Tag Archives for U.S. Department of Health and Human Services

Gridlock Threatens Elder Programs, Services

Published in Pawtucket Times, October 11, 2013

At press time, this week continued heated partisan bickering on Capitol Hill that threatens to unravel a fragile economy, along with putting the brakes to an economic upturn that slowly was pushing the nation out of its financial doldrums. With this stand-off, a partial shutdown of the federal government continues. The Republican-controlled House, captured by the ultra-right Tea Party, has refused to budge, opposing the passage of a continuing resolution (CR) to fund government agencies past Sept. 30. House Republican leadership has demanded that passage of the CR must be tied to either the repeal or partially dismantling of President Obama’s signature achievement, the Affordable Care Act. The Democratic President along with a Senate Democratic leadership say no.

Meanwhile, the Democratic-controlled Senate passed a “clean” CR to provide funding through Nov. 15, not putting ACA on the GOP’s chopping block. Even if both legislative chambers sort out differences and hammer out a compromise agreement to open the doors of the federal government, this would not shield the nation from the disastrous impact of the impending second round of sequester cuts and a Oct. 17 deadline for the government to raise the debt ceiling. No action means a first-ever default on the nation’s debt that could send the stock market tumbling and push the nation’s and the world’s economy into a tailspin.

Treasury officials say that congressional deadlock and no action will result in the federal government running out of cash to pay its bills if Congress does not act to raise the nation’s debt ceiling this month.

Get Your House in Order

With the debt crisis looming, AARP Executive Vice President Nancy LeaMond called on Congressional lawmakers to settle the debt ceiling debate to avoiding default on the nation’s debt, specifically to protect the retirement of seniors and future generations.

In her letter, LeaMond expressed concern that any delay in raising the nation’s debt limit may unnecessarily increase borrowing costs, negatively impact retirement savings accounts and harm the nation’s fragile economy.

“Our members are worried that the benefits they have earned may be cut as part of a deal to reduce the deficit, fund government operations, or increase the debt ceiling, and they are increasingly worried that if there is no agreement very soon, they may not receive their Social Security checks and may lose access to their health care,” noted LeaMond.

Ten days ago, the nation entered a government shutdown, forcing furloughs of 800,000 workers, without pay, and suspending services. The last time this occurred was 17 years ago during the Clinton administration. The Congressional impasse has closed national parks and monuments, federally owned museums, such as the Smithsonian, offices overseas that give visas to foreigners hoping to visit the United States, and even many federal regulatory agencies.

So, how does this impact programs and services for older Americans? Simply put, impact on programs and benefits may vary throughout the federal bureaucracy.

The U.S. Department of Health & Human Services will furlough over 40,512 of its 78, 198 employees. The largest percentage of these employees comes from “grant-making and employee-intensive agencies,” such as the Administration for Community Living. This federal agency would not be able to fund the Senior Nutrition programs, Native American Nutrition and Supportive Services, Prevention of Elder Abuse and Neglect, the Long-Term Care Ombudsman program, and Protection and Advocacy for persons with developmental disabilities.

As reported, Social Security checks will be mailed, Medicare and Medicaid benefits will continue to be paid out, because these are considered mandatory programs, not discretionary ones. Benefits under the Supplemental Nutrition Assistance Program, commonly referred to as food Stamps, will continue in October, despite the federal shutdown.

Food Program Takes Budgetary Hit

Jenny Bertolette of the Meals on Wheels Association of America charges that the Federal Government shutdown “adds insult to injury as Senior Nutrition Programs are already dealing with devastating cuts due to sequestration, funding that has never kept up with inflation, increased food and transportation costs and increased need as significantly more seniors are aging and struggling with hunger than ever before.”

Bertolette says that should a shutdown persist for any considerable length of time, local Meals on Wheels programs that rely on government funding could experience a delay in reimbursements for meals and services delivered. Facing such funding uncertainty, programs could be forced to suspend meal services, create or expand waiting lists for meals, cut the number of meals or days they serve and reduce delivery days.

