Advocates on aging issues review their priorities for Gov. McKee’s policy agenda

Published in RINewsToday on Nov. 14, 2022

Over 3 months ago, the Senior Agenda Coalition of Rhode Island (SACRI) invited the six Gubernatorial candidates to give the details of their aging policy positions to hundreds gathering at East Providence High School, and watching virtually. With the dust settling after the Nov. 8 midterm elections, aging advocates are asking the winner, Gov. Dan McKee, to place a high priority on enacting aging policies that he supported during SACRI’s 143-minute forum.

McKee goes on the record

McKee addressed the issue that Rhode Island nursing home and home care providers can’t provide sufficient and sustainable wages to attract and retain workers because of low state reimbursement. When questioned about how he would rebuild and sustain a viable workforce to provide services to seniors and persons with disabilities, the Governor stated he has addressed staffing issues at home health agencies and nursing homes by expanding the Wavemaker Fellowships to include healthcare workers and increasing reimbursement rates for home health agencies by $900,000 annually.

More seniors prefer to age in place at home in their community rather then enter nursing homes. McKee gave his thoughts about Medicaid rebalancing and expanding the program to keep seniors at home. He touted the $10 million invested this year to rebalance the long-term care continuum, announcing his plans to soon issue an Executive Order to direct state agencies to review existing policies through

At the forum, McKee stated he will also direct all state agencies to appoint a representative to a task force, also including municipalities and community-based nonprofits, that will create a Statewide Aging Plan to determine where federal monies and grants can be utilized to support older Rhode Islanders.

During the mid-1990s the Department of Elderly Affairs (DEA) had a staff of 65. Demoted to the Office of Healthy Aging within the state’s Department of Health and Human Services, Gov. McKee went on record that he will support legislation next year to make the state’s Office of Healthy Aging a full cabinet department. He pledged to provide an adequate budget and staffing to oversee its programs and services to Rhode Island’s growing senior population.   

Gov. McKee also supported a yearly cost-of-living increase to the state Supplemental Security Income payment in the 2024 proposed budget. He also supported the increasing of eligibility for the Medicaid Savings Programs for seniors and people with disabilities in the proposed 2024 budget by eliminating the asset test and increasing eligibility to at least 185% Federal Policy Level. 

With the state passing $250 million in funding for housing, Gov. McKee agreed to provide an adequate amount to support senior housing.  He stated: “we’re off and running”, noting that he recently announced an investment of $80 million to construct 825 units in 17 communities.  The Governor noted that his 2030 plan speaks specifically on the issue of senior housing.

Make aging policy a priority

“With the growing needs of seniors throughout the country and within our state it is time to return to a function of government which “had teeth” to enact change for elders who were at risk,” says Bob Robillard, LMHC, President of Rhode Island Senior Center Directors Association, representing 34 Senior Centers, noting that his aging group is pushing for the passage of bipartisan legislation next session that will elevate the Office of Healthy Aging to a full department – cabinet – status. 

According to Robillard, having a seat at the table as a cabinet position, the Director would directly advocate with the Governor’s Office to address unmet needs and seek creative solutions for our seniors. 

Robillard also urged the Governor to continue efforts to develop secure and affordable housing that meets the need for increased  homelessness of Rhode Island seniors. ”Their income level and having to make difficult choices to survive each month is seen in our interactions with seniors every day, and they are increasingly utilizing food banks, emergency services, and our centers, and funding these basic services needs to be a top priority,” he says.

While some federal funds have been used to address this issue, Robillard says there is a “global need for a full and comprehensive Aging Plan for Rhode Island including the voices of direct service providers like the Senior Centers, senior advocates, caregivers and, of course, seniors, themselves.” 

Finally, Robillard believes that there should be a strong focus on transportation for seniors to access their community. “Safe, respectful and person-centered transportation in our rural areas throughout our state needs to be a focus,” he says, noting that if you cannot access your community in these ways then you cannot participate in them either.

