Tag Archives for Senator Sherrod Brown

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.

Medicare slow to fix equity issue for seniors’ access to at-home COVID test kits

Published on Feb. 7 in Rhode Island News Today

Today home test kits were made available in a variety of ways – but, for Medicare recipients, it was a different story, being forced to go thru a different purchasing and payment process than those having private insurance, or no insurance. That process required the oldest and most at-risk population to take more than several steps, put up their own money, do a lot of paperwork, to seek reimbursement.

The White House made changes in testing so that at-home tests are now fully covered by health insurances. Those insured can pick up their test kits in a store and have them paid for at the time of purchase by their insurance, at no cost to the person. They aren’t required to visit their physician or get a prescription to obtain the free test. They have a limit of 8 test kits per month.

But, when the program began, this was not the plan for those insured through the government’s Medicare and Medicare Advantage plans.

Red Tape… Upfront Charges for COVID-1

Jane, a 65-year old Medicare beneficiary from Warwick went through the steps to get a kit after a relative she had seen found out she was exposed to COVID.  Before Medicare announced easing up on the purchasing process of COVID-19 test kits, she expressed frustrations to this writer about the regulatory hoops she faced because she was on Medicare – purchasing the test kits and getting reimbursed for the upfront charges. “First, I had to request a prescription from my physician and say that I had either been exposed to someone who had COVID, or I was having symptoms, myself,” recalls the frustrated Medicare beneficiary.  “Once my physician sent the prescription over to CVS, I was notified that it would take a couple of days before I could pick up the kits and that I would only be given two kits per prescription”, she fumed, knowing that sometimes it takes 4 or 5 days of testing to test positive, but was only eligible to receive two, and she might have to go through the whole process again in a few days.

“Three days later CVS finally left me a message saying these kits were in. I used the drive-up window for pickup and the cashier asked me for $46,” Jane remembered.  “When questioning this charge, a pharmacist came to the window to assist and told me that I had to pay for the kits upfront and then seek reimbursement,” she added.

Paying for the kits, Jane went home, and called Blue Cross, her Medicare supplement company and was told she needed to request a copy of the prescription which took hours to finally request with the back and forth phone calls to her busy doctor’s office. It was almost two weeks later she finally got a copy of the receipt detailing her $46 payment for the kits. She was then able to upload the copy of the prescription and a copy of her receipt to a BCBS reimbursement screen on her computer (or she could have printed the form out and mailed the whole package in). At press time, Jane is still waiting for her reimbursement, being told it will take from 4 to 6 weeks to receive a check.

It’s better late than never, says Jane, when she heard that Medicare would now cover free over-the-counter COVID-19 tests. “Not everyone can put out $46 and wait two months to get it back, home health tests were made available in a variety of ways – but, for Medicare recipients, there was a different process. More concerning was all the steps I had to take to complete the process they had originally intended for us to do. How many people would really complete all those steps?” she says. “We talk a lot about equity, but seniors need equitable healthcare processes, too.”

Just days ago, the Centers for Medicare & Medicaid Services (CMS) announced that beneficiaries in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, estimated to be in April. Under the new CMS initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). A prescription will not be required.

CMS Unveils New Medicare Benefit

According to CMS, this new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.

CMS’s announcement follows last month’s announcement that the Biden-Harris Administration would be requiring commercial health insurance companies to cover at-home COVID tests for free.

Until the new benefit kicks in, Medicare beneficiaries can access free tests through a number of channels established by CMS, too. Now, they can request four free over-the-counter tests for home delivery at covidtests.gov. Or beneficiaries can access COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. Many cities and towns are also giving out free test kits at drive-up handout programs as the state receives supplies.

CMS’s Feb. 3 statement noted that Medicare beneficiaries can also access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, says CMS.

In addition, CMS says that Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits. Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.

Finally, all Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

“AARP applauds today’s announcement that will guarantee access to at-home over-the-counter COVID-19 tests at no cost for Medicare’s 64 million beneficiaries and we thank [Health and Human Resources]Secretary Becerra and CMS Administrator Brooks-LaSure for their diligence in addressing this issue. Expanded access to no-cost testing will help protect seniors who have been hit hardest by the pandemic and ensure they can remain connected with their loved ones and community.,” says AARP Executive vice president and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement issued with CMS’s Feb. 3rd announcement of the new Medicare benefit.

