Questions Raised About the State’s New Independent Provider Program

Published in the Woonsocket Call on July 15, 2018

In the waning days of the 2018 legislative session, the Rhode Island General Assembly passed legislation (S 2734 Sub A, H 7803 Sub A) that establishes in the Ocean State the “Independent Provider” (IP) model of at-home care, which allows consumers to hire and manage caregivers of their own choice while the state takes on certain responsibilities, such as setting caregivers’ wages, qualification standards and hours. With Gov. Gina M. Raimondo’s signature, the legislation became law on June 29th.

The enacted legislation is backed by the Rhode Island Campaign for Home Care Independence and Choice, a coalition that includes the Senior Agenda Coalition, RI Working Families Party, RI Organizing Project, District 1199 SEIU New England, RI AFL-CIO, Economic Progress Institute and the RI Chapter of the National Organization of Women (NOW). But, although on the losing side of the legislative debate the Rhode Island Partnership for Home Care continues to express its concern about the impact on the delivery by IPs to seniors and persons with disability.

Overwhelming Support on Smith Hill

The health care legislation, sponsored by Senate Majority Whip Maryellen Goodwin (D-Providence) and Rep. Christopher R. Blazejewski (D-Providence), easily passed both the House and Senate Chambers. The Senate Committee on Labor unanimously passed the measure by a 9-0 vote. By a count of 33-0, the legislation easily passed on the Senate floor. Meanwhile, in the other chamber, the House Committee of Finance put its stamp of approval on the measure by a vote of 13-0, with the legislation ultimately passing of the House floor by a vote of 60-11. But, because the House amended the bill (in committee and on the floor), it had to come back to the Senate for consideration again. The Senate vote on the revised legislation was 28-3.

In a statement announcing the new law, Goodwin and Blazejewski, say “By increasing both availability and quality of at-home care options, the new law’s ultimate goal is to move Rhode Island toward greater use of care in the community rather than in nursing facilities, since at-home care is both more comfortable and satisfying for consumers and less expensive than nursing facilities.”

“Presently, Rhode Island ranks 42nd in the nation in terms of investment in home care. Ninety percent of older Americans prefer home care. Not only is it more comfortable for seniors, it’s more cost-effective, as we’ve seen in states like Massachusetts. High-quality home care is what people want, and it saves money. I’m proud to support this effort to help make excellent home care available to more Rhode Islanders,” said Goodwin.

Adds, Blazejewski, “There is little question that people prefer to stay in their homes as long as possible. Particularly now, as the over-65 population in our state is rapidly expanding, Rhode Island must shift more of our long-term care resources toward supporting home care. Our legislation will help provide more options for home-based services, enhance access to them and establish standards that assure high-quality care.”

Hiring, Finding and Managing a Caregiver

Currently around 77 percent of Medicaid funding for long-term services and supports goes to nursing facility care rather than community-based care. Those who use community-based care generally go through agencies or find, hire and manage a caregiver on their own. This bill would create a third option.

Under the Independent Provider model, which has been in place in Massachusetts since 2008, consumers would still be the direct employer who determines when to hire or fire an employee, but the state would take on responsibilities for maintaining a registry of qualified caregivers, and would set parameters such as rates, qualifications and hours.

While the new law stipulates that they are not employees of the state, it would give home care workers the right to collectively bargain with the state over those parameters. Allowing them to organize would ensure that this otherwise dispersed workforce has a unified voice and a seat at the table to tackle the issues facing Rhode Island’s long term services and supports system, said the sponsors.

Consumers in states with independent provider models report higher levels of client satisfaction and autonomy, received more stable worker matches, improved medical outcomes, and reduced unmet need with agencies delivering fewer hours of care relative to the needs of the consumer.

In testimony supporting the health care legislation, Director Charles J. Fogarty, of Rhode Island’s Division of Elderly Affairs (DEA), told lawmakers that the health care legislation supports two goals of DEA, first it would enable elderly and disabled Rhode Islanders who are medically able to stay at home and second, it would address Rhode Island’s direct service provider workforce shortage.

Fogarty said it’s critical for older adults and people with disabilities to have access to the quality of care that is right for them. “In some cases, care from an independent provider they know and trust will best meet their needs to remain independent. In other cases, a home care agency will be the right fit. And for some, particularly those with complex medical needs, our quality nursing homes are the right option,” he said.

