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. 

AARP Rhode Island Shows RI Facilities Remain Hotbed for COVID-19

Published in RINewsToday on February 14, 2021

As the Rhode Island Health Department (RIDOH) announces that cases of COVID-19 are declining and is loosening up restrictions on the reopening of bars and our social gatherings, AARP Rhode Island warns that the state’s nursing homes remain a hotbed for COVID-19 infections, and the “death rate remains disturbing.”  Rhode Island’s largest aging advocacy group calls on the General Assembly to take action this session to enact legislation to protect facility staff and residents. 

Since the beginning of the pandemic, more than 162,000 residents and staff in nursing homes and other long-term care facilities have died nationwide, and nearly 1.3 million people are known to have been infected with coronavirus in these facilities. Rhode Island has recorded 1,430 deaths in skilled nursing facilities, nursing homes, assisted living facilities and other eldercare facilities.
On Feb. 11, AARP Rhode Island released its Nursing Home COVID-19 Dashboard, the data revealing that the COVID-19 pandemic crisis in these facilities still continues despite incremental improvements in all four dashboard categories.

The dashboard analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

Taking a Snapshot 

According to the data (Dec. 21 to Jan. 17) from AARP Rhode Island’s latest Nursing Home COVID-19 Dashboard, the rate of new coronavirus cases per 100 residents declined from 15.7 to 10.6 among residents and from 12.5 to 10.6 among staff. While cases are lower than in the previous time period, resident cases remain the second highest in New England in AARP’s dashboard analysis, with nearly four times the cases in Rhode Island nursing homes reported in October and November.

Meanwhile, the latest dashboard data indicated that resident death rates dropped from 2.60 to 1.82 for every 100 people living in a nursing home and that nursing home staff cases dropped from 12.5 per 100 workers to 10.6.The dashboard also reveals that PPE shortages dropped sharply. Shortages of personal protective equipment (PPE) have declined from 20.3 percent of nursing homes without a one-week supply to 4.3 percent — the lowest number since the first dashboard report in June, 2020. Staff shortages were relatively steady, dropping from 41.9 percent of facilities reporting shortages to 40 percent.

AARP Rhode Island calls on Governor Gina Raimondo and Lt. Governor Dan McKee to protect nursing home residents and staff from COVID-19. “We are approaching the one-year anniversary of the first known coronavirus cases in nursing homes, yet they remain appallingly high, said AARP Rhode Island State Director Kathleen Connell in a statement announcing the release of the latest dash data said, “The devastation this pandemic has brought to nursing home residents and their families has exposed fundamental reforms that must be made in nursing homes and to the long-term care system. We cannot lower our guard, she says.

AARP Rhode Island’s COVID-19 Legislative Agenda

The Rhode Island nursing home industry has struggled with quality care and infection control for years. Connell called for Rhode Island lawmakers to act immediately, focusing this year on: 

1.   Enacting or making permanent the components of AARP’s five-point plan:·         

— Prioritizing regular and ongoing testing and adequate personal protective equipment (PPE) for residents and staff—as well as for inspectors and any visitors.·  

—  Improving transparency focused on daily, public reporting of cases and deaths in facilities; communication with families about discharges and transfers; and accountability for state and federal funding that goes to facilities.·         

— Ensuring access to in-person visitation following federal and state guidelines for safety, and require continued access to virtual visitation for all residents.·        

—  Ensuring quality care for residents through adequate staffing, oversight, and access to in-person formal advocates, called long-term care Ombudsmen.

2.      Reject immunity and hold long-term care facilities accountable when they fail to provide adequate care to residents.

3.      Establishing minimum nursing staffing standards.

4.      Ensuring that increases in facility’s reimbursement rates are spent on staff pay and to improve protections for residents.

5.      Ensuring progress is made so that in-person visitation can safely occur and facilitating virtual visitation.

“Additionally, our leaders must reject policies that take away the rights of residents to hold nursing homes accountable when they fail to provide adequate care, Connell added. “Now is not the time to let nursing homes off the hook for abuse, neglect, and even death.”  AARP Rhode Island wrote a letter to Gov. Raimondo, urging her to withdraw her nursing home immunity Executive Order.  At press time, there has been no reply.