“Every American should have an easy way to get at-home COVID tests. We know that people 65 and older are at much greater risk of serious illness and death from this disease – they need equal access to tools that can help keep them safe. The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus, adds LeaMond.

Successfully Advocating the Seniors

Last month, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI) along with 17 of their  Senate colleagues including Rhode Island Democratic Senators Reed and Sheldon Whitehouse wrote to HHS Secretary Becerra and  CMS Administrator Brooks-LaSure urging them to expand Medicare coverage of free at-home rapid COVID-19 testing.

Aging groups also joined the Senators in pushing Medicare to offer the new testing kick benefit.  “It is clear that regular testing is a crucial part of managing the spread of COVID-19. That’s why AARP has been calling for coverage of at-home tests, says AARP’s LeaMond, noting that the nation’s largest aging advocacy group “will continue to watch for details about when and how at-home COVID tests are made available to those in Medicare.”

Thankfully CMS quickly heeded their calls.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)

Stay tuned for free N95 masks to be made available to all coming up soon.

Voter reform must include accessibility for seniors and persons with disabilities

Published in RINewsToday on May 17, 2021

It’s over 540 days until the November 8, 2022 mid-term elections. The clock is ticking, say voter rights advocates, who are gearing up to push back at voting bills they see as restrictive being introduced at multiple state houses.  

As of March 24, 2021, GOP State legislators, responding to claims of voter fraud and election irregularities in last year’s Presidential election, have introduced 361 bills seen as restrictive by voter rights advocates in 47 states. “That’s 108 more than the 253 similar bills tallied as of February 19, 2021 — a 43 percent increase in little more than a month,” according to data compiled by the New York-based Brennan Center for Justice.

“These measures have begun to be enacted. Five restrictive bills have already been signed into law. In addition, at least 55 restrictive bills in 24 states are moving through legislatures: 29 have passed at least one chamber, while another 26 have had some sort of committee action (e.g., a hearing, an amendment, or a committee vote),” says the nonpartisan law and policy institute, noting that in some cases “a single bill can have provisions with both restrictive and expansive effects”.

President Joe Biden and Congressional Democrats are pushing back at GOP efforts they see as “suppressing voting” and introduced H.R. 1, For the People Act, which would be intended to “expand voting rights, change campaign finance laws, end partisan gerrymandering and create new ethics for federal lawmakers”.  The bill is considered to be the largest overhaul of U.S. voting in a generation, and is opposed by GOP lawmakers, who call it overreaching.

Fix Voter Access Issues for Seniors, and Persons with Disabilities

Although newspapers regularly cover both voter security and voter rights issues, voter access issues impacting seniors and persons with disabilities don’t receive adequate ink. 

Now, a national report’s findings reveal that some obstacles still exist for disabled voters at the polls. The recently released U.S. Election Commission (EAC)’s comprehensive 52-page national report, “Disability and Voting Accessibility in the 2020 Elections,” identified accessibility issues for voters with disabilities.  The study focused on polling place access, mail and absentee voting accessibility, election administration challenges, COVID-19 obstacles, and community involvement.

As the EAC plans for future elections, this data will be crucial in helping officials adopt new voting technologies and address the ever-growing accessibility needs of an aging demographic.

“In an election year with so many obstacles and unknowns, the improvement in accessibility for voters with disabilities is a testament to the hard work and dedication of election officials,” EAC Chairman Ben Hovland said, in a February 16, 2021 statement announcing the release of the report. “We are proud of election officials’ accomplishments during an especially difficult election season. This study provides the EAC with indispensable feedback as we continue our work with election officials and accessibility experts to ensure all Americans can vote privately and independently,” he said.

The EAC spearheaded the study under clearinghouse and research mandates outlined in the Help America Vote Act (HAVA). The goal of the study was to analyze the 2020 election experience for voters with disabilities amid the COVID-19 pandemic. Building on a similar 2012 study also conducted by the EAC in conjunction with Professors Schur and Kruse, of Rutgers University, the project launched immediately after the 2020 general election.

The 2020 study engaged 2,569 respondents including 1,782 voters with disabilities and 787 voters without disabilities. As in 2012, the oversampling of voters with disabilities was designed to produce a sample large enough for more accurate measurements and reliable breakdowns by demographic variables and type of disability.