When quizzed asked about The Rhode Island Health Care Association’s position, Virginia Burke, President and CEO, recognized the value of home care in the state’s long-term care continuum but stressed that residents in the state’s nursing facilities “are too sick or impaired to mange at home.” She said, “Our only concern with this proposal is the suggestion that it could drain Medicaid funding from the frailest and most vulnerable among our elders in order to pay for a new Medicaid service. Surely our elders deserve good quality and compassionate care in all settings.”

Calling for More Education, State Oversight of IPs

While most who testified before the Senate and House panel hearings came to tout the benefits of bringing IP caregivers into the homes of older Rhode Islanders and persons with disabilities, Nicholas A. Oliver, Executive Director of the Rhode Island Partnership for Home Care, sees problems down the road and calls the new policy “duplicative and costly.”

In written testimony, if the legislation is passed Oliver warns that Rhode Island will be authorizing untrained and unsupervised paraprofessionals to deliver healthcare to the state’s most frail seniors without Department of Health oversight, without adherence to national accreditation standards for personal care attendant service delivery and without protections against fraud, waste and abuse.

Furthermore, his testimony expressed concern over the lack of oversight as to the quality of care provided by IPs to their older or disabled clients. Although the legislation called for supervision from the Director of Human Services (DHS), this state agency does not have the mandated legislative authority to investigate IPs to ensure that patient safety is met and the recipients of care are protected against harm in their homes. Nor does it require daily supervision for adherence to the patient’s authorized plan of care, he says, noting that is a requirement for licensed home health and hospice agencies.

Oliver observes that the legislation does not require IPs to receive the same level of intensive training that Certified Nursing Assistances (CNAs) receive from their home health care and hospice agencies. While the state requires all CNAs to complete 120 hours of initial training, pass a written and practical examination, become licensed by the Department of Health and maintain a license by completing a minimum of 12 hours of in-service training annually, the legislation only requires IPs to take three hours of generalized training and no continuing in-service training is required.

CNAs deliver the same personal care attendant services as the IPs but have a specific scope of practices that they must follow as regulated by the Department of Health and their licensure board while IPs do not have these requirements, says Oliver.

Finally, Oliver says that “to ensure quality of care [provided by home care and hospice agencies], CNAs are supervised by a registered nurse (RN) that is actively involved in the field and who is available to respond to both the patient’s and the CNA’s needs on-demand to reduce risk of patient injury, harm or declining health status and to reduce risk of CNA injury, harm or improper delivery of personal care.” IPs do not have this supervision., he says.

Safe guards are put in place by home health and hospice agencies to ensure the safety of patient and direct care staff, says Oliver, noting that these agencies are nationally accredited by The Joint Commission, the Community Health Accreditation Program (CHAP) or the Accreditation Commission for Health Care (ACHC) in partnership with the Department of Health for compliance of state and federal rules and regulations, as well as national clinical standards for personal care attendant service delivery.

With the Rhode Island General Assembly bringing IPs into the state’s health care delivery system, the state’s Executive Office of Health and Human Services, granted authority by the legislation to develop the program, might just consider establishing a Task Force of experts to closely monitor the progress of the new IP program’s implementation to ensure that quality of care is being provided and to make suggestions for legislative fixes next year if operational problems are identified. Unanticipated consequences of implementing new rules and regulations do happen and every effort should be state policy makers that this does will not happen in Rhode Island with the creation of the new IP program.

To watch Oliver talk about the Rhode Island Partnership for Home Care’s opposition to the enactment of IP legislation that would increase state involvement in the home care sector, go to http://m.golocalprov.com/live/nicholas-oliver.

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Splaine Consulting Gears Up to Update State’s Alzheimer’s Plan

Published in Woonsocket Call on July 8, 2018

With the securing of a total of $30,000 in grants, Lt. Governor Dan McKee officially begins Rhode Island’s effort to update its state’s five-year plan on Alzheimer’s Disease and Related Disorders to combat the rapidly increasing incidence of Alzheimer’s disease.

When announcing the successful fundraising effort, McKee noted that Rhode Island has been in the forefront of Alzheimer’s research. “Each day, we make great strides in expanding clinical trials and innovating treatments. Over the last few years alone, the local landscape of prevention and treatment has changed dramatically and positively. The updated State Plan will be an invaluable tool for local leaders, researchers, physicians, advocates and families as we work together to build the momentum in the fight against Alzheimer’s,” he said.

That day, Donna McGowan, Executive Director of the Alzheimer’s Association, Rhode Island Chapter, warned “We face an emerging crisis with the prevalence of Alzheimer’s disease projected to increase to as many as 27,000 Rhode Islanders by 2025. Alzheimer’s disease is a pivotal public health issue that Rhode Island’s policymakers cannot ignore. With the rapidly growing and changing extent of the Alzheimer’s crisis, it is essential that Rhode Island’s State Plan becomes a living document that stakeholders regularly consult and re-evaluate. We will continue to work diligently to ensure that the vision of our state’s Alzheimer’s Disease Plan is translated into actual public policy.”

