Tag Archives for Workforce shortage

Senior Agenda Coalition of RI Unveils 2026 Legislative Agenda at Annual Briefing

Published in RINewsToday on March 16, 2026

At its 10th annual Legislative Leader’s Forum, the Senior Agenda Coalition of Rhode Island (SACRI) unveiled its 2026 legislative agenda. More than 160 participants, including older adults, advocates, and state and federal officials, gathered at Gaige Hall at Rhode Island College for the event.

The event, “Voices of Advocacy — Anchors of Hope,” addressed the challenges facing Rhode Island’s growing older population and the policy changes needed to improve affordability, health care access, housing, and community supports.

The briefing opened with remarks by Rhode Island College President Jack R. Warner, SACRI Board Chair, Kathleen McKeon, and Executive Director Carol Anne Costa, who served as host. 

Costa began with a thank you to Rep. Joseph Solomon and Senator Mark McKeeney (who were present) for introducing the bill creating the Office of the Elder Advocate.  SACRI Policy Advisor Maureen Maigret outlined an Affordable Policy Agenda. Other speakers included representatives from the Rhode Island Coalition for Elder Justice, Economic Progress Institute, and Rhode Island Organizing Project.

A number of top elected officials followed, including U.S. Sens. Jack Reed and Sheldon Whitehouse, Congressman Seth Magaziner, Gov. Dan McKee, State Treasurer James Diossa, House Speaker K. Joseph Shekarchi, and Senate Majority Leader Frank Ciccone, who discussed previous and current legislative efforts affecting older Rhode Islanders.

Rhode Island’s Aging Demographics

“One in five Rhode Islanders is 65 or older,” Maigret said, adding the state is also among the top five for residents 85 and older.

The share of residents 65 and older rose from 16% in 2016 to 19% today. Maigret reminded officials that older residents are a powerful voting bloc. In 2024, over one-third of ballots were cast by older voters.

Nearly 73% of households led by those 65 and older own their homes, while 28% rent. Housing costs burden 31% of older homeowners and 52% of renters, who spend over 30% of their income on housing.

Around 4% of older Rhode Islanders live in nursing facilities, and about 485 aged 55+ are unhoused including 164 persons aged 65+.

Older adults drive Rhode Island’s economy: 40% of the workforce is 55+, about 40,000 provide unpaid family care, and approximately 45,000 volunteer formally in their communities.

Residents aged 50 and older contribute $27 billion annually to Rhode Island’s GDP. Social Security brings $3.9 billion into the state each year, with every $1 in benefits generating about $2 in economic output.

Despite these contributions, financial insecurity persists. Older adult poverty has increased and now exceeds 11%, and nearly a quarter of older households live on less than $25,000 a year.

A healthy single older homeowner without a mortgage needs nearly $29,000 annually to cover basic expenses, exceeding what about a quarter of older households have.

SACRI’s Legislative Priorities

Maigret said affordability is the central challenge facing older residents especially those with modest incomes, and SACRI has organized its agenda around four “building blocks”: health care, economic security, housing, and community supports.

Eliminating the $9,950 asset limit for the Medicare Savings Program is a top priority. SACRI recommends removing this limit entirely to allow more low-income residents to qualify for help with Medicare costs.

 “In 2025 the legislature raised the income eligibility to about $27,000, this year we want to take the next step,” Maigret said. “And the next step is to eliminate the very restrictive asset test.”

Maigret also urged lawmakers to fully fund provider rate increases as recommended by the Office of the Health Insurance Commissioner, specifying that these funds are needed to close workforce shortages in home care.

These increases address shortages of home care workers. The coalition also urges nursing home cost-of-living adjustments to the federal 3.1% recommendation, ensuring increases reach frontline workers.

Additional SACRI recommendations include increasing funding for the Long-Term Care Ombudsman Program to expand oversight and supporting an all-payer Primary Care Investment Target to increase access to primary care.