Jenny Bertolette of the Meals on Wheels Association of America charges that the Federal Government shutdown “adds insult to injury as Senior Nutrition Programs are already dealing with devastating cuts due to sequestration, funding that has never kept up with inflation, increased food and transportation costs and increased need as significantly more seniors are aging and struggling with hunger than ever before.”

Bertolette says that should a shutdown persist for any considerable length of time, local Meals on Wheels programs that rely on government funding could experience a delay in reimbursements for meals and services delivered. Facing such funding uncertainty, programs could be forced to suspend meal services, create or expand waiting lists for meals, cut the number of meals or days they serve and reduce delivery days.

Heather Amaral, Executive Director of Meals on Wheels of Rhode Island, agrees, noting that her Providence-based nonprofit program, has already lost $70,970 in 2013 federal funds due to last year’s sequestration cuts.

Amaral says that as a result of these cuts, to maintain meal delivery at the same numbers as last year (360,299 meals), she had to reduce menu items that were once offered. “Although the government shutdown doesn’t have an immediate impact on our program, I am concerned that it could lead to additional cuts,” she says, noting that should the shutdown continue until year end, the nonprofit agency will be forced to rely on donations and reserves to maintain service levels.

“We provide a safety check along with each home delivered meal and are often the only contact our client has that day, adds Amaral, who stresses that her program may be the only thing keeping a senior at home. “If we are forced to reduce the number of meals we serve, these people may be forced to live with a family member or enter a nursing home,” she warns.

Meanwhile, the U.S. Housing and Urban Development (HUD) agency will be unable to fund additional payments to public housing authorities, many providing shelter to older Americans. HUD expects the 3,300 Public Housing Authorities it funds to have enough funding to get through the month of October. But, if the shutdown continues, some public housing authorities will not be able to maintain normal operation.

Also, Quarterly formula grants will not go out for the Low-Income Home Energy Assistance Program (LIHEAP), the Social Services Block Grant (SSBG), or the Community Services Block Grant (CSBG).

Nutrition programs serving older adults face a double whammy with no FY14 appropriations and no reauthorization of the Farm Bill. The Senior Farmers’ Market Nutrition Program expired along with the Farm Bill on Sept. 30. The Commodity Supplemental Food Program (CSFP) requires appropriations to continue operating.

According to well-known Aging Advocate Susan Sweet, this is a partial shutdown that hasn’t really hit aging programs yet. There are funding reductions in programs for older people, but that is due to the sequester, which will have another round of cuts in October, she says.

Sweet predicts that the negative effects of the shutdown itself will become worse with every passing day. For example, there is doubt that veterans benefits and social security will be paid in or after October absent a funding bill. Death benefits, including burial subsidies, have not been paid to the survivors of fallen armed forces members, she notes. Because of the public outcry regarding this outrage, a private charity has stepped up to pay the benefits with the promise of reimbursement when the government re-opens.

“Reduced to its true absurdity, the United States of America has lost the ability to rationally govern,” states Sweet. “The sequester cuts, previously characterized as “cuts for dummies”, have been implemented, we are in a war yet cannot bury our dead from that war, can’t even agree on a temporary fix, and are arguing whether the US should pay its bills or default,” she adds.

“It is perplexing, and we have heard many, many concerns from Rhode Island members, “ said AARP State Director Kathleen Connell. “Since the U.S. government has never failed to meet its financial obligations, we don’t know what payments it could make if the President and Congress fail to reach an agreement.

“One cannot help but wonder what effects this uncertainty has on people – many of whom struggle enough with health and financial issues,” Connell added. “We’re doing whatever we can to urge Congress and the President to act responsibly.”

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. His weekly commentaries can be found on his blog, herbweiss.wordpress.com. He can be reached at hweissri@aol.com.

Report Examines Myths, realities of Consumer -Directed Services

Published in Pawtucket Times on March 17, 2003

Eighty-nine-year-old Lillian Brannon raves about the Arkansas-based “Independent Choices (A Cash and Counseling Demonstration Program) that allowed her to stay independent and at home with the assistance of four aides.

The program “has really changed my life so much,” she says. “It has really helped me to live more independently than I have ever have …I would not trade it for anything.”

