lastly,

LeadingAgeRI supports the FY 25 Budget’s increase in the housing bond to $120 million, and calls for a portion of it to be used to expand safe and affordable senior housing, the lack of which is well-documented, including a recent report by the Long-Term Care Coordinating Council. According to Nyberg, one legislative priority that remains is to establish a Medicaid rate add-on for private rooms in nursing homes, since Medicaid is the primary payer for nursing home care.  “This would be an important step in helping to support a more homelike environment and resident privacy and dignity,” he says.

“RI nursing homes have been chronically underfunded since the implementation of the reimbursement methodology over thirteen (13) years ago,” charges John E. Gage, President & CEO of the Rhode Island Health Care Association, representing 62 nursing home providers. “Cuts to the annual inflation index, failure to re-base rates every three years since, and skyrocketing costs since the beginning of the pandemic have put RI nursing facilities at significant financial risk,” he says.

“The FY ’25 Budget passed the Rhode Island General Assembly includes funding for the first-ever rebase of Medicaid Rates since the inception of the Priced Based Reimbursement System back in 2013,” says Gage, noting that this increase represents a 14.5% increase with an estimated increase in revenue of $66 million beginning October 1, 2024, based on actual expenses from the most recent Medicaid Cost Reports from 2022. 

Additionally, Gage says that the budget as passed includes $10 million in State Fiscal Recovery Fund Grants to stabilize RI’s nursing facilities from July 1, 2024, through the implementation of the new rates on October 1. 

Pension changes initiated 

“Our primary task during this past General Assembly session has been to strongly support Bill H-8193, introduced by Rep. Pat Serpa, which would see the return of the COLA which was so ruthlessly slashed away in 2011. It applied to all current and future retirees, including teachers, state workers, and some municipal employees, says Sandra Paquette, representing Advocates for COLA Restoration and Pension Reform, a non-profit representing 4,700 retirees.

However, the actual pension provision in this year’s budget provides for the restoring of a compounded COLA to those who retired prior to July 1, 2012, notes Paquette. “Initially, this was a disappointment to our organization, as we had hoped for much needed relief for all who have been so detrimentally affected by Rhode Island Retirement Security Act — creating a financial crisis in the lives of so many lifetime workers. But further thought and consideration caused us to realize that the pension benefits in this year’s budget represent a huge step in a 13 year’s duration of no progress whatsoever in alleviating the injustice, she adds.

“And we are delighted that after so many years, older persons in the state retirement system who retired prior to 2012 will finally see a COLA,” says Maigret, “This is especially important for those who do not receive Social Security benefits.”

Editor’s Note: Added comments

Union thoughts…

Jesse Martin, Executive Vice President of SEIU 1199 NE and President of Rhode Island SEIU State Council said, “For months, union members of Rhode Island SEIU State Council have been working to raise awareness of issues that matter most to working Rhode Island families and, as a result, made great strides in healthcare, wages, funding, retirement, career training and more to the benefit of all. This year’s budget contains emergency funding to keep Linn Health open until August, provides funding to paraprofessional healthcare workers to help them advance in their careers, streamlines the hiring process at DHS and DCYF in order to attract new qualified candidates and finally enables domestic workers to earn the minimum wage. We thank all our elected leaders who offered their steadfast support and prioritized the needs of working Rhode Islanders.” 

The Rhode Island SEIU State Council, which is representative of all four SEIU affiliate locals, represents a variety of workers across the state, including healthcare, Department of Children and Families, Janitorial, Family Child Care, Department of Labor and Training, Security, Workforce Development and more. Nationwide, the Service Employees International Union represents over two million members.

Kathleen Gerard, Advocates for Better Care in Rhode Island, added, “”We were very glad to see the passage of the full Medicaid reimbursement increases recommended by the OHIC this session, and will continue to advocate for measures that ensure that our public funds are put towards the public good of improved wages for direct care staff and improved care for residents.” 

Advocates, providers on new Nursing Home mandates

Published in RINewsToday on April 29, 2024

In the shadow of Rhode Island’s ongoing staffing shortage, the Center for Medicare and Medicaid Services (CMS) issued its 329-page final rule on Nursing Home Minimum Staffing Standards (CMS 3442-F) on April 22 in the Federal Rule. 

CMS affirmed its commitment to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare-and Medicaid-certified long-term care facilities.  

According to CMS, over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.

