Tag Archives for Roberta Hawkins

Senior Advocates Push Legislation That Would Save State Money

Published in the Pawtucket Times on April 14, 2003

While the Rhode Island General Assembly is tackling hot-potato political issues like separation of powers and gambling, hundreds of bills have been thrown into the legislation hopper. Senior advocates are tracking about 13 legislative priorities in the 2003 legislative session.

Lawmakers are considering a wide array of legislation -creating long-term care tax credits, expending the Rhode Island Pharmaceutical Assistance to the Elderly Program, strengthening the state’s ombudsman’s office and ratcheting up Medicaid payments to nursing facility providers. One bill would establish special funds to care for severely disabled (age 65 and over) legal immigrant elders who are not eligible for Medicaid.

As they deal with a huge state budget deficit, Gov. Don Carcieri and lawmakers will be wary of enacting legislation that will have a fiscal impact on the state coffers.

But senior advocates are pushing for enactment of several legislative proposals that are either budget neutral or will actually save taxpayer dollars.

One legislative proposal (H 5841/S 876) that would create revisions to the state long-term care ombudsman law to expand the scope and authority for this state’s elderly advocate.

“Previously, the Rhode Island state statute has not reflected federal law, and this bill remedies that oversight,” said Roberta Hawkins, executive director of the Alliance for Better Long-Term Care and  state ombudsman, who noted federal law requires each state’s ombudsman statute to reflect the federal Older American Act.  Currently, Rhode Island’s statute does not.

Hawkins said the proposed statute changes also add additional duties authorized by the federal Older Americans Act to those required of the ombudsman under Rhode Island law. Companion bills introduced in the House and Senate call for the state ombudsman to represent the interest of nursing facility residents or clients of service providers before  government agencies, and to seek administrative, legal and  other remedies to protect their health, safety, welfare and rights.

They also mandate that the state ombudsman review and comment on any existing and proposed laws, regulations and state policies impacting nursing facility residents and clients of service providers.

The legislative proposals would make a new section of the state ombudsman law that fines a person up to $ 1,000 who willfully interferes with the ombudsman duties.

At press time, these bills were approved by the House’s Health Education and Welfare Committee and the Senate’s Health and Human Services Committee for consideration for floor action at a later date.

Meanwhile, Susan Sweet, an elder rights advocate who also consults for nonprofit agencies, noted two legislative proposals would actually save the state money while providing more appropriate services to older Rhode Islanders.

Sweet said these legislative proposals (H 5246/ S 314) would require the Department of Human Resources to reallocate funds to support already federally-approved assisted-living support services. At present, more than 35 people have qualified for this program but still remain in costly nursing facilities (at $ 130 per day) rather than reside in assisted living facilities which cost approximately 50 percent what the state is paying for nursing facility services.

At press time, these legislative proposals are still under consideration in the Senate and House Finance committees.

“If the General Assembly fails to enact funding for federally approved assisted living services, I would hope they would reallocate resources to at least allow those currently on the waiting list – some of whom are already in  nursing facilities costing the state twice as much = to be under the waiver,” said Sweet. “This would save half of the money currently being paid while providing these elders a better quality of life.”

Another legislative proposal (H 5418/ S 506) said Sweet, would establish a fund for severely disabled elderly legal immigrant Rhode Island residents who are not eligible for Medicaid.

Presently, these legal elderly immigrants receive care only from hospital. Sweet said there are currently four or five of these disabled elders residing at Eleanor Slater Hospital at a cost to taxpayers of $ 749 per day per person. If this legislation were enacted, these severely disabled elders could be transferred to a nursing home at the Medicaid rate of less than $100 per day.

At press time, these legislative proposals are still under consideration in the Senate and House finance committees.

Sweet noted the requested allocations for placement in nursing facilities for disabled elders who are legal immigrants is just $ 250,000 a year.

“Considering that we know that care for one persona at Eleanor Slater Hospital costs the state $ 749 per day, more than $ 273,000 annually passage of this bill is a no-brainer,” says Sweet. “In times when money is tight, there is more reason to save money while providing more appropriate services to our elders.”

In the shadow of a huge budget deficit, the Rhode Island General Assembly now has the opportunity the state money. They should seize the day by enacting they legislative proposals.

Governor’s Budget is Silent Regarding Many Senior Issues

Published in Pawtucket Times on March 24, 2003

Many of Gov. Don Carcieri’s policy initiatives can be found sprinkled throughout Fiscal Year 2004 Budget address.

While Carcieri’s 3,200-word speech identified his administration’s priorities – that is, maintaining human services, investing in education and creating jobs and fixing the state’s crumbling roads and bridges- it was silent on issues of interest to aging advocates and seniors.