To address Rhode Island’s housing shortage, SACRI recommends a housing bond of at least $120 million, with a requirement that at least 30% be allocated to populations including older adults, persons with disabilities and the homeless. SACRI further urges that new residential developments be required to include more accessible units than the current 8% rate.

Maigret called for stronger support for caregivers and community services. Proposed policies include a caregiver tax credit up to $1,000, increasing the Medicaid home care asset limit, funding homemaker services, awarding a state grant to the Village Common of Rhode Island to aid aging in place, and establishing an Office of the Elder Advocate.

Other Policy Concerns

Nina Harrison, policy director at the Economic Progress Institute, argued that Rhode Island’s tax system places a heavier burden on lower-income residents.

“The lowest-income earners in the state pay a higher portion of their wages in taxes than the top income earners,” Harrison said. She supports creating a new tax bracket for annual income above $640,000, which she said could generate about $203 million annually for public services.

Ray Gagné of the Rhode Island Organizing Project called for restoring recent service cuts at the Rhode Island Public Transit Authority and creating a stable, long-term funding source for the system.

Lawmakers Respond

House Speaker Shekarchi shared a personal story about caring, along with his siblings, for their 100-year-old father with Alzheimer’s disease, stressing the importance of allowing older adults to age in place.

“Everything is a compromise. Everything is a negotiation,” Shekarchi said of the legislative process. He highlighted recent state investments, including $18 million to keep Roger Williams and Fatima hospitals operating, $12 million added last year to nursing home funding to address workforce shortages, and more than $40 million to increase reimbursement rates for primary care physicians.

Shekarchi also pointed to legislation allowing Accessory Dwelling Units (ADUs) as a step toward addressing the state’s housing shortage.

“That’s a big benefit,” he said.

Senate Majority Leader Ciccone said lawmakers are considering 17 bills to make health care more affordable and accessible. “Throughout this session, we will evaluate the financial burdens facing Rhode Islanders and the programs they rely on,” Ciccone said.

Gov. McKee argued that his “affordability for all” plan would benefit all Rhode Islanders, with key provisions for seniors, including the complete elimination of the state tax on Social Security and policies to control rising utility costs.

The Governor outlined several proposals in his budget, including increasing funding for senior centers by $200,000 for a total of $1.8 million and phasing out the state tax on Social Security income over three years, beginning with lower-income residents.

His budget also includes $9.5 million to assist nearly 10,000 residents whose HealthSource RI insurance premiums have increased sharply.

State Treasurer Diossa gave an overview of agency programs spanning the age spectrum, from baby bonds to retirement planning. He noted that his Secure Choice retirement program addresses the needs of the 40% of private-sector workers who lack access to retirement benefits.

At the federal level, Sens. Reed and Whitehouse warned that changes to federal policies could threaten Social Security, Medicare, and Medicaid.

U.S. Rep. Seth Magaziner also called for federal action to lower costs, including expanding Medicare drug price negotiations and creating tax incentives to increase the housing supply. He also announced plans to pursue bipartisan legislation to establish a permanent House Select Committee on Aging. “Seniors deserve a dedicated forum in Congress focused on the challenges they face,” Magaziner said.

SACRI’s Costa ended the Forum with a call to collective action, urging attendees to leverage their influence for unified advocacy on behalf of older adults and people with disabilities in Rhode Island.

Let’s make our voices heard and ensure Rhode Island’s leaders are held accountable for advancing these critical priorities. Together, we can drive lasting change and truly roar for progress.

Two Attendees’ Perspectives

Mary Lou Moran, director of Pawtucket’s Division of Senior Services/Leon Mathieu Senior Center, said the briefing successfully brought together leaders from across government to focus on the needs of older residents.

“The continued work to eliminate the Medicare Savings Program asset limit, create an Office of the Elder Advocate, and expand funding for programs such as the Long-Term Care Ombudsman and Medicaid home care was all highlighted,” Moran said.