Consultants Bring Content Expertise to Project

With two $15,000 grants provided by the Rhode Island Foundation and Tufts Health Plan Foundation, the Alzheimer’s Association, Rhode Island Chapter, as fiscal agent, released a request for proposal (RFP) for a consultant who would bring writing skills, expertise in public policy initiatives to provide programs and services to persons with Alzheimer’s disease, to the project.

Five consultants responded to the RFP and after a month long-search and a series of interviews, Michael Splaine and Kate Gordon, of Splaine Consulting, a small advocacy and government affairs consulting firm based in Columbia, Maryland, got the contract. No question, Splaine and Gordon brought the right blend of skills to the project. The consultants have provided content matter expertise to over two dozen State Alzheimer’s Plans.

Immediately prior to starting this company eight years ago, Splaine served as Director of State Government Affairs in the Public Policy Division of the Alzheimer’s Association for over 23 years, leading its grassroots network to accomplish state policy priorities, including persuading states to develop comprehensive state Alzheimer Plans in 2007-2008.

While at the Association he was a staff team member for the Association’s Early Stage Initiative (a program working to promote inclusion and programs for persons with Alzheimer’s.) and provided leadership in the Association on the government affairs aspects of the Healthy Brain Initiative, a cooperative agreement with the U.S. Centers for Disease Control, and Prevention continues this work as a consultant to the Association.

Kate Gordon, who has worked with Splaine for over 18 years, has a reputation for being a skilled health policy analyst and grassroots advocacy strategist. She brings expertise in a diverse range of health and long-term care issues topics, including federal and state policies affecting persons with dementia, caregiver interventions, and direct care worker training. Her previous work includes assisting in the development of the first United States National Alzheimer’s Plan and 18 state government Alzheimer’s disease plans.

Gordon was also awarded the prestigious 2013 HHSinnovates People’s Choice and Secretary’s Choice award winner for “Connecting to Combat Alzheimer’s.”

“Kate and I have worked with every level of government from local to global that is taking on the challenge of Alzheimer’s disease, including regionally and globally with the World Health Organization,” explains Splaine. The company’s long listing of clients includes the Alzheimer’s Association in their public health work with Center for Disease Control and Prevention (CDC), Alzheimer’s Disease International, the umbrella organization for over 90 national organizations devoted to persons with dementia, and overtime Splaine Consulting has also worked with the national center on elder abuse, Consumer Voice, Arthritis Foundation to name just a few.

The path that led Splaine Consulting to being chosen to update Rhode Island’s Alzheimer’s Plan may seem ironic to some, says Splaine, because it has most certainly brought him back home. He started his early professional life in the Ocean State, graduating Rhode Island College with a gerontology certificate, even having been married to a native Bristol resident for 41 years.

“My earliest work with people with cognitive impairment included volunteer teaching for Fr. (now Msgr.) Gerry Sabourin who was developing what was then called a special religious ed program and my field placement for Rhode Island College at two different adult day care centers,” says Splaine.

“I am thrilled to welcome Splaine Consulting to our team as we relaunch Rhode Island’s coordinated effort to fight Alzheimer’s disease and provide patients with the highest level of support and care,” said McKee. “Rhode Island is a leader in Alzheimer’s research and treatment but knowing how other states are addressing this devastating disease is essential to our success. Splaine’s experience in crafting other State Plans and their thorough understanding of the national landscape make Michael and Kate valuable partners.”

Combatting the Alzheimer’s Epidemic

The update of the State’s initial five-year Alzheimer’s Plan approved by the Rhode Island General Assembly in 2013, is a collaborative effort of the Rhode Island chapter of the Alzheimer’s Association, the Division of Elderly Affairs and the Office of the Lt. Governor. The final plan will provide state lawmakers, municipalities and the state’s health care system with a policy strategy to confront the anticipated Alzheimer’s epidemic. It will also take a look at the current impact of Alzheimer’s disease on a growing number of Rhode Islanders and most importantly, details the steps the state must take (legislatively and regulatory) to improve programs and services for people with Alzheimer’s and their family caregivers.

Once the updated report is completed and approved by the Rhode Island General Assembly, the state’s Long-Term Care Coordinating Council’s Executive Board will seek legislative and regulatory changes to carry out its recommendations to ensure that it is more than just a document—that it comes to shape the state’s public policies on Alzheimer’s.