Tammy Svihla, who suffers from MS gives a thumbs-up to the New Jersey-based “Personal Preferences” programs that has allowed her to more creatively used Medicaid funds. Svihla notes she was able to purchase a “Lazy-boy” lift chair, usually not covered by Medicaid. It was logical for Svihla to purchase the lift chair because it was difficult for her to get up from her couch because of soft cushions.

These two  testimonials, among three others, set the tone for a newly released report that examines the myths and realities that now surrounds the philosophy of consumer-directed services.

The orientation allows consumers to make choices about the services they receive, assess their own needs, and determine how ad by whom these needs should be met, and then  monitor the quality of services they have received.

“The Myths and Realities of Consumer-Directed Services for Older Persons,” authored by Marie R. Squillace, PhD., federal project officer, National Family Caregiver Support Program with the U.S. Department of Health and Human Services, and President and CEO James Firman, Ed.D., of the National Council on Aging, attempts to build upon current knowledge obtained from research and demonstration projects to make   consumer direction “an integral part of the options available for all older persons who may need long-term care.”

Throughout the 24-page report the authors use personal experiences, case studies, and research to dispel 12 myths about the philosophy of consumer-directed services.

Let’s take a look at three of the myths.:

Squillace and Firman urge the reader to not believe the myth that consumer-directed services are not appropriate for seniors with disabilities or for those with cognitive impairments.

Here’s the reality: studies of programs like California’s In-Home Supportive Services (IHSS), show that many elderly can express daily preferences for care and can benefit from that control. For more than 30 years, low-income persons over age 65 who are enrolled in the IHSS program have  hired, fired, trained, scheduled and supervised individual providers.

Moreover, the Family Caregiver Alliance in San Francisco adds research indicates that persons with early to moderate cognitive impairment still can express daily preferences for their care, sharing their values and preferences.  For those with significant cognitive disabilities, a University of Maryland Center on Aging report suggests family caregivers, a circle of friends, or close associates who know the consumer well can interpret the person’s non-verbal expressions.

Another myth of the Squillace and Firman report is that “self-directing consumers will “misuse funds” or “be exploited.”

Not true, say the authors, citing “Cash and Counseling Programs” that will allow consumers to use their alliances to purchase needed services so they can stay in their own homes with the assistance of a fiscal intermediary organization (FIO).

In reality, the authors note most prefer to have their funds held by the FIO, which conducts bookkeeping and accounting services to help them manage their individual helpers and pay taxes for their workers. The management can minimize concerns about misuse of funds and financial exploitation of vulnerable individuals while diminishing the administrative responsibilities placed on self-directed consumers, the report says.

Finally, some spread the myth that consumer direction is just an experiment, noting more, nothing less. But Squillace and Firman say this philosophy has progress “far beyond the experimental phase.

A growing number of consumer advocates, program administrators and policy makers are now embracing this philosophy.”

The authors recite a 2001 survey that identified 139 consumer-directed service programs that were operating across most of the nation, except Tennessee and the District of Columbia. “The estimated total number of people being served by these programs reached about half a million.

Squillace and Firman state: “Consumer direction is not a sliver bullet or a panacea for the nation’s long-term care challenge, but it is an important part of the solution.”

I believe that.

If they haven’t, hopefully the directors of the Department of Elderly Affairs and Human Services will develop programs that encompass the philosophy consumer directed services.  Enhanced quality of life can be a result of aging baby boomers and seniors controlling the choice over the purchase of their long-term care services. Ultimately, it is all about empowerment.

For more information about consumer-directed care, visit www.consumerdirection.org.

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Staffing Crisis Hits Nation’s Nursing Facilities

Published in the Pawtucket Times on February 25, 2002

A yet-to-be released federal report paints a very bleak picture about the quality of care provided in the nation’s nursing facilities.

According to an article published last week by The New York Times, a draft federal report finds that 90 percent of the nation’s nursing facilities do not have enough nursing staff to properly care for their residents.

Simply, put, the lack of staffing reduces the quality of care provided in nursing facilities, increasing the incidence of bedsores, falls, malnutrition, weight loss, urinary tract infections and blood-borne infections, the report notes.