With Rhode Island experiencing a critical shortage of homecare workers, Maureen Maigret, chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee, calls on Gov. McKee to provide funding in the FY2024 budget to increase wages for CNAs working in home care. “The current budget includes $10 million to rebalance long term care. These funds should be used for wage increases for homecare direct care staff as an initial step to bring these invaluable workers fair wages,” says Maigret.

“It is also important to provide more resources to the Office of Healthy Aging and support for local senior services. Governor McKee started to increase funds for local aging services in the current budget and the Office of Healthy Aging has requested funding to provide each community ten dollars per person aged sixty-five and over next year,” adds Maigret, urging the Governor to include this in the budget he presents to the legislature for FY2024 as well as other funding requested by the Office including $.5million to support the state’s Aging and Disability Resource Center known as THE POINT. 

Gerontologist Deb Burton calls for the Governor to move forward to pass an Olmstead Plan to create opportunities for individuals to live in the least restrictive environments. “The Olmstead Plan would fit hand in glove with providing resources for individuals to age in the community, and not in institutions,” says Burton, who serves as Executive Director of RI Elder Info.  

Finally, Vincent Marzullo, well-known aging advocate who served as a federal civil rights and national service administrator, suggests that McKee direct the RI Commission for National/Community Service to identify AmeriCorps (national service) opportunities that would help build capacity and service delivery for our local senior centers and human services offices.  “Their needs have grown considerably during COVID,” says the West Warwick resident.

Editor’s Note: During the COVID weekly press conference time, Gov. Raimondo noted that changes need to be made in how people live in Rhode Island’s nursing homes, both from a communicable disease point of view, and from a humanity point of view. She announced a fund of $5 million to be put aside to support nursing homes transitioning their physical “plants” to be single room – single bathroom accommodations. Since Raimondo left office, there has been acknowledgement that this fund was set aside, but no action taken to address the mandate moving forward.

Gubernatorial Candidates Put Spotlight on Rhode Island’s Fragmented LTC Continuum

Published in RINewsToday on August 8, 2022

Last week, hundreds of seniors and aging advocates gathered at East Providence High School to learn more about aging policy positions from 6 Rhode Island Gubernatorial candidates. Many more watched virtually as the event was streamed online.

During the 143-minute forum, the invited Gubernatorial candidates (five Democratic and one Republican, gave two-minute responses to seven questions previously given to them and hammered out by the Senior Agenda Coalition of Rhode Island (SACRI) and its 17 cosponsors, that would elicit how each, if elected Governor, would fix Rhode Island’s fragmented long-term care continuum and provider payment systems.

According to Bernard J. Beaudreau, Executive Director of the Providence-based SACRI about 300 seniors and aging advocates came to personally see the Gubernatorial candidates outline their position on aging issues. Multiple platforms on Facebook and YouTube were promoted by a variety of senior advocacy groups that resulted in the over 300 virtual audience. Some held “watch parties” at one or more of the 12 senior centers, with approximately 135 people participating from throughout the state.

Before the forum began at 10:00 a.m., Deborah Burton, Executive Director of RI Elder Info, one of the forum’s sponsors, provided the welcome, explaining why it was so important for older voters to understand the aging agenda of the next Rhode Island Governor and their commitment to funnel funding and resources to the state’s aging program and services. “The policies of the incoming Governor will impact a large number of baby boomers in the state,” said Burton, noting that the Gen X’s, often forgotten, are right behind them. “We need to have a system [long-term care continuum] in place that is effective, that is funded, and is what we need and want as we age,” she said.

“It was very evident that these candidates came prepared and took the forum and all the issues impacting older Rhode Islanders very seriously,” said a very pleased Beaudreau.

Talking the Talk about Senior Issues

Here is a sampling of policy issues touched on by the candidates:

The attending candidates gave their thoughts as to how they would rebuild and sustain a viable workforce of nursing homes and homecare providers.

Two term Secretary of State Nellie Gorbea said she felt that we, as a society, do not value caregiving. She called for investing in the workforce of nursing home providers by increases tothe state’s Medicaid rates. The educational sector can become a pipeline to “nurture and grow” jobs for this sector, she said.

