Keynote: Fine Calls for Community Health Stations Across Rhode Island

Published in the Woonsocket Call on May 20, 2018

Last week, the Rhode Island Minority Elder Task Force (RIMETF) held a Health and Wellness Fair at the Cape Verdean Progressive Center in East Providence to put a spot light on minority health care needs.

Dr. Michael Fine, a primary care physician who formerly was the state’s Health Director, and now serves as Senior Population Health and Clinical Officer at the Blackstone Valley Community Health Care, Inc., gave the keynote address, calling for an overhaul of America’s ailing health care delivery system.

Although RIMETF’s primary mission is to raise money and seek grants to provide limited emergency assistance to low-income seniors in crisis situations, the organization also promotes the advancement of inclusive programs for minority elders, says Susan Sweet, the nonprofit’s founder, a former state official who advocated for, developed and operated programs and services provided to the state’s vulnerable populations, including elders. She continued that work after retirement from the state. “During the last two decades, RIMETF provided more than $53,000 in grants,” she said.

According to Sweet, RIMETF’s $200 grants help low income seniors to pay utility costs, rent, food, medications, clothing, furniture, personal healthcare items and other necessities of life. She says that 80 grants are given out annually, about half going to minority applicants.

But, the decision to host a Health and Wellness Fair on May 11, 2018, was tied to minorities having a lack of access to health care services and to have Dr. Fine outline a better way of providing care to Rhode Island’s minorities, adds Sweet. “To this day the state’s diverse minorities continue to remain in the dark about health care programs and services that they can access and that lack of information has a detrimental impact on their health and well-being,” says Sweet.

Health Disparities in Rhode Island

During his thirty-minute keynote, Dr. Fine, a primary care physician who formerly was the state’s Health Director, and now serves as Senior Population Health
and Clinical Officer at the Blackstone Valley Community Health Care, Inc., provided the details as to how lack of access to health care adversely impacts the health and life expectancy of Rhode Island’s minorities.

According to Dr. Fine, infant mortality in the African American population is about three times as high than in the white population. Diabetes is about two times more common in the African-American population than it is in the white population. He also noted that life expectancy in the United States is 4.5 years less among the African American population than it is among the white population.

Zeroing in on Cape Verdeans, Dr. Fine noted that the Rhode Island Department of Health does not track the health of this minority group separately from other groups. The state’s primary care practices and community health centers don’t have a good way to decide who counts as a Cape Verdean for health tracking purposes, he said. But about half of the Cape Verdean community in Rhode Island live in Pawtucket and Central Falls, so that health information collected using the electronic medical record by Blackstone Valley Community Health Center (BVCHC), Inc, provides the first ever look at the health status of Cape Verdeans in Rhode Island.

It’s difficult to know if that data is complete, because it doesn’t allow us to count all Cape Verdeans at the BVCHC, but only those people who speak Cape Verdean Creole or those who identify themselves as having been born in Cape Verde. “Because we have no complete way to identify the health status of the Cape Verdean population, we have no certain way to identify specials needs and opportunities to provide better health care to this minority group,” says Dr. Fine. In addition, because Cape Verdean Creole is not a written language, “we have no way to certify Cape Verdean medical translators” which means some of the health care needs of Cape Verdeans go unaddressed, he adds.

But, there are better ways to improve the health care of Rhode Island’s Cape Verdeans, says Dr. Fine. “We must make sure that all Cape Verdeans are enrolled in a primary care practice or community health center,” he says, noting that electronic medical systems can provide better measures of the health of this population.

Dr. Fine called for Cape Verdeans to be appointed to boards of health care organizations to represent them in decision of allocation of resources, to demand better translation services, and to improve delivery of health care to Rhode Island’s Cape Verdeans.

As to Rhode Islanders, Dr. Fine noted that 25 to 45 percent don’t get primary care and prevention. As a result, there are 1,200 unnecessary deaths a year from heart disease and stroke. There are 200 unnecessary deaths a year from colon cancer and 65-70 unnecessary cases of HIV. Up to 200,000 Rhode Islanders remain smokers, he says.

Dr. Fine continued to detail the negative impact on the health of Rhode Islanders if they did not visit a primary care physician. More than 1,500 babies are born to teenagers, more than a third to minorities. Not to mention that there are 330 to 400 avoidable deaths from influenza every year due lack of immunization (500,000 Rhode Islanders are currently not immunized every year). And there are 330 deaths a year from prescriptions and other drug overdoses, he says.

It’s Time for a Change

Dr. Fine warns that major changes must be made to the nation’s health care delivery system to reduce spiraling health care costs and to provide better access. This solution can be modeled after his Central Falls Neighborhood Health Station (CFNHS), he says. It’s a multi and interdisciplinary approach, bringing a wide variety of health care professionals together, from physician, nurses, physician assistants, mental health workers, nutritionists, substance abuse workers and midwifes, to rehabilitation professionals, CFNHS’s must also provide urgent care and primary care services, be open on weekends and have “sick today access appointments.” Says Dr. Fine.

Fine has documented early successes in the CFNHS’s delivery of health care. Adolescent pregnancy was been reduced by 24 percent in 2016 and emergency medical service runs were reduced by 5 percent in just 12 months.

Dr. Fine envisions a Neighborhood Health Station in every community of 10,000 persons. When up and running, “we’ll increase life expectancy, reduce infant mortality and revitalize the local economy,” he says, by reducing health care costs.

Concluding the Health and Wellness Fair, Director Charles J. Fogarty, of the Rhode Island Division of Elderly Affairs, who will be retiring next month, was recognized by RIMETF for his 40 years of public service and his support for the work of the Minority Elder Task Force.

For more details regarding the work of the RI Minority Elder Task Force or to make a donation, write RIMETF, 5 Leahy Street, Rumford, RI 02916 or call Lori Brennan Almeida, Chairperson, at 401-497-1287.