At an AARP debate of gubernatorial candidates, Carcieri was asked if he would budget $15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing home residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million, for a total increase of $ 30 million.

At the debate, Carcieri acknowledged it would be difficult to find $15 million to fix the system because of the state’s looming budget deficit.

After a first read, Alfred Santos, executive director of the Rhode Island Health Care Association, found the recently released administration budget did not allocate the $ 15 million in new funding to allow nursing facilities to be reimbursed for the actual cost of care that they provide to frail residents.

Santos hopes to schedule a meeting with Gov. Carcieri and his policy staff to discuss Medicaid reimbursement and staffing issues.

“One of the biggest disappointments for seniors in the governor’s budget is his failure to include funding to allow more low-income persons to choose Medicaid waiver-funded assisted living,” noted Maureen Maigret, who serves as Lt. Governor Fogarty’s director of policy and executive director of the state’s Long-Term Care Coordinating Council.

“This has been a priority for the senior advocacy community, and the governor was supportive of this funding during his campaign,” says Maigret.

Maigret told All About Seniors that more than a year ago, the federal government had approved an additional 180 units in the state’s Medicaid assisted living waiver to respond to Rhode Islander consumer demands.

“Failure to fund these units is short-signed in terms of saving taxpayer dollars and denies low-income seniors the option to choose a less restrictive care setting,” said Maigret, who calls the state’s current assisted living waiver program a great success.

According to Maigret, in the last fiscal year, there was a decrease in state-funded nursing home use of about 50,000 days and an increase in Medicaid funded Assisted Living of about the same number of days. “We have reached the funding cap for these Medicaid-funded assisted-living units and have a waiting list of 35 persons,” she said, noting that some of these persons will now be forced to enter nursing facilities at twice the cost of the state.

Meanwhile, Maigret added that the governor’s budget does not address the dire need of more regulatory staff in the Health Department to monitor assisted living and enforce state standards.

On the other hand, the Rhode Island Pharmaceutical Assistance for the Elderly Program (RIPAE) is intact, Maigret said.

“With the costs of prescription drugs increasing at such alarming rates, RIPAE is a vital safety net for thousands of Rhode Island seniors.

Maigret noted that changes this year in Blue Chip and United Health senior plans may further impact many seniors’ accesses to prescription drugs, as these plans have new features which limit benefits for brand name drugs. Legislation proposed by Fogarty and introduced by Sen. Elizabeth Roberts and Rep. Peter Ginaitt will address this pharmaceutical issue, she said.

Finally, Maigret said senior advocates must watch other areas of the state budget that will ultimately impact seniors. Some community grants, such as those that support senior centers, are targeted for 10 percent cuts. While nursing homes are in line for an annual cost of living increase (COLA) in their Medicaid rates, no similar COLA is included for home and community care providers.

Maigret added the governor’s budget cuts about $ 10 million (state and federal funds) to continue its efforts of downsizing the Eleanor Slater Hospital Cranston campus, with a proposal to close two more wards. To offset these closures, the budget includes about $ 800,000 to fund about 20 more nursing home placements and new funds to increase capacity to serve persons with mental illness in community residential settings.

The push to get residents back into the community concerns Roberta Hawkins, state ombudsman and executive director of the Alliance for Better Long-Term Care. She opposes the closure of wards because there are persons in the community who require a higher level of care, a level that is only available at the Eleanor Slater Hospital.

Hawkins noted the administration budget does not include Medicaid funding to pay for dental services to seniors in the community and those residing in nursing facilities.

“The short-sidedness of this fiscal policy ultimately will increase care costs when the resident must be hospitalized for malnutrition, dehydration and bed sores, all caused by dental problems,” Hawkins said. “On a human level, who would want to constantly suffer from pain all night because of a toothache or gum problems?” she added.

Sandy Centazao, president and CEO of Meals on Wheels of Rhode Island, is still waiting to see if Carcieri will ultimately institutionalize her nonprofit group’s funding rather than continue to allocate it as a legislative grant. She expects this decision to be made before the enactment of the state’s FY 2004 budget on July 1.

With a looming recession and a nation at war, Carcieri and the General Assembly must ultimately make difficult decisions as to how to slice the state’s FY 2004 budget. The state’s final budget must  provide the funding and adequate resources to enable long-term care providers to take care of the state’s burgeoning older population. It’s the right thing to do, even n times of uncertainly.

Rhode Island Nursing Homes Scramble to get Dental Coverage for Residents

Published in Pawtucket Times on March 3, 2003

According to Alfred Santos, executive director of the Rhode Island Health Care Association (RIHCA), one company’s business decision has left Rhode Island nursing homes scrambling to bring dental coverage to thousands of nursing home residents.