Just the Nuts and Bolts

CMS say that central to its final rule are new comprehensive minimum nurse staffing requirements that would significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.  The agency is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities are given the flexibility to use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.

CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

This final rule provides a staggered implementation timeframe for facilities to meet the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors. The requirements of this final rule prioritize safety and health care quality while taking into consideration the unique workforce challenges some nursing homes are facing, especially those operating in rural areas. 

CMS will closely monitor and evaluate the provisions of this final rule, including but not limited to, the minimum staffing standards, the 24/7 RN requirement, the exemption process, and the definition of rural, as they are implemented over the next several years to determine whether any updates or changes are necessary in the future. 

Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

Provider, advocate positions on new CMS final rule

At press time, the RI Department of Health (RIDOH) had no comments about CMS’s new final rule released last week, say Joseph Wendelken, RIDOH’s public information officer.  The state agency is reviewing the rule and assessing its impact and applicability in Rhode Island,” he says.

With the final rules release, senior advocates and providers are expressing their opinion about its impact.

Former President Donald Trump, who is challenging President Joe Biden for the presidency, has not addressed quality of care in nursing homes with a formal position.  Kathleen Heren, Rhode Island’s Ombudsman, speculates that by releasing the CMS mandate before the upcoming presidential election, President Biden is just trying “to establish a record” of enhancing quality of care in nursing homes.

“Nursing homes cannot find  Registered nurses (RN), and Nursing Assistances to hire,” notes Heren.  The CMS mandate will force nursing homes to downsize, like we have just seen happen at the Scandinavian Home,” she predicts.

According to Heren, the final CMS rules do not include the minimum staffing of LPNs. More important, “it’s an unfunded mandate,” she says.

Gerontologist Deb Burton, MS, executive director of RI Elder Info, is pleased to see a Federal minimum staffing mandate of 3.48 hours of daily nursing care. “It’s important to understand mandates don’t make workers appear and a minimum staffing mandate is only an average amount of time allotted for care across all residents in the facility,” she says, noting that this rule doesn’t mean each resident will receive 3.48 hours of care each day.

According to Burton, the CMS Nursing Home Compare website, as of April 2024, notes there are 6 Rhode Island facilities that would not meet the lower federal minimum staffing mandate if it were enacted today. “The workforce shortage and the dire need to increase Medicaid reimbursements to attract and retain adequate staff with a proper wage are common topics of meetings,” says Burton. 

“When workers say ‘It’s only me on the floor – do I help the resident eat their supper or take the other resident to the bathroom? I can’t do both,’ – we need to listen,” says Burton. “The new federal minimum staffing mandate is a good step forward, but we need more. One day it will likely be us waiting for that workers’ help,” she warns. 

Like other RI senior advocates, Maureen Maigret, policy director for the Senior Agenda Coalition of RI, sees the importance of CMS releasing its final rules.  “It is important that these regulations have been finalized as providing for minimum nurse staffing levels in nursing homes helps  ensure residents across the country will receive quality and resident-centered care,”  she says. 

According to Maigret, Rhode Island has had a provision for 24/7 RN coverage even before the state’s minimum staffing law was passed so that is not a new requirement here. She pointed out the regulations will also promote transparency and accountability by requiring public reporting on how much of the Medicaid payments are spent on direct care staff and that the federal government has committed to invest over $75 Million in an initiative to increase the number of nurses working in nursing homes through such things as financial incentives for tuition reimbursement.   

“We are dismayed that the Biden Administration is moving forward with this one-size-fits-all staffing mandate,” says John E. Gage, President and CEO of the Rhode Island Health Care Association. “In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors in Rhode Island and across the country,” he warns, noting that when nursing homes can’t find nurses and/or certified nursing assistants (CNAs), they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need.

New final rule just another unfunded mandate

Like the 2021 RI staffing law, the Federal rule is an unfunded mandate, charges Gage. “Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers, he states.

According to Gage, nationally, the nursing home workforce has declined by 124,200 individuals (-7.8%) since the start of the pandemic. Rhode Island’s numbers are even worse, down 1,495 individuals (-15.3%). Gage calls on Congress to step up and support the bipartisan Protecting America’s Seniors’ Access to Care Act, which would prevent CMS from enforcing this unfunded and flawed mandate.

“Together with our national association, the American Health Care Association (AHCA), we will continue to fight for more common-sense solutions and do everything we can to preserve access to care for Rhode Island seniors,” says Gage.

