World issues pushed nursing home reform to the side in State of the Union. But it’s there

Published on March 7, 2022 in Rhode Island News Today

More than a week ago, President Joe Biden, with Vice President Kamala Harris and House Speaker Nancy Pelosi, sitting behind him in the House Chamber in the United States Capitol, delivered his first State of the Union Address. Harris and Pelosi made history marking the first time two women have been on the dais during a presidential address before the joint session and the American people

According to C-SPAN, Biden’s speech was the fourth-longest of the seven most recent presidents’ speeches, beating out Presidents George H.W. Bush, George H. Bush and Ronald Reagan. Amid frequent applause breaks, chanting from both sides of the aisle and heckling, Biden’s prepared remarks delivered Tuesday, March 1, 2022, totaled around 7,762 words, lasting over one hour and two minutes.

Biden spoke mostly on-script with his prepared remarks on a wide range of topics before lawmakers, Supreme Court Justices, guests, many waving small blue and yellow Ukraine flags or wearing the country’s colors to show solidarity with the people of Ukraine. While the first half touched on the Russian invasion of Ukraine and the need for a global coalition to respond, the second half addressed inflationCOVID-19 and the “new normal,” increasing domestic manufacturing, health care, prescription drugs, energy and taxes, voting rights legislation, and the nomination of Judge Ketanji Brown Jackson to the Supreme Court

Biden concluded his speech by proposing a “Unity agenda” calling for a fight against the opioid epidemic, pushing Congress to pass a mental health package, supporting Veterans returning from the battlegrounds of Iraq and Afghanistan and finding a cure for cancer.

The State of the Union and nursing homes

While Biden’s speech briefly touched on the quality of care in the nation’s nursing homes, his Administration is clearly making this a major domestic issue.  During the address, Biden expressed strong concerns about Wall Street firms that were taking over many nations’ nursing homes. “Quality in those homes has gone down and costs have gone up. That ends on my watch,” he told the packed chamber. “Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect and [they’ll be] looked at closely,” he said.

A day before the State of the Union address, the White house released a detailed document, entitled, “Fact Sheet: Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes,” outlining dozens of proposed changes on how U.S. nursing homes are regulated and operate, including a vow to adopt federal minimum staffing requirements for facilities, step up enforcement of regulations and to eliminate overcrowded patient rooms.

Amid the ongoing COVID-19 pandemic that continues to wreak havoc on the nation’s nursing homes, where 200,000 residents and workers have died from COVID-19, nearly a quarter of all COVID-19 deaths in the United States, the Biden Administration says that staffing shortages are getting worse, reducing the quality of care provided to residents

Poorly performing facilities will be held accountable for improper and unsafe care and must immediately improve their services or will be cut off from tax payor dollars. Biden calls for better information to be provided to the public to assist them in better understanding the conditions they will find in each facility and to assist them in choosing the best care options available.  

Centers for Medicare & Medicaid Services (CMS) will begin to explore ways to reduce resident room crowding in nursing homes by phasing out rooms with three or more residents and promoting private, single occupancy rooms. Multi-occupancy rooms increase the risk of the spread of infectious diseases, including COVID-19.  The agency will also establish a minimum nursing home staffing requirement, the adequacy of staffing is closely linked to quality of care provided.

Meanwhile, CMS also plans to strengthen the Medicare Skilled Nursing Facility Value-Based Purchasing Program and base payment on staffing adequacy (including over weekends) and retention and the resident experience.  Although the nation has seen a dramatic decrease in the use of antipsychotic drugs in nursing homes in recent years, CMS will continue its efforts to identify problematic diagnoses and bring down “inappropriate use” of such drugs.

Enhancing accountability and oversight

The Biden Administration calls for the enhancing and accountability and oversight of the nation’s nursing homes by adequately funding inspection activities, beefing up scrutiny on more of the poorest facility performers, expanding financial penalties and other enforcement sanctions, and increasing the accountability for chain owners whose facilities provide substandard care. CMS will work with nursing homes to improve care by providing technical assistance.

To enhance transparency, CMS will create a new database that will track and identify owners and operators across states to highlight previous problems with promoting resident health and safety.  The agency will also collect and publicly report data on corporate nursing home ownership and will enhance the Nursing Home Care website. Finally, CMS will examine the role that private equity investors play in the nursing home sector.