The updated report must be completed by October 31, after which there will be a follow up survey to all stakeholders in the process to see “how we did at capturing their ideas,” says Splaine.

Now, Splaine and Gordon begin their analytical review work of reviewing the existing Alzheimer’s Disease Plan, contacting key state agencies for their input, and planning formal interviews over the next 6 weeks with key persons from care, research, academia, and persons with dementia and family caregivers.

Community input is crucial, says Splaine. “Through the Long-Term Care Coordinating Council’s Executive Board under the leadership of the Lt. Governor, caregiver subcommittee we have a survey out [to solicit comments] that will stay open through the end of August that will be available online and offline, he says. Kicking off on August 5 and concluding August 10, 18 community town meetings are scheduled to allow Rhode Islanders to give their thoughts as to what should be included in the updated State Alzheimer’s Plan.

For a schedule of community town meetings visit, ltgov.ri.gov/alz.

Graduating College Seniors Get Some Advice from Rhode Island’s Authors

Published in the Woonsocket Call on July 1, 2018

Throughout May and June, robed college graduates listened to commencement speeches delivered by well-known lawmakers, judges, television personalities, actors, and chief executive officers of businesses. Many of the orators advised the young adults on how to create a more rewarding personal and professional life in their later years.

Members of the Association of Rhode Island Authors (ARIA) also have insightful advice on aging gracefully in a challenging and changing world to give to the Class of 2018, and some of what the authors would have said if they had been invited to speak follows.

Hopefully, all readers will benefit from the commencement tips and find time to take a look at the authors’ books.

The ABCs of Aging Gracefully

Norman Desmarais, 71, professor emeritus at Providence College, lives in Lincoln and is an active re-enactor and a former librarian. He is the author of “The Guide to the American Revolutionary War in Canada and New England,” “The Guide to the American Revolutionary War in New York” and “The Guide to the American Revolutionary War in New Jersey.” These books intend to provide comprehensive coverage of the confrontations of the American War of Independence and to serve as a guide to the sites. For book details, go to http://www.revolutionaryimprints.net.

Commencement tips: “It’s nice to be important but more important to be nice. Remember that the people you pass climbing the ladder of success will be the same people you meet on the way down. They will often be the people you will need to be successful.

Rick Billings, 59, a retired firefighter and emergency management technician lives in Barrington. He authored and illustrated two children’s books, “The Tragic Tale of Mr. Moofs, a story about the changing relationship between a stuffed toy and a boy’s older sister and more recently “Melba Blue,” a light introduction for children on the works of Edgar Allen Poe and William Shakespeare. For book details, go to http://www.reddogart.com.

Commencement tips: “What are you waiting for? This is my mantra. I became a firefighter at age 35. I wrote, illustrated and self-published my first book 19 years later. Today, I cycle between 40 and 80 miles each week. I travel. I laugh. I love. Embrace family, nature, health, spirituality, peace, creativity and the purity of the new. What are you waiting for?”

Patricia Hinkley, 73, a former holistic counselor and journey practitioner in private practice, lives in Wakefield. She authored “Chasing Sleep/Lonely Tussles in the Dark,” a book that explores the issues and challenges surrounding sleep deprivation and how to overcome them by changing attitudes and behaviors and “Claiming Space/Finding Stillness that Inspires Action,” a book that invites you to step back from the busy world to uncover the peaceful intelligence, genuine happiness, and capabilities within. For book details, go to http://www.patriciahinkley.com.

Commencement tips: “Find what you love and do it. Learn about your world and become a part of positive change. Respect and peacefully negotiate with people who differ from you. Know history, government and civics. Involve yourself to make a better world. Trust your heart’s wisdom when deciding what is right. Speak up for it.”

Hank Ellis, 69, formerly employed by the Rhode Island Department of Environmental Management, lives in Exeter. He authored “The Promise: A perilous Journey,” a book appealing to all ages and a must-read for those who love the magic of a childhood adventure. For book details, go to Amazon.

Commencement tips: “Know what is important to you: happiness or wealth. You can have both, but it can be more difficult. Be open to change, roll with the punches and don’t punch back. Always be kind. Be brave and stretch yourself. The greatest advice I can give is to give of yourself. Serve others in all you do. I guarantee amazing results.”

Barbara Ann Whitman, 62, a family support specialist, lives in Johnston. She authored “Have Mercy,” a book about the effects foster care can have on a child. For book details, go to http://www.facebook.com/BarbaraAnnWhitmanAuthor.