“The good news about the Biden Administration’s final rule, there are phase-ins over multiple years that will provide an opportunity to challenge the mandates through legislation and/or possible AHCA litigation on the national level,” adds Gage. “The federal mandate highlights how much of an outlier RI’s staffing mandate is.  The RI statute has the highest staffing metrics and the highest fines in the country – 10% above the federal standards.  Without the Executive Actions of Governor McKee, RI nursing homes would be fined $90 million in the first full year of enforcement – devastating facilities and forcing further closures.  RI excludes hours worked by administrative nurses from counting toward the RN metric, yet they are included in the federal standards.  RI also excludes med techs’ and nurse aides in training’s hours from the CNA metric, while CMS includes them,” noted Gage.

Gage adds that the CMS final rules consider Rhode Island to be “urban.” As a result, the state has 2 years to phase-in the 24×7 RN requirement.

Rhode Island regulations and law have required 24×7 RN coverage in nursing homes for many decades, says Gage. “While challenging to maintain compliance given the shortage of registered nurses, this should not be a major concern for RI facilities,” he adds, noting that there will be 3 years to comply with the required 0.55 HPRD for RNs and 2.45 HPRD for CNAs. 

Additionally, Gage says that there are also waiver opportunities in certain circumstances.  “During the implementation phase, facilities and all stakeholders must be laser-focused on building a sufficient pipeline of qualified nurses and CNAs to the nursing home workforce,” he says.  

Like Gage, James Nyberg, executive director LeadingAgeRI, sees the CMS mandate as less onerous than the RI staffing mandate that “fortunately” remains suspended. “We remain concerned about the impact of this national mandate on providers in Rhode Island, and its broader impact on consumers and the health care industry,” he says.

According to Nyberg, the state’s current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (six nursing homes have already closed since the COVID pandemic began and two more have embarked on significant downsizing). 

“These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes,” says Nyberg, noting that LeadingAgeRI is working with numerous stakeholders on various initiatives to develop a pipeline of workers. “But the simple fact is that it will take time and an infusion of resources,” he adds.

“CMS proposes to spend $75 million on a nursing home staffing campaign.  That amount might help a state like Rhode Island, but that money is national, so it is a drop in the bucket in terms of the support the industry needs, states Nyberg.  “On the home front, we have been working with the Administration and the General Assembly to provide an infusion of funding to try and rescue the homes from their dire financial straits and try to stabilize the industry.  But the federal mandate, and all the related details and requirements embedded in the rule, do nothing to further that cause,” he says.

For the Minimum Nursing Standard final rules, go to https://public-inspection.federalregister.gov/2024-08273.pdf

For the CMS Fact Sheet  on Minimum Nursing Standard final rules, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

Shortage of direct care professionals a local and national concern

Published in RINewsTdoay on April 22, 2024

Last week, at  the Senate Dirksen Building, Room SD-562,  Chairman Bob Casey, of the U.S. Special Committee on Aging, (D-PA), showcased S. 4120, legislation that he introduced with U.S. Senators Tim Kaine (D-VA), and Tammy Baldwin (D-WI). The Long-Term Care Workforce Support Act, introduced during the 118thCongress, would ensure that direct care professionals have a sustainable, lifelong career by providing substantial new funding to support these workers in every part of the long-term care industry, from nursing homes to home care, to assisted living facilities.

The Senate Aging Committee details a number of statistical findings showing the need for Congress to address the nation’s severe ongoing direct care professional workforce shortage. “A recent survey revealed 92% of nursing facility respondents and nearly 70% of assisted living facilities reported significant or severe workforce shortages.

In 2022, a survey of nursing facilities showed more than 50% of the facilities were limiting the number of new admissions due to staffing vacancies or shortages.  Another recent survey of Home and Community Based Service providers showed that all 50 states were experiencing home care worker shortages, and 43 states reported that some HCBS provider groups have closed due to worker shortages,” says the fact sheet.

Addressing the cause

By improving compensation, benefits, and support systems, S.4120  would ensure the United States has a “strong, qualified pipeline of workers to provide desperately needed care for older adults and people with disabilities.” notes a statement announcing the introduction of Casey’s legislative proposal.  

Specifically, S. 4120 would increase the number of direct care professionals, especially in rural communities.  It also would provide pathways to enter and be supported in the workforce for women, people of color, and people with disabilities.