Over the last two months, Santos has met with state regulatory officials to inform them of this latest health-care access problem.

Here’s the scoop:

Access Dental Care, a major provider of dental services to nursing facilities, announced in a Nov. 4 member to its 40 nursing home clients that it would no longer offer onsite dental care, beginning Jan 1, 2003. The brief memo cited the extreme physical challenge to dental staff who provided dental services to residents outside the normal dentistry setting as the rationale for dropping onsite dental care.

But a nursing home trade group says that there may be a bigger issue behind Access Dental Care’s decision to not provide onsite dental services to nursing home residents.

RIHCA’s Dental Services Committee believes the actual reason for this business decision may well be tied to a low Medicaid reimbursement for dental care services, said Chair john Gage, who also serves as the trade group’s vice-president. Currently, Gage is the administrator at Riverview Heatlh Center in Coventry.

Gage said 80 percent of nursing home residents rely on Medicaid to pay for their dental services. Access Dental Care’s decision to not perform dental services on site will force m any frail, bedridden residents to be transported outside the facility for treatment, causing needless pain and suffering to them, he said.

“With a severe staffing shortage facing many facilities it will be even more difficult to assign a staff person to accompany the resident,” Gage noted.

According to Gage, it’s not so easy for nursing homes to find other providers to deliver onsite dental services. Complicating this health care access issue, Geage said, is HealthDrive’s policy not to contract with any nursing home to only provide dental services.

At press time, state officials from the Department of Health and Human Services were unavailable for comment about this payment issue.

State Sen. H. Elizabeth Roberts

(D-Cranston), who is chairing a subcommittee of the state’s Long-Term Care Coordinating Council (LTCCC) is currently looking at Medicaid issues, said Access Dental Care’s decision to not provide treatment to Medicaid recipients in the nursing home setting only exacerbates an ongoing problem. That Is, low Medicaid reimbursement  keeps low income seniors from receiving the appropriate preventative and restorative dental care they need.

Roberts said, “inadequate Medicaid rates make it hard for dentists to see residents, because the rates are so far below their costs. When combined with the medical complexity of nursing home patients, the low reimbursement is even more of a barrier, she said.

Robert’s LTCCC subcommittee plans to turn their attention to investigating the obstacles that keep dental care from being provided to Medicaid-eligible seniors in nursing homes and in their homes.

Bringing dental services to low-income children and seniors became an important issue to Roberts when care to a young constituent in the Rlte Care program required the use of an operating room for dental work because of severe tooth decay.

This operation could have been prevented with ongoing dental care, she said, noting that it “took the attention of state government to locale a provider who would accept the low Medicaid provider rate.”

Roberts is working to ratchet up the Medicaid reimbursement for dental care and to streamline the payment process through legislation she has recently introduced. The senator intends to bring together the state’s Dental Society and nursing homes to develop a plan to bring dental care to facilities that no longer received onsite dental service.

Robert Hawkins, state ombudsman and executive director of the Alliance for Better Nursing Home Care, agreed with Roberts’ assessment that there has been limited access to dental services in nursing homes over the past couple of years.

Hawkins has been pushing for appropriate dental treatment for nursing home residents for more than 25 years.

“Medicaid-eligible seniors who are mobile can more easy travel to dental clinics, if they can find treatment, especially with the low Medicaid rates,” Hawkins said. “For the old, sick and feeble, why should they have to go to through the turmoil of leaving the facility to get their dental care?

“Lack of access to dental care is a form of discrimination for those unfortunate to be lower-income and on Medicaid, Hawkins charged.

The Medicaid system has always been “penny wise and pound foolish,” Hawkins said. “When you don’t treat a dental problem early, residents don’t eat, they lose weight, develop bed sores, ultimately requiring costly hospital care.

“Can any one remember having a tooth ach all night long with no where to go?,” Hawkins asked.

Susan Sweet, a consultant to nonprofit groups and a longtime elder rights advocate, added there is also a lack of dental care for low-income seniors that extends into the community as well.

“For some reason, dental care is treated in the health care community as less important as other medical care,” she said, adding that reimbursement for dental care has lagged behind reimbursement for other medical care.

So where do we go from here?

Roberts’ plans to bring the state’s Dental Society together with nursing homes to craft a short-term solution is the first step in removing the obstacles of providing dental services to Medicaid-eligible residents. But a more permanent solution is needed.

With Gov. Don Carcieri poised to shortly release his budget, I hope he and the General Assembly counter Medicaid’s traditional “penny wide and pound foolish,” philosophy by increasing Medicaid payments for dental services. An inadequate reimbursement rate will ultimately reduce the needless pain and suffering that dental problems cause in nursing homes across the state.