Commencement tips: “Before you can be kind to others, you must first be kind to yourself.
If you want to be honest, start with the person in the mirror.The same principle applies to being authentic, loyal and loving. Being selfless is overrated. Indulge and invest in knowing yourself.
Only then will you be ready to share your gifts with the world.”

Etta Zasloff, 70, lives in Hope Valley. She published an alphabet book for all ages on her 70th birthday, “Beginning with Xs and Os: The Evolution of Alphabet.” It’s a child’s first chapter book! Personified letters change, rearrange, and interchange in rhyming stories of origin. For book details, go to ettazasloff.com

Commencement tips: “Live, really live. Look out the window more than in the mirror or at your phone. Explore the world. Engage with people beyond your immediate circle. Pursue your passion with education, experience and practice to mastery. Have the courage to forge your own path and leave a trail for others to follow. Always think of those who follow.”

Harris N. (“Hershey”) Rosen, 85, ran a Pawtucket-based candy company for 40 years before retiring. He lives in Providence, and he authored “My Family Record Book,” providing easy tips on organizing personal information, financial plans and final wishes for seniors, caregivers, estate executors, etc. For book details, go to myfamilyrecordbook.com.

Commencement tips: “Achievement is 90 percent perspiration and 10 percent inspiration. So in life, find your purpose in something you enjoy and don’t be afraid to aim high. Look around for help and value your network of friends you made in college. Persist in realizing your goal, knowing that it’s OK to fail (you will) but not to quit. You’ll get there; I promise.”

BJ Knapp, 44, a former college radio station disc jockey, lives in Coventry. She authored “Beside the Music.” Image if a washed up 80s metal band moved in to your house. It happens to Brenda and Time in “Besides the Music.” Can Brenda be one man’s wife and another man’s muse. For book details, go to http://www.bjknapp.com.

Commencement tips: “Never forget how to laugh at yourself, how to be silly and how to make others laugh. Laughter is great for your abs, for your soul and for your relationships. And it’s not all about you. Don’t turn every situation around so it’s about you. Most of the time it’s about someone else, and it’s up to you to be supportive of that person. They will do the same for you when it really is all about you.”

Alison O’Donnell, 52, a freelance editor, proofreader and ghostwriter, lives in Pawtucket. She authored “Stupid Cupid~ A Survivor’s Guide to Online Dating.” The book has a sarcastic slant toward online dating, chronicling 100 really bad dates followed by a moral learned experience from each experience. For book details, go to http://www.facebook.com/AuthorAlisonODonnell.

Commencement tips: “Do not fear your own power! There are people who will try to beat you down; rise above it. There are people who will use their power to beat you down. Go around it. Then, mentally thank them for the life lesson. There are people who will support you. Show gratitude. Your success will have been earned. Embrace it.”

Michael A. Battey, 65, a podiatrist, lives in East Greenwich. He authored “The Parent Trap, Vol. 1,” the first of a two-volume collection of humorous and insightful observations on contemporary teen parenting. For book details, go to http://www.parenttrapcolumns.com.

Commencement tips: “There is a power to kindness.There is no act, which you can choose, which will be more powerful. It is stronger than the most reasoned logic. It can vanquish the sharpest wit. Deceptive at times and preternaturally puzzling, it is your best ally. It elevates discussions and makes you a better person. It is defining, and it is memorable.”

L. A. Jacob, 50, a government claims auditor for CVS, lives in Central Falls. She authored “Grimaulkin,” a book about a young wizard who was sent to prison for summoning demons. Now he’s out trying to be a better man, but others want to use his knowledge and abilities – against his parole. For book details, go to http://www.paperangelpress.com/pages/books/grimaulkin.php.

Commencement tips: “I published my first book at 48, but I’ve been writing since I was 15. Why did I wait so long? Because I was afraid. Afraid of what my family would say about me, of how the book would be received. Here’s my advice: Don’t wait. Life is too short. Buy the darn shoes you love.”

Phyllis Calvey, 68, an educator and story teller who lives in Bellingham, MA. Her latest book, “The Butterfly Club,” presents real people’s stories of how God can, and does, use signs to communicate His presence to those in need. For book details, go to http://www.butterflyclubbook.com.

Commencement Tips: “The odds were probably a thousand to one to be published, and yet I quit my job to be a writer. My Dad said, “You could be the one. How much does a book sell for these days? $6.95? When you sell a million, that’s…” But all I heard was the word “when”, it immediately seemed to change the odds!”

For more information about the ARIA, go to http://www.riauthors.org.