According to the draft report, which was ordered by Congress, is expected to be officially released by the U.S. Department of Health and Human Services in April, reaching appropriate staffing in nursing facilities would cost the federal government big bucks.

With a $ 7.6 billion annual price tag, about an 8 percent increase over current expenditures – the report – entitled “Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes” – recommends cheaper ways to fix the staffing crunch in the nation’s facilities.

Rather than regulate minimum ratios of nursing staff to residents, the report calls for better management techniques and training of certified nursing aides CNAs) to increase staff productivity and to decrease CNA turnover. Additionally, market demand sparked by an informed public that has access to publicly reported nursing staff data may even increase nurse staffing levels in facilities, the report notes.

The New York Times article does not get to the root of the nation’s staffing problems in nursing facilities, charges Al Santos, executive director of the Rhode Island Health Care Association, the state’s largest trade group that represents nursing facility providers.

“While the article only focused on the inadequacies of staffing levels across the country, it failed to report on its cause – a lack of adequate government reimbursement for nursing facility care,” Santos said.

Santos stated the federal report, which is detailed in the New York Times, is correct in its assessment that the shortage is “likely to become worse.

It should come as no surprise to policymakers that in order to increase wages and to make frontline nursing jobs competitive. Medicaid can no longer pay roughly $ 4 per hour, per patient for shelter, meals, labor costs, special care, certain therapies and other items,” Santos adds. “Costs far outweigh government reimbursements for patient care, and chronic under-funding of Medicaid directly impacts staffing.”

There is no doubt in my mind that the lack of adequate staff in facilities create poor quality of care,” says Roberta Hawkins, executive director of the Alliance for Better Long-Term Care, who also serves as the state’s ombudsman on nursing facility issues. Hawkins said she fears that the continuing staff shortage in Rhode Island facilities will chip away the past 25 years of improved resident care that has resulted from state and federal nursing facility reforms.

Although inadequate pay and benefits are obstacles to retaining staff, Hawkins predicts that it will become even more difficult to recruit CNAs when more horror stories about poor care appear in local newspapers or on state or federal agency websites.

“As a society, all of us are responsible for the care not being provided to nursing facility residents. If we don’t provide that money to pay for the best of care, we are partially responsible for that care not being provided,” Hawkins said.

Hawkins sees as permanent fix to this ongoing staffing shortage found in Rhode Island facilities – tie the reimbursement rate to the level of resident care provided. For instance, facilities with heavy-care residents would receive a higher Medicaid reimbursement rate, which takes into account the increased staffing needs of those residents.

But adequate Medicaid funding is not the only solution to the continuing staff shortage dilemma facilities face, Hawkins warned.

“We need to create upward mobility in nursing jobs, improve training specialty care provided to Alzheimer’s residents, bedridden residents and to those requiring rehabilitation,” she said.

The new federal study doesn’t surprise Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council (LTCCC) and to those involved in providing or regulating nursing facility care in the Ocean State.

Just last year, a statewide LTCCC study found Rhode Island’s nursing facilities reported a shortage of certified nursing assistants, the staff who provide 90 percent of the direct care to residents.

“The report gives us useful information to look at the issue of staffing and quality in Rhode Island nursing facilities,” Fogarty said. “It also should serve as a clear signal to Congress that it must do a better job of planning and funding long-term care.”

A state commission chaired by Human Services Director Jane Haywood, is currently studying how the existing Medicaid reimbursement system can be improved.

Even with a mounting state budget deficit, it is now time for the governor, state lawmakers and state officials to put the energy and resources into tackling this ongoing staff shortage issue.

With major input from the nursing facility industry and from Hawkins and her resident advocates, Haywood’s final blueprint for changes in the state’s Medicaid program must be taken seriously. With a state election looming in November, candidates running for governor, the Rhode Island General Assembly and Congress must do their homework, study the staffing crisis in the state’s nursing facilities, and develop their positions to confront this pressing policy issue.

More than 10,000 nursing facility residents and their families pray that the report to be issued by the Department of Human Services will not end up in some back office on a dusty shelf.