Governor Dan McKee stated he addressed staffing issues at home health agencies and nursing homes by expanding the Wavemaker Fellowships to include healthcare workers and increasing reimbursement rates for home health agencies by $ 900,000 annually. McKee also noted that in last year’s budget it gave the state’s nursing facilities a cost-of-living increase to ensure funding to increase their workforce.

Healthcare provider businesswoman Ashley Kalus, a Republican candidate, also called for increasing the Medicaid reimbursement rate. “Respect long-term care as a career choice which means there needs to be a path from home health care aide, to certified nursing assistant, licensed practical nursing, registered nurse and Nurse Practitioner through apprenticeship and training programs,” she said.

Former CVS Executive Helena Foulkes supports expanding Medicaid, but we must hold the nursing homes accountable to make sure that the increases of state funding go to workers and not to equity owners of nursing homes.

Healthcare advocate Dr. Luis Daniel Luis Muñoz says we should increase reimbursement rates for providers. He calls for the creation of a state-based medical school to create more dental professionals and physicians. “That is how we can increase the providers necessary to serve Rhode Islanders,’ he says.

Former Secretary of State Matt Brown blamed Rhode Island’s staffing shortage on the General Assembly slashing Medicaid reimbursement rates over the years. He called for an increase in Medicaid reimbursement rates and increasing minimum wage to direct care workers in Medicaid nursing facilities to $20 per hour. This would attract workers from Southern Massachusetts, he predicted.

The attending candidates also gave their thoughts as to their strategies for Medicaid rebalancing and the program’s expansion to improve home and community-based care opportunities along with ensuring financial viability of nursing homes.

Muñoz called for a targeted approach to supplementing wages for providers taking care of seniors, noting that “twenty dollars is not a livable wage. We lost the culture of taking care of people,” he said, “but it will take money, increasing providers; but programmatically the state needs to make a commitment to expand its community and home-based programs working with multiple departments, to bring back this culture of care.”

Brown warns that 87 percent of nursing homes are in risk of closing and the state must address this by increasing Medicaid rates so as to give these facilities the financial stability they need. As to home care, pay must be increased to direct home care workers. But do not forget about family caregivers.

“We do not have an adequate paid Family Leave program in the state,” he says. As Governor, Brown would call for creation of a program to give 16 weeks of adequate pay.

Kalus calls for seniors to be placed in the least restricted setting. There should be adequate senior housing available to allow a person to live independently in the community. “We must reimage the continuum of care,” says Kalus, stressing that different types of care must be working together.

According to Kalus, if you go to a hospital there should be an incentive to discharge you to a nursing home with rehab, if that is possible, and then provide an incentive to move a person to less restricted continuum of care from there, such as home care and then independent living. An organization, like an Accountable Care Organization, must ensure there are no incentives to keep you in one type of care environment, over a less restrictive one, she says.

McKee touted the $10 million dollars invested this year to rebalance the long-term care continuum. He announced that he plans to shortly issue an Executive Order to direct state agencies to review existing policies through a healthy aging lens and address accessibility and impacts on Rhode Island’s aging population. He will also direct state agencies to appoint a representative to the task force that will create a Statewide Aging Plan.

Foulkes called for the state to create a long-term comprehensive plan for providing programs and services for seniors. Politicians seem to implement short term fixes year to year, making small timeframe moves. She urges improving discharge planning and technology and compensating family members to keep seniors at home. Nursing home care should be changed to provide single rooms with single-use bathrooms to ensure their dignity of living in a nursing home, and prevent spread of infectious diseases, a lesson learned from the pandemic.

Gorbea says Rhode Island is “clearly off the mark” as to how it spends its Medicaid dollars on home care services. Twenty six percent of the state’s Medicaid budget is spent on home care, compared to many states allocating over 41 percent. “That’s where we have to go,” she says. “If you are going to encourage people to stay at home, you must have housing and transit options,” she notes.