Moran emphasized legislative and federal efforts to support older adults and expressed optimism that the initiatives discussed will drive progress in the next session.

“The Governor’s FY 2027 State budget is fully committed, has little new revenue & substantial federal cuts in the Affordable Care Act, Medicaid, Housing Voucher & food subsidies will leave an unresolved budget hole,” says North Kingston Resident David R Kaloupek. Kaloupek, 87, asks: “How will the Rhode Island General Assembly narrow its spending targets for the state’s most vulnerable, frail older adults, nursing home residents, home care beneficiaries, and unhoused older Rhode Islanders?  When the dust settles after the upcoming legislative sessions conclude, we’ll see who will be helped and who will be abandoned.”

A final note…  The coming together of aging advocates and Gov. McKee, the House Speaker, and Senate Majority Leader might just create the political will to support key parts of SACRI’s legislative agenda, such as eliminating the Medicare Savings Plan asset limit, the state tax on Social Security, or creating an Office of Elder Advocate, which could significantly boost the chances of those proposals becoming law. The agreement between aging advocates and state lawmakers on several fronts suggested a strong potential for legislative progress on senior issues in the upcoming session.

SACRI’s 2026 Legislative Leaders’ Forum was sponsored by: Age-Friendly Rhode Island, Delta Dental, United Healthcare, Neighborhood Health Plan, SEIU Local 580 and Capitol TV.

https://capitoltvri.cablecast.tv/show/11856

Advocates, providers on new Nursing Home mandates

Published in RINewsToday on April 29, 2024

In the shadow of Rhode Island’s ongoing staffing shortage, the Center for Medicare and Medicaid Services (CMS) issued its 329-page final rule on Nursing Home Minimum Staffing Standards (CMS 3442-F) on April 22 in the Federal Rule. 

CMS affirmed its commitment to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare-and Medicaid-certified long-term care facilities.  

According to CMS, over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.

Just the Nuts and Bolts

CMS say that central to its final rule are new comprehensive minimum nurse staffing requirements that would significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.  The agency is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities are given the flexibility to use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.

CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

This final rule provides a staggered implementation timeframe for facilities to meet the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors. The requirements of this final rule prioritize safety and health care quality while taking into consideration the unique workforce challenges some nursing homes are facing, especially those operating in rural areas. 

CMS will closely monitor and evaluate the provisions of this final rule, including but not limited to, the minimum staffing standards, the 24/7 RN requirement, the exemption process, and the definition of rural, as they are implemented over the next several years to determine whether any updates or changes are necessary in the future. 

Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

Provider, advocate positions on new CMS final rule

At press time, the RI Department of Health (RIDOH) had no comments about CMS’s new final rule released last week, say Joseph Wendelken, RIDOH’s public information officer.  The state agency is reviewing the rule and assessing its impact and applicability in Rhode Island,” he says.

With the final rules release, senior advocates and providers are expressing their opinion about its impact.

Former President Donald Trump, who is challenging President Joe Biden for the presidency, has not addressed quality of care in nursing homes with a formal position.  Kathleen Heren, Rhode Island’s Ombudsman, speculates that by releasing the CMS mandate before the upcoming presidential election, President Biden is just trying “to establish a record” of enhancing quality of care in nursing homes.

“Nursing homes cannot find  Registered nurses (RN), and Nursing Assistances to hire,” notes Heren.  The CMS mandate will force nursing homes to downsize, like we have just seen happen at the Scandinavian Home,” she predicts.

According to Heren, the final CMS rules do not include the minimum staffing of LPNs. More important, “it’s an unfunded mandate,” she says.

Gerontologist Deb Burton, MS, executive director of RI Elder Info, is pleased to see a Federal minimum staffing mandate of 3.48 hours of daily nursing care. “It’s important to understand mandates don’t make workers appear and a minimum staffing mandate is only an average amount of time allotted for care across all residents in the facility,” she says, noting that this rule doesn’t mean each resident will receive 3.48 hours of care each day.

