Tag Archives for Susan Sweet

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.

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.

Retiring Senior Advocate Played Key Role in Shaping Long-Term are Policy Debates  

Published in Pawtucket Times on November 18, 2002

Sheila Cabral Sousa, a long-time and well-respected senior advocate, leaves her post as executive director of the Rhode Island Association of Facilities and Services for the Aging to become a broker with statewide Residential properties.

Sousa has played a key role in shaping the Ocean State’s long-term care policy during her 12-year tenure representing nonprofit providers who operate nursing facilities, assisted living facilities and senior housing sites.

Sousa’s professional life experience would help her to successfully lead a major statewide nonprofit provider group, providing a continuum of  long-term care services to Rhode Island’s vulnerable elderly.

As a teenager, Sousa dreamed of becoming a lawyer. Once she received her bachelor of education degree from Rhode Island College, the young woman entered the Suffolk University School of Law in Boston.

Ultimately, she would complete a four-year night program, receiving a J.D. in 1971. Eight years in private practice would sharpen her legal skills, skills that would become valuable in helping her to lobby and shape public policy.

In 1979, a job offers given to her husband brought the young couple to Washington, D.C. Briefly, Sousa owned an operated an antique and collectible store in Alexandria, Va., until she found employment in the federal government.

While working for the Veterans Administration, her experience working on the Board of Veterans Appeals gave her a working knowledge of medical issues.

After the couple divorced, Sousa came back home to Rhode Island in 1986, where she would become the field manager for the Richard Licht campaign.  Her efforts helped him to become Lieutenant governor. From there, she became executive director of the Rhode Island Mental Health Association, a position that would give her an understanding of mental health issues in Rhode Island and a familiarity with the state legislature.

In 1989, Sousa would take the helm of the Rhode Island Association of Facilities and Services for the Aging (RIAFSA)

For 13 years, she would give credibility and recognition to the views of the nonprofit provider group to lawmakers, state policy makers and to the general public.  As executive director, Sousa would not represent one segment of the long-term care continuum, but the full spectrum, from nursing facilities, assisted-living facilities to senior housing.

Sousa leaves her position with many admirers.

“Enormously intelligent,” “quick-witted” and “a very committed advocate for social justice, women’s issues and the elderly” are traits used to describe Sousa, as quoted by Maureen Maigret, director of public policy for Lt. Gov. Charles Fogarty.

“Sousa was not afraid to push people to really examine all the policy issues. She really forced one to take a look at all the angles of an issue to make sure the best results happened,” said Maigret, whose personal and professional friendship with Sousa spans back to the 1970s.

According to Maigret, Sousa has a strong interest in elderly housing issues and has called for the need of supportive housing services to be offered to the residents.

“Through Sousa’s efforts, the Rhode Island Housing Resources Commission wrote a report looking at the need for supportive housing for the elderly and those with disabilities,” Maigret stated, adding that this report will be released in the near future.

Adds Susan Sweet, a consultant to nonprofit agencies and an elder rights advocate who is also a longtime friend of Sousa, “She can pierce the babble of irrationality with her quick and sharp wit and is never afraid to do so. She is fearless and funny, smart and compassionate. Quite a combination, adds Sweet.

“Wherever she spends her time, she will bring her considerable strengths to it and it will do well and do good things,” added Sweet.

Steve Horowitz, CEO of East Greenwich-based St. Elizabeth Community and RIAFSA’s past president told All About Seniors that Sousa is “a dynamic person” and a “visionary,’ and that she was the nonprofits first and only executive director.

“She was instrumental in bringing RIAFSA to the table when the state discussed policy issues,” he said.

“She didn’t look at an issue as to how it would affect us today, but how it would impact RIAFSA down the road,” said Horowitz.

Furthermore, Sousa had a tough job because she worked with only a part-time assistant.

“If you see her accomplishments over the years, you would think we had a staff of five people-based on all the work that was done,” noted Horowitz.

Roberta Hawkins, executive director of the Alliance for Better Long-Term Care and the state ombudsman, called Sousa a tireless woman who worked extremely hard on behalf of her nonprofit providers without ever losing sight of the elderly clients that they served.

“I will miss her tenacious nature and wonderful sense of humor. Her sense of humor brought levity to intense policy decisions, observes Hawkins.

While Sousa worked hard, she also enjoyed life, too. She is a great cook and has a love for Irish country dancing and music and playing poker, her colleagues say. She is also quite an interior decorator, with an eye for color, too.

Sousa, 60, is not  turning her attention toward her new challenging mountains to climb.

“It’s tie to try new career options,” she said.

Some people say that everyone is replacement.” But in Sousa’s case, and to those who have come to love and admire her, the person who takes the helm of RIAFSA will have big shoes to fill.

A farewell party for Sousa will be held on Thursday, Nov 21, 2002, from 4 to 6 pm, ag Green Tea, 5600 Post Road, East Greenwich. For more information, call Steve Horowitz at 471-6069.