In Retrospect…

“While there were similar opinions, each candidate presented their own perspective,” said SACRI’s Beaudreau, noting that he did not hear anything anyone said that would be objectionable to aging advocates. “We now have on record their pledge and commitment that there will be a plan and anaction agenda that will benefit all seniors of the state,” says Beaudreau, “if they are elected Rhode Island’s 77th Governor next November.

“It is clear we have a slate of very quality candidates,” says Beaudreau at the conclusion of the forum.

Maureen Maigret, chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee and SACRI Board Member stated, “the Forum exceeded my expectations in terms of attendance (in-person and virtual), and I consider it an absolute success.”

Maigret reported that all candidates supported: “making the Office of Healthy Aging a full cabinet/department with review of sufficiency of resources; expansion of Medicare Savings Program which I have been advocating for at least 5 years and adding a state COLA to SSI payments; requiring better data on minority older adult inclusion; addressing community living, housing and transportation needs of older persons and developing and implementing a comprehensive, interdepartmental strategic Plan on Aging.

What was most important is that this event made them really pay attention to the fact the state has a significantly growing number of older persons which calls for transformative change. By highlighting some policies needed to address these demographic changes and getting candidates on record in support of them, they can be held accountable,” says Maigret. “The other significant outcome was to have so many co-sponsors come together in support of the policies put forward,” she added.

“There needs to be immediate leadership and follow-thru with all appropriate stakeholders to design and implement a seamless state/local delivery system for “aging in place” services, including increased care payments and efficient reimbursement to providers,” says Vincent Marzullo, well-known aging advocate who served as a federal civil rights and national service administrator. “With vision and commitment, Rhode Island can be a more appealing retirement community by aggressively addressing healthcare disparities and elevating the RI Office on Healthy Aging to full Departmental status with broader authority/responsibilities. This conversation must now include our General Assembly leaders,” said Marzullo, a West Warwick resident who serves on SACRI’s Board.

Co-sponsoring this event was a broad coalition of 18 service providers and advocates: 

A Community Together, Alzheimer’s Association of RI, Carelink, Community Partners Network of RI, Economic Progress Institute, Leading Age RI, NAACP Providence Branch, Ocean State Center for Independent Living, PACE, Progreso Latino, RI Assisted Living Association, RI Elder Info, RI Health Care Association, RI Organizing Project, RI Senior Centers Directors Association, SEIU Healthcare 1199, Senior Agenda Coalition of RI and Village Common of RI.

To watch the forum, go to https://www.youtube.com/watch?v=okQ5FguKMao.

For info about the Senior Agenda Coalition of Rhode Island, go to https://senioragendari.org/.

New resources to protect Seniors before, during and after Natural Disasters

Published in RINewsToday on July 18, 2022

Just last year alone, the Washington, DC-based AARP noted that the nation experienced more than 1,300 tornadoes, 21 named storms (with winds of 39 mph or greater), nearly 59,000 wildfires that burned more than 7.13 million acres, along with numerous ice storms and other weather events that caused major damage and fatalities. With hurricane season now approaching, AARP teamed up with the U.S. Federal Emergency Management Agency (FEMA), announcing the release of new resources specifically designed to help local and state officials and Emergency Management Agency (EMA) officials protect seniors in their communities.

“By 2034, adults ages 65 and over will outnumber those under 18 in the United States for the first time. This has profound implications during natural disasters and extreme weather events,” said Nancy LeaMond, Executive Vice President and Chief Advocacy & Engagement Officer at AARP, in a statement announcing the released resources. “State and local leaders and emergency officials must be better equipped and prepared to ensure that older adults are kept safe and their needs are met when a disaster strikes,” warns LeaMond.

The 9-page, Guide to Expanding Mitigation: Making the Connection to Older Adults, released by FEMA, highlights how natural hazards uniquely affect seniors and provides specific remedies as to how local mitigation and emergency planners can include seniors in community efforts to lower their risks.

Throughout its 44 pages, the AARP Disaster Resilience Took Kit features strategies to help local, state and community leaders and aging advocates reduce the risk and impact of disasters on older persons. 