According to Burton, the CMS Nursing Home Compare website, as of April 2024, notes there are 6 Rhode Island facilities that would not meet the lower federal minimum staffing mandate if it were enacted today. “The workforce shortage and the dire need to increase Medicaid reimbursements to attract and retain adequate staff with a proper wage are common topics of meetings,” says Burton. 

“When workers say ‘It’s only me on the floor – do I help the resident eat their supper or take the other resident to the bathroom? I can’t do both,’ – we need to listen,” says Burton. “The new federal minimum staffing mandate is a good step forward, but we need more. One day it will likely be us waiting for that workers’ help,” she warns. 

Like other RI senior advocates, Maureen Maigret, policy director for the Senior Agenda Coalition of RI, sees the importance of CMS releasing its final rules.  “It is important that these regulations have been finalized as providing for minimum nurse staffing levels in nursing homes helps  ensure residents across the country will receive quality and resident-centered care,”  she says. 

According to Maigret, Rhode Island has had a provision for 24/7 RN coverage even before the state’s minimum staffing law was passed so that is not a new requirement here. She pointed out the regulations will also promote transparency and accountability by requiring public reporting on how much of the Medicaid payments are spent on direct care staff and that the federal government has committed to invest over $75 Million in an initiative to increase the number of nurses working in nursing homes through such things as financial incentives for tuition reimbursement.   

“We are dismayed that the Biden Administration is moving forward with this one-size-fits-all staffing mandate,” says John E. Gage, President and CEO of the Rhode Island Health Care Association. “In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors in Rhode Island and across the country,” he warns, noting that when nursing homes can’t find nurses and/or certified nursing assistants (CNAs), they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need.

New final rule just another unfunded mandate

Like the 2021 RI staffing law, the Federal rule is an unfunded mandate, charges Gage. “Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers, he states.

According to Gage, nationally, the nursing home workforce has declined by 124,200 individuals (-7.8%) since the start of the pandemic. Rhode Island’s numbers are even worse, down 1,495 individuals (-15.3%). Gage calls on Congress to step up and support the bipartisan Protecting America’s Seniors’ Access to Care Act, which would prevent CMS from enforcing this unfunded and flawed mandate.

“Together with our national association, the American Health Care Association (AHCA), we will continue to fight for more common-sense solutions and do everything we can to preserve access to care for Rhode Island seniors,” says Gage.

“The good news about the Biden Administration’s final rule, there are phase-ins over multiple years that will provide an opportunity to challenge the mandates through legislation and/or possible AHCA litigation on the national level,” adds Gage. “The federal mandate highlights how much of an outlier RI’s staffing mandate is.  The RI statute has the highest staffing metrics and the highest fines in the country – 10% above the federal standards.  Without the Executive Actions of Governor McKee, RI nursing homes would be fined $90 million in the first full year of enforcement – devastating facilities and forcing further closures.  RI excludes hours worked by administrative nurses from counting toward the RN metric, yet they are included in the federal standards.  RI also excludes med techs’ and nurse aides in training’s hours from the CNA metric, while CMS includes them,” noted Gage.

Gage adds that the CMS final rules consider Rhode Island to be “urban.” As a result, the state has 2 years to phase-in the 24×7 RN requirement.

Rhode Island regulations and law have required 24×7 RN coverage in nursing homes for many decades, says Gage. “While challenging to maintain compliance given the shortage of registered nurses, this should not be a major concern for RI facilities,” he adds, noting that there will be 3 years to comply with the required 0.55 HPRD for RNs and 2.45 HPRD for CNAs. 

Additionally, Gage says that there are also waiver opportunities in certain circumstances.  “During the implementation phase, facilities and all stakeholders must be laser-focused on building a sufficient pipeline of qualified nurses and CNAs to the nursing home workforce,” he says.  