As the first year of the COVID-19 pandemic approaches, RIDOH notes that 64 percent of all deaths have women and men in Rhode Island’s nursing homes and assisted living facilities. In the past 13 days, 116 new cases in these facilities have been diagnosed – with 41 new deaths. At weekly updates from Dr. Nicole Alexander-Scott, it used to be that the death statistics were broken down by age, noting how many were lost “in their 60s, in their 70s”, etc. but notably this no longer is reason for pause and expression on condolence.

Unless Rhode Island lawmakers act quickly, older Rhode Islanders in these facilities will continue to be at a very high-risk of catching COVID-19 and the fatality death rate will remain disproportionately high for seniors. As residents receive their vaccine shots, first and second, we in turn hope that the refusal rate of staff to the vaccination is going down.

It’s time to act. 

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard.  

For more information on how COVID is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes.

Study Takes Look at Decision Making in Getting a COVID-19 Vaccine

Published in the Pawtucket Times on January 25, 2021

Last month, the first shipment of COVID-19 vaccines came to Rhode Island. With limited stockpiles, debate in the state is heating up as to who gets priority in getting vaccinated. While many Rhode Islanders are waiting for the opportunity to be vaccinated, it has been reported that others, including health care workers, are declining to be inoculated. They turned down the chance to get the COVID-19 vaccine because of their concerns it may not be safe or effective.  Now research studies are being reported as how to increase a person’s likelihood to be vaccinated.

Last week, the COVID-19 Vaccine Education and Equity Project Survey, a group whose mission is to increase public dialogue on vaccine education, released survey findings that ranked preferred locations to receive COVID-19 vaccines, as well as leading information sources that would influence a person’s decision to get vaccinated. 

The CARAVAN survey was conducted live on December 18-20, 2020 by ENGINE INSIGHTS, among a sample of 1,002 adults over the age of 18 who had previously volunteered to participate in online surveys and polls. The data was weighted to reflect the demographic composition of the population. 

The researchers found that nearly two-thirds of the public (63 percent) say they will “definitely” or “probably” get vaccinated against COVID-19. The numbers of those indicating they would “definitely” or “probably” get vaccinated varied widely by race. While 67 percent of white respondents indicated they would get a vaccine, the numbers fell to 58 percent among Hispanic respondents and only 42 percent among Black respondents. 

Influencing a Person’s Decision to Get a COVID-19 Vaccine 

This study, commissioned by the Washington, DC-based Alliance for Aging Research, one of the three nonprofit organizations leading the project, found the majority (51 percent) of respondents ranked their healthcare provider or pharmacist as one of the sources most likely to influence their decision to get a COVID-19 vaccine. Almost two-thirds (64 percent) of respondents said they would prefer to receive a COVID-19 vaccine in their healthcare provider’s office. 

After healthcare providers and pharmacists, when asked to provide the top two additional sources of information about COVID-19 vaccines that would most influence their decision to get vaccinated, 32 percent of respondents cited nationally recognized health experts, and 30 percent named family and friends. However, older respondents were increasingly more likely (75 percent ages 65 and older) to trust their healthcare provider or pharmacist, followed by 43 percent (ages 65 and older) trusting nationally recognized health experts. 

“While we’re encouraged to see the majority of respondents planning to get vaccinated, we need to continue to educate about the safety of receiving COVID-19 vaccines from various healthcare professionals, including pharmacists in drug stores, supermarkets, and vaccine clinics,” said Susan Peschin, President and CEO of the Alliance for Aging Research, in a Jan. 14 statement released announcing the study’s findings.  “It is critical to our pursuit of health equity that all Americans have confidence in and access to COVID-19 vaccines,” she said. 