The guide and tool kit are the result of a multi-year collaboration between AARP and FEMA to identify and provide resources, spark ideas and encourage organizations to better engage older Americans in disaster mitigation, preparedness, response and recovery operations. This long-term, strategic alliance aims to advance accessible, safe and livable communities for people of all ages, says AARP.

“Adults aged 65 and older are a growing demographic who are often disproportionately impacted by severe weather. These disparities can be compounded by other factors, such as low-income or chronic illness, producing inequitable results for this vulnerable population when it comes to disaster preparedness,” said FEMA Administrator Deanne Criswell in a statement. 

“Effective mitigation planning requires that we consider the needs of all populations, and FEMA’s partnership with AARP on these guides will help community planners ensure our older communities are more resilient in the face of hurricanes and other natural disaster,” she said.

According to AARP, a growing body of evidence compiled shows that seniors are disproportionately impacted by the types of weather-related emergencies and natural disasters that are becoming increasingly frequent and severe. Individuals who have chronic illnesses, functional limitations or disabilities are especially vulnerable, as evidenced by the impact of the global COVID-19 pandemic on seniors.  Not only are older people at a higher risk of death from infectious diseases and disasters, but the long-term effects on those who survive often undermine their physical and mental health, economic security and overall well-being.

Although many communities support older adults in preparation for disasters, expanded mitigation planning can help reduce the loss of life and property by minimizing the impact of disasters before they happen, says AARP, noting that mitigation actions and strategies that make cities, towns and neighborhoods safer for older adults can benefit all residents and increase community resilience overall.

Protecting Seniors from Natural Disasters in the Ocean State

“One standout recommendation from the AARP/FEMA report was the adoption of more resilient and efficient building and land use standards, including the consideration of hazards in siting senior living facilities,” says RI Lieutenant Governor Sabina Matos, who oversees the Emergency Management Advisory Council that reviews information and programs regarding emergency management and makes recommendations to the Governor on these issues.

“One of my highest priorities is the creation of more affordable housing of every kind, and we have to walk the line of growing not only quickly, but thoughtfully. As we consider how to use this budget’s $250 million investment in housing, we want to ensure that new developments meet FEMA standards and will keep Rhode Islanders safe. We’re already working with local communities’ EMA departments to review their community disaster preparedness plans, as well as their applications for FEMA Hazard Mitigation Grants — funding to help implement exactly the strategies outlined in this report,” she says.

“One omission that stands out to me is resources for unhoused seniors. According to the Rhode Island Coalition to End Homelessness’s 2021 State of Homelessness report, over 500 Rhode Islanders aged 55 or older experienced homelessness over the course of a year. We need to strongly consider what kinds of hazard mitigation strategies could help this uniquely vulnerable population. Additionally, Rhode Island must especially focus on preparing sustainable mitigation and response systems that account for the effect of climate change on our coastal communities, which we know have large senior populations and will become increasingly vulnerable to flooding,” says Matos.

”FEMA has provided a very valuable tool with the Guide to Expanding Mitigation – Making the Connection to Older Adults guide. At the Rhode Island Emergency Management Agency,  we work with our local emergency managers, non-profits (Rhode Island Community Food Bank, Red Cross of Rhode Island, United Way and more) and other state agencies including the Department of Health and the Office of Healthy Aging to ensure older Rhode Islanders have the resources they need when disaster strikes. These reports will help us in our efforts to continue to support individuals in this vulnerable group,” says Director Marc Pappas, of the Rhode Island Emergency Management Agency.

“Preparedness is a core function of public health. This is especially true when it comes to climate change and older adults. As these resources highlight, it is critical that the unique needs of older adults are considered when planning for weather-related emergencies and natural disasters. This is already a priority for us at the Rhode Island Department of Health when it comes to emergency preparedness, and it will continue to be a focus,” says Joseph Wendelken, Public Relation Officer for the Rhode Island Department of Health.