Like Gage, James Nyberg, executive director LeadingAgeRI, sees the CMS mandate as less onerous than the RI staffing mandate that “fortunately” remains suspended. “We remain concerned about the impact of this national mandate on providers in Rhode Island, and its broader impact on consumers and the health care industry,” he says.

According to Nyberg, the state’s current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (six nursing homes have already closed since the COVID pandemic began and two more have embarked on significant downsizing). 

“These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes,” says Nyberg, noting that LeadingAgeRI is working with numerous stakeholders on various initiatives to develop a pipeline of workers. “But the simple fact is that it will take time and an infusion of resources,” he adds.

“CMS proposes to spend $75 million on a nursing home staffing campaign.  That amount might help a state like Rhode Island, but that money is national, so it is a drop in the bucket in terms of the support the industry needs, states Nyberg.  “On the home front, we have been working with the Administration and the General Assembly to provide an infusion of funding to try and rescue the homes from their dire financial straits and try to stabilize the industry.  But the federal mandate, and all the related details and requirements embedded in the rule, do nothing to further that cause,” he says.

For the Minimum Nursing Standard final rules, go to https://public-inspection.federalregister.gov/2024-08273.pdf

For the CMS Fact Sheet  on Minimum Nursing Standard final rules, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

Senior Agenda Coalition of RI zeros in on key aging legislation 

Published in RINewsToday on May 30, 2022

As the General Assembly winds down, the Senior Agenda Coalition of Rhode Island (SACRI) is tracking 16 House and Senate Bills along with FY 24 Budget Articles that have an impact on the state’s senior population. In a legislative alert, SACRI details a listing of 16 House and Senate bills and FY23 Budget Articles relating to care givers, mobile dental services, supplemental nutrition, housing, tax relief and home care worker wages. 

The state’s largest organization of aging groups is focusing and pushing for passage of the following four bills during the upcoming weeks.

SCARI puts on its radar screen S-2200/H-7489 to push for passage. The legislation (prime sponsors Senator Louis DiPalma (D-District 12) and Representative Julie Casimiro (D-District 31), establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24-member advisory committee, to provide review and recommendations for rate setting, and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.  

Meanwhile, DiPalma and Casimiro have also introduced S-2311/H-7180 to require a 24-member advisory committee to provide review/recommendations for rate setting/ongoing review of social service programs licensed by state departments/agencies and Medicaid. The House and Senate Finance Committees have recommended these measures be held for further study.

Ratcheting Up the Pay for Rhode Island’s Home Care Workers

In testimony on April 28th, SACRI’s Executive Director Bernard J. Beaudreau says, “Because payment levels for services have not been updated in years, especially in our current inflation ,levels, the low-pay level of direct care workers has created workforce shortages, impoverished workers and has put at risk our ability to provide proper care for our aging elder population.”

“Shamefully, an estimated 1 in 5 Rhode Island home care workers live in poverty and most have insufficient incomes to meet their basic needs,” says Beaudreau, calling for enactment of this bill to raise the wages of the lowest paid care workers as a top priority. 

S-2200 was referred to the Senate Finance Committee and companion measure, H 7489, was referred to the House Finance committees for review.  After hearings in their respective chambers, both bills are being held for further study. 

At press time, the Rhode Island General Assembly is hammering out its state budget for Fiscal Year 2023, taking effect July 1, 2022, to June 30, 2023.  SACARI calls on the state to make it a budgetary priority to address Rhode Island’s home care crisis.

According to Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, who also serves SACRI as a volunteer policy adviser and Board Member, says that the Governor’s budget calls for suspending use of an estimated $38.6 million in state funds which, by law, should be used to enhance home and community-based services. This law, says Maigret, is referred to as the “Perry-Sullivan” law after its sponsors.

Maigret calls for these funds to be used to increase home care provider rates so they may be fair and competitive to home care workers and increase rates for independent providers.  Many of these workers are low-income, women, and women of color, she says.