Overall, the researchers say that survey responses provided important information about the factors influencing the likelihood to get vaccinated and where respondents prefer to receive COVID-19 vaccinations. As to the likelihood to be vaccinated, the study’s findings reveal that about a quarter (24 percent) of respondents said they would “probably not” or “definitely not” get a vaccine, with Black respondents more likely to say they would not receive the vaccine (25 percent), compared to Hispanic (15 percent) and white (13 percent) respondents. Respondents that said they will “probably not” get a vaccine also tend to be younger (13 percent ages 18-34, 14 percent ages 35-44). 

Identifying Preferred Locations to be Vaccinated 

Researchers looked into what is the preferred location to be vaccinated. The survey asked respondents to select one or multiple locations where they would prefer to receive a COVID-19 vaccine. The majority (64 percent) of respondents indicated they would prefer COVID-19 vaccination in their healthcare provider’s office, while 29 percent prefer a pharmacy, 20 percent a drive-thru vaccine clinic, and only 13 percent would like to receive the vaccine at a grocery store pharmacy. 

Researchers found a generational split among these options (health care providers office, pharmacy, drive-thru clinic and grocery store-based pharmacy). When asked about their top two considerations, older respondents were much more likely (72 percent ages 65 and older) to cite preference for receiving COVID-19 vaccines in their healthcare provider’s office, compared to over half (56 percent) of respondents ages 18-34.

More than a third (36 percent) of those ages 18-34 prefer to be vaccinated at a pharmacy. In evaluating location preferences, nearly two-thirds (61 percent) of respondents said they would prefer to get vaccinated from a healthcare provider they know. This percentage was higher when looking at respondents over the age of 65 (74 percent). Additional factors driving the location where respondents would like to receive the vaccine included the ability to get the vaccine quickly or not have to wait in line (45 percent) and a location close to home (41 percent), the study found. 

Debunking Some Myths and Misconceptions 

RIDOH has compiled a listing of frequency asked questions about COVID-19.  Here is a sampling: Some believe that vaccines are ineffective due to the vaccine’s fast track development, fearing corners have been cut during the clinical trials. The Rhode Island Department of Health (RIDOH) stresses that “the vaccines are 95% effective in preventing symptomatic laboratory-confirmed COVID-19 and in preventing severe disease.” 

It’s been reported that some people may choose to not get vaccinated because that believe that the vaccine contain a microchip.  That’s not true, says RIDOH. “There is no vaccine microchip, and the vaccine will not track people or gather personal information into a database. This myth started after comments made by Bill Gates from the Bill & Melinda Gates Foundation about a digital certificate of vaccine records. The technology he was referencing is not a microchip, has not been implemented in any manner, and is not tied to the development, testing, or distribution of COVID-19 vaccines,” says RIDOH.  

Others express concerns that MRNA vaccines can alter your DNA.  “The COVID-19 vaccines currently available, which are messenger RNA (mRNA) vaccines, will not alter your DNA. Messenger RNA vaccines work by instructing cells in the body how to make a protein that triggers an immune response, according to the Centers for Disease Control and Prevention. Messenger RNA injected into your body does not enter the cell nucleus where DNA is located and will not interact with or do anything to the DNA of your cells. Human cells break down and get rid of the messenger RNA soon after they have finished using the instructions,” states RIDOH.  

A vaccine will not give you COVID-19.  RIDOH says: “None of the COVID-19 vaccines currently in development or in use in the US contain the live virus that causes COVID-19. The goal for each of the vaccines is to teach our immune system how to recognize and fight the virus that causes COVID-19. Sometimes this process can cause symptoms, such as fever. These symptoms are normal and are a sign that the body is building immunity. It typically takes a few weeks for the body to build immunity after vaccination. That means it’s possible a person could be infected with the virus that causes COVID-19 just before or just after vaccination and get sick, but this is not because they got the vaccine. This is because the vaccine has not had enough time to provide protection.” 

For more resources on the impact of COVID-19 vaccination uptake in protecting individuals, families and communities, and for details on how organizations can partner with the COVID-19 Vaccine Education and Equity Project, visit https://covidvaccineproject.org. Want to know more about COVID-19 Vaccinations?  Go to https://health.ri.gov/publications/frequentlyaskedquestions/COVID19-Vaccine.pdf