Biden’s nursing home reforms will ensure that every nursing home has a sufficient number of adequately trained staff to provide care to the 1.4 million residents residing in over 15,500 Medicare and Medicaid facilities across the nation.  Nursing home staff turnover can be reduced by creating pathways to good-paying jobs along with ensuring staff to join a union.  CMS calls for lowering financial barriers to Nurse Assistant Training, adequate compensation and access to a realistic career ladder. The agency launches a National Nursing Career Pathways Campaign with partners including the Department of Labor.

Finally, Biden puts together his strategy to ensure emergency preparedness in nursing homes during the ongoing pandemic.  He calls for continued COVID-19 testing in nursing homes and continued COVID-19 vaccinations and boosters to be provided to residents and staff. CMS will strengthen requirements for on-site infection prevention, and make changes to its emergency preparedness requirements,   Finally, the agency will take what it has learned during the pandemic and integrate new lessons on standards of care into nursing home requirements around fire safety, infection control, and other areas, using an equity lens.

Point/Counter Point

In a released statement after Biden’s State of the Union address, AARP CEO Jo Ann Jenkins stated: We were also encouraged to hear the President describe new actions to ensure that residents in nursing homes will receive the safe, high-quality care they deserve. For yearsAARP and AARP Foundation have sounded the alarm about problems in America’s nursing homes. The COVID-19 pandemic exposed the chronic, ongoing issues with our long-term care system and emphasized the need for reform. It is a national disgrace that more than 200,000 residents and staff in nursing homes and other long-term care facilities died. AARP urges the federal government to act swiftly to ensure minimum staffing standards, increase transparency, and hold nursing homes accountable when they do not provide quality care.”

On the other hand, the nursing home industry had its views as to Biden’s call for nursing home reforms.  “The nursing home profession has always been committed to improving the quality of care our residents receive, and we appreciate the Biden Administration joining us in this ongoing effort. Over the last decade and prior to the pandemic, the sector made dramatic improvements. Fewer people were returning to the hospital, staff were providing more one-on-one care than ever before, and the unnecessary use of antipsychotic medications significantly declined,” said Mark Parkinson president and CEO of AHCA, in a released statement.

“Those who continue to criticize the nursing home sector are the same people who refuse to prioritize our residents and staff for resources that will help save and improve lives,” noted Parkinson, whose Washington, DC-based nonprofit organization represents more than 14,000 nursing homes and long-term care facilities across the nation. “Additional oversight without corresponding assistance will not improve resident care. To make real improvements, we need policymakers to prioritize investing in this chronically underfunded health care sector and support providers’ improvement on the metrics that matter for residents,” he said.

It’s time to stop blaming nursing homes for a once-in-a-century pandemic that uniquely targeted our residents and vilifying the heroic caregivers who did everything they could to protect the residents they have come to know as family,” said Parkinson. ““Long term care was already dealing with a workforce shortage prior to COVID, and the pandemic exacerbated the crisis. We would love to hire more nurses and nurse aides to support the increasing needs of our residents. However, we cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers,” he said.  

To read the White House Fact Sheet to improving the quality of care in the nation’s nursing homes, go to:

https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/

On Monday, March 7th at 9am, AARP Rhode Island and US Senators Reed and Whitehouse will speak on the need for lower prescription drug prices in a virtual press conference.

AARP Rhode Island State Director Catherine Taylor, Volunteer State President Marcus Mitchell and Volunteer Lead Federal Liaison Dr. Phil Zarlengo will join Rhode Island US Senators Jack Reed and Sheldon Whitehouse for a virtual news conference highlighting the need for Congress to lower prescription drug prices. AARP Rhode Island will present the Senators with a petition signed by more than16,000 Rhode Islanders calling for Congress to act now and stop unfair drug prices.

You can listen in via ZOOM at:  

https://aarp-org.zoom.us/j/98668832992?pwd=bktuTjJBMUZhUDRaVDkvN2dCSXZqUT09

Passcode: 618357

Participants will respond to on-topic media questions posted in chat.