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A Storm Cloud Looms Over Older Americans Month

Published in Woonsocket Call on May 13, 2018

Two years after President John F. Kennedy had formally designated May as “Senior Citizens Month” at a meeting of the National Council of Senior Citizens in 1963, President Lyndon B. Johnson signed the Older Americans Act into law, formally declaring May as Older Americans Month. When Kennedy first proclaimed May as Older American’s Month, there were just 17 million Americans who had reached age 65. According to the recently released 2017 Profile of Older Americans, one in seven Americans are 65 or older, and just two years from now, this this demographic group’s numbers will skyrocket to 56 million people.

Nothing but Empty Words

Since Kennedy’s inaugural proclamation, all presidents have proclaimed the month of May as Older American’s Month. Not surprisingly President Donald J. Trump recently proclaimed May as Older Americans Month, too, calling upon “all Americans to honor our elders, acknowledge their contributions, care for those in need, and reaffirm our country’s commitment to older Americans this month and throughout the year.”

Trump even touted his Administration’s priorities on fighting on the behalf of the nation’s older Americans. “The Department of Justice, for example, is focused on protecting seniors from fraud and abuse. My Administration is also committed to protecting the Social Security system so that seniors who have contributed to the system can receive benefits from it. We are also dedicated to improving healthcare, including by increasing the quality of care our veterans receive through the Department of Veterans Affairs and by lowering prescription drug prices for millions of Americans.”

But do Trump’s words in his April 30th resolution to proclaim May as Older Americans Month, match his past political actions. Not so.

Just almost three months ago the President released his 2019 budget and this fiscal blueprint did not show a commitment to aging programs and services.

Draconian Cuts in 2019 Trump Budget

Although Trump’s 2019 budget proposal was “Dead on Arrival” on Capitol Hill, as reported in my February 18, 2018 Commentary, his budgetary wish list of cuts would have been devastating to many programs and services for older Americans, as detailed by a policy analysis performed by the Washington, DC.-based National Committee to Preserve Social Security and Medicare (NCPSSM).

Trump’s budget included $1.4 trillion in Medicaid cuts, $490 billion in Medicare cuts, and repeal of the Affordable Care Act. Breaking his campaign promise not to touch Social Security, Trump called for steep cuts up to $64 billion from the Social Security Disability Insurance program.

Trump’s budget proposal also called for over $500 billion in cuts to Medicare, many of these savings coming from cuts to Medicare providers and suppliers. This was another campaign promise broken.

Trump’s budget cuts would have drastically impacted Medicare’s spending on prescription benefits and beneficiary costs, too. It would save $210 million over 10 years by eliminating the cost-sharing on generic drugs for low-income beneficiaries.

Not surprisingly, Medicaid was not immune to Trump’s 2019 budget cuts. He called for changing the structure of the program into either a per capita cap or Medicaid block grant, with a goal of giving states more flexibility of managing their programs. Through 2028, the president’s budget would cut $1.4 trillion from the Medicaid program through repealing the Affordable Care Act, and restructuring the program.

Trump’s budget proposal also calls for the elimination of the Older Americans Act Title V Senior Community Service Employment Program (SCSEP). The program, funded at $400 million in FY 2017. provides job training to nearly 70,000 low-income older adults each year.

Community Services Block Grants ($715 million), the Community Development Block
Grant ($3 billion) and the Social Services Block Grant ($1.7 billion) programs were also targeted to be eliminated. Some Meals on Wheels programs rely on funding from these federal programs, in addition to OAA funding, to deliver nutritious meals to at-risk seniors.

Trump also called for the elimination of funding to the Low-Income Home Energy Assistance Program, cutting assistance for heating and fuel costs to low income seniors. It would have also eliminated funding for The Senior Corps programs including the Retired and Senior Volunteer Program, Foster Grandparents and Senior Companions. These programs enable seniors to remain active and engaged in their communities, serving neighbors of all ages, with the benefit of enhancing their health and wellbeing.

Finally, research into cancer, Alzheimer’s Parkinson’s and other diseases affecting older persons would be negatively impacted with $ 46 million in funding cuts to National Institute on Aging at the National Institutes of Health.

Also reported in my December 10, 2018 Commentary, Trump and the GOP-controlled Congress successfully passed the Tax Cut and Jobs Act, that was projected to add $1.5 billion to the nation’s deficit over the next decade. Under the 2010 “pay-as-you-go” law, that triggers automatic spending cuts to domestic programs when the nation’s deficit increases, the GOP’s sweeping tax plan (that Trump strongly supported) would have triggered automatic spending cuts to federal programs, including a $25 billion cut to Medicare in 2018 alone. But vigorous lobbying by AARP and NCPSSM, along with a long-list of other aging, health care and union groups, narrowly averted the draconian cuts by convincing the House and the Senate to waive them as part of a temporary spending bill to prevent a government shutdown.

Strengthening Federal Assistance to Seniors

When President Johnson signed the Older Americans Act into law on July 14, 1965, to raise the awareness of the problems facing seniors and to honor them, he formally proclaimed the month of May as Older Americans Month.

This year’s Older Americans Month is celebrated in every community across the nation as Medicare, Medicaid and Older Americans Act programs are under fierce legislative attack by President Trump and the GOP-controlled Congress.

With the 2018 mid-term elections just six months away, older voters can send a message to Capitol Hill – Strengthen Social Security, Medicare, and the Older Americans Act, expand Medicaid, and bring back health insurance to millions of Americans who lost their coverage because of the Republican tax plan that repealed key provisions of Obamacare.

With a Democratic-controlled Congress, next year’s theme for the Older Americans Month, might be “Strengthening Federal Assistance to Seniors.”