“Before, during and after a natural disaster, the safety and wellbeing of older Rhode Islanders must always be a top concern,” said AARP Rhode Island State Director Catherine Taylor

“Emergency planners and managers at the state and especially local levels, along with first responders and many others, play a critical role in reducing anxiety and any subsequent harm when disaster strikes. Whether it’s a hurricane, flooding, extreme heat or infectious disease, ongoing planning and the coordination of all available resources is necessary to minimize consequences,” says Taylor.

“The AARP/FEMA guide and toolkit can go a long way towards mitigating deaths and long-term impacts among Rhode Island’s most vulnerable citizens. We encourage all leaders involved in Rhode Island public safety and public health to take advantage of this new resource. There are many aspects of age-friendly, livable communities – resilience in the face of disaster is chief among them,” Taylor adds.

AARP Rhode Island Volunteer State President Marcus Mitchell has firsthand disaster management experience. “As a former Division Commander with the US Coast Guard Auxiliary and Community Emergency Response Team Instructor for Providence Emergency Management Agency, I am actively involved with emergency & disaster mitigation, response and recovery efforts that dramatically and profoundly impact our older population physically, emotionally and financially,” he said. 

“Not only are seniors often hit first and hardest but their families are deeply affected as well,” Mitchell added. “We hope to save lives throughout the community, mitigate damages and reduce injury by vigorously distributing the new guide and toolkit to our members and the community at large.”

West Warwick resident Vincent Marzullo gives a thumbs up to AARP/FEMA’s released resources, saying that their information will be extremely valuable to the State and local EMA officials charged with protecting the state’s aging and vulnerable population during natural disasters. “Several barriers prevent older adults from evacuating when needed. Many older adults cannot drive and do not have access to reliable, accessible public transportation, depend on home-based medical equipment, require specialized accessibility supports, or cannot bring pets when evacuating. Some older adults are caregivers to spouses or partners with one or more vulnerabilities that may also hinder their ability to take timely action and remain safe, says Marzullo, who served for 31 years as a federal civil rights & social justice director for the Corporation for National & Community Service and a Federal Disaster Cadre Coordinator for the National Service Agency.

“State and local EMA officials must regularly outreach to the older Rhode Islander on the Rhode Island Department of Health’s “Special Needs Emergency Registry” to check their status/needs, especially individuals who are isolated and immobile.  There are approximately 15,000 individuals with chronic illnesses that have opted-in to the registry in order to be checked in times of emergency/disasters.  These older adults are vulnerable and need periodic support,” says Marzullo.

Marzullo calls for on-going disaster resilience webinars to be available to better prepare State and local EMA officials and organizations to respond to sudden natural disasters.  Targeted organizations might include the Red Cross, AARP RI, Senior Agenda Coalition of RI, Senior Center Directors Association, AARP members, RIElder Info, 211/The Point, and the Emergency Management Advisory Council (EMAC).

Melissa Carden, RIEMA’s Chief Public Affairs Officer says while winter storms, hurricanes and flooding are most common in the Ocean State, expect climate change to have a profound effect on the weather, including more storms and greater precipitation. “This fuels other extreme weather events like flooding (coastal and inland – remember the flooding in RI in 2010). Although scientists are uncertain whether climate change will lead to an increase in the number of hurricanes, there is more confidence that warmer ocean temperatures and higher sea levels are expected to increase their intensity and impacts.”

 To view and download the Guide to Expanding Mitigation: Making the Connection to Older Adults, visit  https://www.fema.gov/sites/default/files/documents/fema_mitigation-guide_older-

adults.pdf

To download a PDF of the AARP Disaster Resilience Tool Kit, featuring strategies to help local, state and community leaders and advocates reduce the risk and impacts of disasters on older adults, go to  https://www.aarp.org/content/dam/aarp/livable-communities/tool-kits-resources/2022/AARP%20Disaster%20Resilience%20Tool%20Kit-singles-060122-.pdf

The following (free) Livable Publication booklets and guides, go to https://www.aarp.org/livable-communities/tool-kits-resources/livable-publications-order-form/https://www.homecareassistancerhodeisland.com/