Compared to 2012, overall results show election officials made great progress serving voters with disabilities and ensuring they could cast a private and independent ballot. Obstacles continue to exist, but improvements were evident.

According to the researchers, voting difficulties among people with disabilities declined markedly from 2012 to 2020. About one in nine voters with disabilities encountered difficulties voting in 2020. This is double the rate of people without disabilities, but a sizeable drop from 2012.

The study’s findings indicated that among people with disabilities who voted in person, 18 percent reported difficulties, compared to 10 percent of people without disabilities. The disability figure is down from 30 percent in 2012.

During a general election that experienced a shift to mail and absentee voting, 5 percent of voters with disabilities had difficulties using a mail ballot, compared to 2 percent of voters without disabilities. One in seven (14 percent) of voters with disabilities using a mail ballot needed assistance or encountered problems in voting, compared to only 3 percent of those without disabilities. 

The researchers found that five of six (83 percent) of voters with disabilities voted independently without any difficulty in 2020, compared to over nine of ten (92 percent) of voters without disabilities. Voting difficulties were most common among people with vision and cognitive impairments.

Close to 75 percent of voters with disabilities voted with a mail ballot or early in-person in 2020. This represents a significant increase from 2012 and is higher than the two-thirds of non-disabled voters who did so in 2020, say the researchers. No doubt the pandemic influenced the increase.

Finally, the researchers note that people with disabilities voted at a 7 percent lower rate than people without disabilities of the same age, pointing toward a continuing disability gap in voter turnout.

Senate Moves to Remove Barriers for Seniors and Disabled

Last month, U.S. Senators Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, and Amy Klobuchar (D-MN), Chairwoman of the U.S. Senate Committee on Rules & Administration, introduced the Accessible Voting Act, legislation to remove barriers to voting for seniors and people with disabilities.  This legislation is cosponsored by U.S. Senators Ron Wyden (D-OR), Sherrod Brown (D-OH), Tammy Duckworth (D-IL), Richard Blumenthal (D-CT) and Jeff Merkley (D-OR). Notably, an all Democratic sponsorship at this time.

This legislative action was triggered by a Government Accountability Study that found that combined deficiencies in architectural and voting booth access resulted in only 17 percent of polling places being fully accessible in 2016. The Accessible Voting Act would make polling places and voting systems more accessible, expand options for casting a ballot in federal elections and establish an Office of Accessibility within the Election Assistance Commission, dedicated to overseeing and supporting state efforts to make voting more accessible.

“The right to vote is one of the fundamental pillars of American democracy. That right is jeopardized when seniors and people with disabilities are pushed to the margins by barriers that prevent or make it hard for them to cast their ballots,” said Senator Casey in a statement announcing the introduction of the bill. “The Accessible Voting Act would remove these barriers and support the ongoing efforts by state and local agencies to make voting a truly equitable and accessible process,” he said.

“The right to vote is the foundation of our democracy, but exercising that right is not possible for too many Americans. Inaccessible polling places and voting booths, limited access to transportation, insufficient options for casting ballots, and inaccessible voter information websites are all obstacles to voting for millions of Americans,” adds Klobuchar. “The Accessible Voting Act would help ensure that we remove barriers to voting for citizens with disabilities, the elderly, Native Americans, and those with limited English proficiency. Our democracy works best when all citizens can make their voices heard at the ballot box,” she said.

“Despite existing federal law protecting the rights of people with disabilities, far too often, these rights are overlooked and forgotten in our electoral process. The Accessible Voting Act seeks to bolster the protections for voters with disabilities, as established by the Americans with Disabilities Act and Help America Vote Act, and ensure equitable access to every American voter in our democracy for years to come,” said Curt Decker, executive director, National Disability Rights Network.

The Accessible Voting Act would create a national resource center on accessible voting to conduct cultural competency training for election officials and poll workers.  It would establish a new state grant program for the Office of Accessibility to provide dedicated funding to improve accessibility to voting. Finally, it would provide voting information and resources through accessible websites so voters know how to register to vote and cast a ballot.

As Congress grapples with legislation coming from both parties to tighten voter security on one hand, and ease voter restrictions on the other, it will be a significant failure to not also address the issues of accessibility for our population facing aging and disability obstacles.