Lowering the property taxes for Rhode Island’s low-income seniors

SACRI also calls for the Rhode Island General Assembly to provide property tax relief for low-income seniors and Social Security Disability Income (SSDI) recipients. As housing costs rise and property taxes increase, more older Rhode Islanders with limited or fixed incomes and those on SSDI are becoming housing tax burdened, says the Providence-based the aging advocacy coalition. 

In SACRI’s legislative alert, Maigret calls for the passage of H-7127 and S-2192, with primary sponsors Representative Deborah Ruggiero (D-District 74) and Senator Cynthia Armour Coyne (D-32), charging that Rhode Island’s property tax relief law needs urgent updating.

Rhode Island’s Property Tax Review Law, sometimes referred to as the Circuit Breaker Law, needs serious updating. Initially the law was enacted to help provide property tax relief for persons aged 65 and over and to those on SSDI, says Maigret.  It is currently available to those with incomes up to $30,000 (set in 1999) and provides a credit or refund up to $415 against a person’s state taxes owed.  Both homeowners and renters are eligible to a apply. 

H-7127 and S-2192 would make hundreds of older Rhode Islanders eligible to participate by increasing the income cap from $30,000 to $ 50,000. Maigret notes that if these bills pass, a person with household incomes of $35,000 who is not eligible now could be eligible to get a refund of up to $850 next year. “These changes would provide direct relief against high property taxes and make Rhode Island more in line with our neighboring states of Connecticut and Massachusetts,” she says.

Finally, Executive Director Beaudreau testified on May 17th before the House Finance Committee, calling for the passage of H-7616, Reinstating the Department of Healthy Aging. “The time is long overdue for the state to re-invest in serving the needs of aging population,” he says, noting that “the state’s total population of 65 years and older has grown by 20% from 152,283 in 2010 to 182,486 today.”

Beaudreau testified that the “data clearly indicates that Rhode Island should be increasing plans, resources and services to meet the need of the state’s aging population, not cutting back.” The state’s budget has not kept up with the growth needed in the Office of Healthy Aging, charged with overseeing the state’s programs and services for older Rhode Islanders. “Additional funding is needed for increasing the Department’s staffing capacity and increasing financial support of Senior Centers serving thousands of older Rhode Islanders every say,” he adds.

But do not forget oral health of seniors, says SACRI.  According to the aging coalition, the importance of accessing quality oral health care in nursing homes is key to a nursing facility resident’s health, well-being and quality of life. Poor oral health care results in a higher incidence of, pneumonia cardiovascular disease diabetes, bone loss and cancer; all situations increasing the frequency of accessing medical care resulting in higher costs. 

Improving oral health care to Rhode Island’s seniors and special populations

SACRI calls for the passage of S-2588 and H-7756, bills that would provide for reimbursement for patient site encounter mobility dentistry visits to be increased to $180 per visit. The state’s reimbursement for mobile dentistry site visits began in 2008, only in nursing homes, but failed to provide funding for dental care in other settings. 

These bills would also expand the availability of this service to additional community-based group homes, assisted living facilities, adult day health and intellectual and developmental disability day programs. Passage of these bills will increase access to special populations who have difficulty in accessing basic dental services.

S-2588, referred to the Senate Finance Committee, was held for further study.  The House companion measure is scheduled to be heard on May 28th at a House Finance Committee hearing. 

Reimbursement for this service has not increased since it was initially funded over 14 years ago and does not cover the cost of delivering this critical service, says SACRI.

SACRI says “Make your voice heard!  Call House Speaker Joseph Shekarchi (401 222-2466) and Senate President Dominick J. Ruggerio (401 222-6555) and your legislative delegation to urge supporting SACRI’s priority legislation. 

To see a listing of SACRI’s 2022 Priority Legislation, go to https://img1.wsimg.com/blobby/go/049a7960-1c2a-4880-afdd-8d1e0e283acc/downloads/SACRI%20Bill%20Tracker%202022.pdf?ver=1653052514912.

For more details about SACRI, go to https://senioragendari.org/