More information about AARP’s Fair Drug Prices campaign can be found at aarp.org/rx.

“There’s a New Sheriff in Town” at SSA

Published in RINewsToday on June 20, 2020

On June President Joe Biden has asked two political holdovers from the President Trump’s administration, Social Security Commissioner Andrew Saul and his deputy, David Black, who had previously served as the agency’s top lawyer, to resign. Saul ultimately was fired after refusing to resign Friday, July 9, while Black resigned upon the president’s request that day. 

Biden named as acting commissioner, Kilolo Kijakazi, whom he earlier had appointed to a lower-level Social Security Administration (SSA) position, deputy commissioner for retirement and disability policy. 

The White House affirmed its authority to “remove the SSA Commissioner at will” by citing a Supreme Court ruling and a legal opinion from the Justice Department. Previously, under statute, the president could only remove the SSA commissioner for “neglect of duty” or “malfeasance in office.”

Saul’s term as Social Security Administrator ended in 2025 and according to The Washington Post, he states he plans to dispute the White House firing and continue to work remotely at his New York City home.

“I consider myself the term-protected commissioner of Social Security,” Saul told The Washington Post, calling the attempt to unseat him a “Friday Night Massacre.”

Minority Members of Senate Aging Committee Oppose Firing

Ranking Member Tim Scott (R-South Carolina), Senators Susan Collins (R-Maine), Richard Burr (R-North Carolina), Marco Rubio (R-Fla..), Mike Braun (R-Ind..), Rick Scott (R-Fla..), and Mike Lee (R-Utah) sent a letter July 14 to President Biden urging him to reinstate and honor the Senate confirmed, six-year term of Saul as SSA Commissioner. 

Members of the Senate Special Committee on Aging find the politically motivated action especially worrisome as it will have drastic effects on SSA services that help millions of older Americans with basic expenses like housing, food and medicine. 

The letter explains “Commissioner Saul was confirmed by the Senate in an overwhelmingly bipartisan vote in 2019… led the agency through one of the most trying periods in its history during the COVID-19 pandemic… was confirmed by the Senate to serve a full six-year term that expires in 2025 and he should have remained in his position unless removed for cause, as written in federal law.

The committee requested the Biden administration explain what authority an acting commissioner—not confirmed by the Senate—would possess to carry out the statutorily obligated duties of the SSA commissioner. 

 On the Other Side of the Aisle…

“From the beginning of their tenure at the Social Security Administration Andrew Saul and David Black were anti-beneficiary and anti-employee. The Biden Administration made the right move to fire both Saul and Black after they refused to resign, says chairperson John B. Larson (D-CT), of the House Ways and Means Social Security Committee, who had called for Saul and Black’s removal in March 2021. “As [Supreme Court] Justice Alito recently stated, the president needs someone running the agency who will follow their policy agenda,” he says.

According to Larson, since June 17, 2019, Saul’s control over SSA policies have “disproportionately harmed vulnerable Americans like low-income seniors and persons with disabilities, immigrants and people of color.

During Saul’s tenure, Larson noted that the SSA implemented a new rule that denied disability benefits for older, severely disabled workers who are unable to communicate in English, resulting in approximately 100,000 people being denied more than $5 billion in benefits from 2020 to 2029. However, there has been considerable discussion of the misinterpretation of the intent of this change.

SSA also finalized a new regulation that dramatically reduced due process protections for Social Security appeals hearings, by allowing the SSA to use agency attorneys instead of independent judges for the hearings, says Larson.

Larson also expressed concern about SSA proposing to change the disability review process to cut off benefits for some eligible people and proposing to make it significantly harder for older, severely disabled workers to be found eligible for disability benefits. 

According to Larson, Saul also advanced the Trump Administration’s anti-immigrant policies by resuming “no-match letters” to employers with even minor discrepancies between their wage reports and their employees’ Social Security records. These letters effectively serve to harass immigrants and their employers, often leading to U.S. citizens and work-authorized immigrants being fired, he said.

Finally, Larson charged that Saul embraced the Trump Administration’s anti-federal employee policies, including forcing harsh union contracts that strip employees of rights and ending telework for thousands of employees just months before the COVID-19 pandemic started – a particularly ill-fated decision given the critical role telework has played in SSA’s ability to continue serving the public during the pandemic. 