S. 4120 would also improve wage compensation for direct care professionals to reduce vacancies and turnover.  It ensures that direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and provided fair compensation.

The legislative proposal also documents the need for long-term care, identify effective recruitment and training strategies, and promote practices that help retain direct care professionals. It also would strengthen the direct care professional workforce in order to support the 53,000,000 unpaid family caregivers who are providing complex services to their loved ones in the home and across long-term care settings.

At press time, S. 4120 is endorsed by 50 organizations, including Domestic Workers Alliance, SEIU, AFSCME, Caring Across Generations, National Coalition on Aging (NCOA), Justice in Aging, National Partnership for Women & Families, National Council on Independent Living (NCIL), and the National Disability Rights Network (NDRN).

And a companion legislative proposal was introduced in the House by Congresswoman Debbie Dingell (D-MI).

Senate Aging Committee puts spotlight on Direct Care Staffing Shortage 

The April 16th hearing entitled, “The Long-Term Care Workforce: Addressing Shortages and Improving the Profession,” examined the challenges currently facing long-term care workers who are often underpaid and overworked, leading to widespread worker shortages that threaten the availability of care for those who need it.  

“It’s a crisis that stems largely from a lack of support for and investment in our caregiving workforce,” warns Casey in his opening statement. “Between 50 to over 90 percent of long-term care settings and providers report significant staffing shortages, affecting their ability to provide services, accept new clients, or even to remain open,” he says.

Casey noted that many direct care professionals have to work multiple jobs or overtime just to be able to support themselves and their families.  In 2022, their medium wage was just above $15 dollars an hour, well below what is paid for warehouse and convenience store jobs, per Casey.

“The direct care workforce, the majority of whom are women of color, are more likely to live in poverty compared to the general public,” notes Casey.

“Cumbersome federal regulations, requirements, and protections” and a “one-size fits all approach” won’t fix the direct care staffing shortage, responds Ranking Member Mike Braun (R-IN).

“To grow the long-term care workforce, the federal government should make it easier for people to enter by removing barriers,” says Braun, in his opening statement, calling for “productive approaches to build and grow the care professions.”

Overworked and not enough money

Nicholas Smith, a direct support professional at SPIN, a Pennsylvania-based organization that provides lifespan services for over 3,000 people with intellectual disabilities and autism, came to testify. “I work nearly 65-70 hours a week… due to my work, I have missed family events, nieces’ and nephews’ recitals, and school functions… a lot of people are leaving this field to make more money,” said the Philadelphia resident who has worked in the long-term care industry for over 25 years.

According to Smith, the national average for direct service professional wages is only $15.43 in long-term care. “We spend time training new hires only to lose them because they cannot make a living wage,” he says, noting that other industries are offering more money.

“While people want to stay in this field, they cannot make ends meet. Pennsylvania has a long waitlist for home and community-based services, and this is due to the workforce crisis,” he says.

In her testimony, Brooke Vogleman, a licensed Practical Nurse with Huntington, Indiana based TLC Management, stated:  “I’ve seen what happens when long-term care facilities lack workers, resources and government support, like during the pandemic. Many of my colleagues got burned out and left the profession, forcing facilities to rely on costly temporary staffing agencies.”

Vogleman called on federal policy makers, including members of the Senate Aging Committee, to address the challenge through “targeted investments, not blanket mandates.”  

For instance, she told the Senators that LPNs are integral to the facility’s interdisciplinary team. “Staffing mandates that do not include our contributions to patient care or recognize us as nurses are very concerning to me and will have unintended consequences on residents,” she says.

Staffing mandates will force facilities to depend more on expensive staffing agencies, warns Vogleman. “Personally, I’m concerned they will actually increase staff burnout, as current caregivers will be stretched thin and working longer hours in order to comply with these impossible standards,” she says.

Matthew Connell, Ed.D., of Ivy Tech Community College of Indiana, came to share the work and achievements of his community college in addressing the shortage of healthcare and long-term care workers in Indiana.

According to Connell, serving more than 190,000 students at 19 campuses and 26 satellite locations as well as on-line, graduates more associate level nurses in Indiana.  Nearly half of these students are pursuing college credit while in high school. Ivy Tech is the nation’s single largest provider of dual credit.