Thumbs Up from Aging Advocacy Groups 

“The Social Security Commissioner should reflect the values and priorities of President Biden, which include improving benefits, extending solvency, improving customer services, reopening field offices, and treating SSA employees and their unions fairly. That was not the case with former Commissioner Saul, and we look forward to President Biden nominating someone who meets that standard,” says Max Richtman, President and CEO, National Committee to Preserve Social Security and Medicare.

Adds Alex Lawson, Executive Director of Social Security Works: “Today is a great day for every current and future Social Security beneficiary. Andrew Saul and David Black were appointed by former President Donald Trump to undermine Social Security. They’ve done their very best to carry out that despicable mission. That includes waging a war on people with disabilities, demoralizing the agency’s workforce, and delaying President Biden’s stimulus checks.”  

Introducing New SSA Commissioner, Kilolo Kijakazi…

Kilolo Kijakazi has a Ph.D. in public policy from George Washington University, an MSW from Howard University, and a BA from SUNY Binghamton University. Kijakazi’s Urban Institute bio notes that she served as an Institute Fellow at the Urban Institute, where she “worked with staff across the organization to develop collaborative partnerships with those most affected by economic and social issues, to expand and strengthen Urban’s agenda of rigorous research, to effectively communicate findings to diverse audiences and to recruit and retain a diverse research staff at all levels” while conducting research on economic security, structural racism, and the racial wealth gap. 

Kijakazi was previously employed as a program officer at the Ford Foundation, a senior policy analyst at the Center on Budget and Policy Priorities, a program analyst at the Food Nutrition Service of the Department of Agriculture, and an analyst at the National Urban League.

According to Wikipedia, before entering the Biden administration, Kijakazi was a board member of the Winthrop Rockefeller Foundation, the National Academy of Social Insurance and its Study Panel on Economic Security, the Policy Academies and Liberation in a Generation, as well as a member of the DC Equitable Recovery Advisory Group, adviser to Closing the Women’s Wealth Gap, co-chair of the National Advisory Council on Eliminating the Black-White Wealth Gap at the Center for American Progress, and member of the Commission on Retirement Security and Personal Savings at the Bipartisan Policy Center. 

“Kilolo has an amazing ability to find and build connections among individuals and institutions that should be working together on critical public policy issues and policy discussions are much better for that inclusionary approach,” says Margaret Simms, an Institute Fellow in the Center on Labor, Human Services, and Population at the Urban Institute.

Protecting Retirement Savings Should Be a Priority

Published on March 7, 2015 in the Pawtucket Times

Last month, President Obama used his presidential bully pulpit to publicly support a proposed U.S. Department of Labor (DOL) rule, endorsed by a coalition of aging, labor and consumer groups, that reportedly limits conflicts of interest, increases accountability, and strengthens protection for Americans receiving retirement investment advice.

At the February 23 press conference held at the Washington, D.C.-based AARP headquarters, attended by Obama, Save Our Retirement Coalition members and lawmakers, the President called for the issuing of the proposed rule, still awaiting Office of Management and Budget (OMB) review and final DOL action. The updating of DOL rules and requirements would require higher standards for financial advisors, requiring them to act solely in their client’s best interest when giving financial advice, said Obama.

The Save Our Retirement Coalition says that the final rule is “needed to help protect Americans’ hard earned retirement savings from advisers who recommend investments based on their own interest – such as those that pay generous commissions – not because they serve their clients’ best interest.”

Existing Rules Outdated

In his remarks at AARP, Obama called the rules governing retirement investments written over 40 years ago “outdated,” filled with “legal loopholes,” and just “fine print,” needing an overhaul.  The existing rules governing retirement investments were written “at a time when most workers with a retirement plan had traditional pensions, and IRAs were brand new, and 401ks didn’t even exist,” the President explained.

At the event, Secretary of Labor Thomas E. Perez., claimed that his agency has substantially reached out to “a wide range of stakeholders,” to craft the proposed rule that was sent to OMB.  “The input we have received to date has been invaluable, but we’re not even close to being done. We have a lot more listening to do, and once the Notice of Proposed Rule Making is published in the coming months, I look forward to hearing from as many stakeholders as I can. We’re going to get this right, because the strength of the middle class depends on a secure retirement,” he says.

“We know the people we represent have worked hard to save for retirement, and we believe that they deserve to have financial advisers who work just as hard to protect what they’ve earned,” said AARP CEO Jo Ann Jenkins, in her remarks.  AARP is a member of the Save Our Retirement Coalition.

“AARP, a major consumer advocate, has been fought for this consumer regulation for over five years to ensure that Americans of all ages get the best financial advice when planning for their retirement,” says Jenkins. “Recently AARP also found that 9 out of 10 employers who sponsor retirement savings plans support holding advice to such a ‘best interest’ standard,” she adds. .

“In today’s world, it’s hard enough to save for retirement and achieve your financial goals” added Jenkins. “We don’t need to make it more difficult by allowing some on Wall Street to take advantage of hard-working Americans. Bad financial advice is just wrong,” she says.

According to Save Our Retirement Coalition, “the need for the proposed rule was made starkly apparent in a White House report released showing that conflicts of interest are costing middle class families and billions of dollars annually. The 30 page report, released last month, details the current regulatory environment for financial planners, providing evidence on the negative financial impact of conflicted professional investment advice draining older American’s retirement saving accounts.

The White House report, issued by Council of Economic Advisors, cited evidence pulled from the literature, showing that “conflicted advice reduces investment returns by roughly 1 percentage point for savers receiving that advice” The report also found that “a retiree who receives conflicted advice when rolling over a 401 (k) balance to an IRA at retirement will lose an estimated 12 percent of the value of his or her savings if drawn down over 30 years.  For those receiving conflicted advice “takes withdrawals at the rate possible absent conflicted advice, his or her savings would run out more than 5 years earlier.”

Holding Wall Street Accountable

“Many investment professionals do what’s right,” said AARP Rhode Island State Director Kathleen Connell. ”But loopholes in the law are allowing some on Wall Street  to take advantage of hard-working Americans, recommending investments with higher fees, riskier investments, and lower returns to make even higher profits for themselves. Last year alone, hidden fees, unfair risk and bad investment advice robbed Americans of as much as $17 billion,” she states.

“AARP agrees that financial professionals of all types serve a valuable role in building the wealth and security of the investing public,” added Connell. “We simply want to achieve some consistency in the standards across the industry. Here is Rhode Island, many retirees are very concerned about their investment savings and they deserve protection. Our position is that retirement accounts managed by a broker should receive the same protections as regular investment accounts held with an advisor,” she says.

“Rhode Islanders have who have worked hard for their money and deserve a new standard that holds Wall Street genuinely accountable for helping them choose the best investments for themselves, their family and their future,” she adds.

Security Trade Group Concern

             The Securities Industry and Financial Markets Association (SIFMA), a trade group representing securities firms, banks and asset management companies, is waiting to see the details of the proposed rule.  SIFMA CEO Kenneth E. Bentsen, Jr., stated: “While we cannot comment on a proposal we have not yet seen, we have ongoing concerns that the DOL regulation could adversely affect retirement savers, particularly middle class workers.  The new regulation could limit investor choice, cause inconsistencies as different regulators would apply different standards to the same regulatory accounts, prohibit guidance, and raise the costs of savings for retirement.”

But, both Obama and the Save Our Retirement Coalition strongly disagree with SIFMA’s assessment of the potential impact of DOL’s proposed rule, which has not yet been issued and is ultimately subject to change after the public comment period.

A large majority of financial planners put their clients first when giving them investment advice. But, as you know a few bad apples can truly spoil the barrel.  If trade groups representing financial planners fail to act to rein in financial planners who give conflicted advice to pad their pockets, than federal regulations can quickly do that job by applying “simple, commonsense standards.”

It makes practical and political sense to me.

Here is a linked to President Obama’s comments at the AARP Press Conference: http://www.whitehouse.gov/photos-and-video/video/2015/02/23/president-obama-speaks-aarp.

Herb Weiss, LRI ’12 is a Pawtucket-based writer who covers aging, health care and medical issues.  He can be reached at hweissri@aol.com . Or call 401/ 742-5372.