Ivy Tech’s programs are especially designed to help graduates enter the workforce quickly and provide critical services for the state’s long-term care population at a tuition rate that is the lowest in the state, he notes. “One in three Registered Nurses [in Indiana] is an alum. More than 90% of its nursing graduates choose to remain in Indiana, working in hospitals and care settings,” he adds.

The last witness, Jasmine L. Travers, assistant professor at New York University’s College of Nursing,  concisely summed up how to fix the nursing shortage.  She suggested: “To improve access to and quality of long-term are, we must ensure that all direct care workers receive a living wage, a safe, respectful work environment, opportunities for advancement, adequate training, and accessible benefits to maintain their health and well-being.  Only when we recognize that these workers are critically important, hardworking processionals, can we begin to improve equity and health outcomes for staff and patients alike.”

Putting the spotlight on Rhode Island’s Direct Care Staffing Shortage

According to John E. Gage, MBA, NHA, President & CEO, of the Rhode Island Health Care Association (RIHCA), the Covid-19 pandemic had a dramatic impact on the healthcare sector across the country and especially in Rhode Island, and a disproportionate impact on nursing facilities. On a national level, in February 2020 nursing facilities workforce totaled 1,587,000. Today, it is 1,462,800, down by 124,200 or 7.8%. In Rhode Island, it is more dramatic. Pre-pandemic RI nursing facility workforce was 9,797 (2/2020). Current BLS data shows the most recent number of workers in RI nursing facilities is 8,300 – down 1,497 workers or 15.3%.  This is just about double the rate of loss of workers post-pandemic in RI compared to the national statistics.

“There are some local efforts to attract workers back to RI nursing homes,” says Gage, noting that there is a need to be laser-focused on workforce development efforts. 

Gage calls for RI Medicaid to increase reimbursements to nursing facilities to cover today’s actual cost of care, not on facility costs from 2011 (13 years ago!) with minimal average inflationary increases in the 11 years since the price-based reimbursement methodology began in 2013.  According to Gage, RI nursing facilities need an adequate, sustainable reimbursement system to foster continued high-quality care and services and provide nursing home with rates that enable them to retain current workers and recruit more caregivers.

RIHCA, a non-profit trade association representing more than 80 percent of the nursing homes in the state, and its parent organization, the American Health Care Association (AHCA) support the legislative efforts of Senator Casey’s Long-Term Care Support Act. “We support all efforts to increase Medicaid rates to enable facilities to regain and grow their workforce – both direct care and ancillary staff, to enhance the quality of care and quality of life for our nation’s and RI’s most frail elder citizens today and for the years ahead,” he says. 

“It is heartening to see the Senate Committee on Aging and leading members of Congress addressing the care worker crisis in long term care including supporting our many thousands of unpaid caregivers who provide a significant portion of long term supports and services,” says Maureen Maigret, policy advisory of the Senior Agenda of RI (SACRI). Multifaceted solutions are needed, adds Maigret that include supporting training programs for nurses and paraprofessionals, career ladders and providing adequate Medicaid provider payments as Medicaid is the primary payer for long term care.

According to Maigret, in homecare alone, 75% of persons referred for subsidized home and community care through the state Medicaid or the Office of Healthy Aging Home Cost Share program are waiting two months, and often longer, to get services. “Our nursing homes are challenged to recruit the nursing staff needed to provide resident-centered quality care. Federal funding during the pandemic brought some funding in to support worker wages but that funding has ended,” she says.

“The state Healthcare Workforce Initiative led by the Executive Office of Health and Human Services and the Department of Labor has been looking at needs across the healthcare system and addressing some of the training and education issues,” says Maigret, noting that advocacy groups, such as the SACRI, support the Medicaid reimbursement rate increases as recommended by the Office of the Health Insurance Commissioner. “These rate increases are necessary to reduce service wait lists and provide livable wages for direct care staff many of whom are women and women of color,” she says. 

Over 23 years ago, in his weekly commentaries in the Pawtucket Times, this writer reported on the crisis of a direct care staffing shortage and inadequate reimbursement being paid to  nursing facilities to care for Rhode Island’s fail seniors. Isn’t it finally time for the Rhode Island General Assembly to come up with the necessary funds and strategy to fix these problem once and for all?

To watch the Senate Aging Committee hearing held on April 16, 2024, go to https://www.aging.senate.gov/hearings/the-long-term-care-workforce-addressing-shortages-and-improving-the-profession