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.

GOP House Budget Fray’s Nation’s Safety Net

Published in the Woonsocket Call on June 24, 2018

Just six months ago, the Republican-controlled House passed their massive $1.5 trillion tax cuts for the nation’s largest corporations and to the wealthiest 1 percent. The day of reckoning has now come as the GOP spells out how it will rein in the nation’s spiraling deficit through its recently released FY 2019 budget resolution. On Tuesday, the House Budget Committee unveiled its 85-page budget resolution, making trillions in spending cuts to Medicare and Medicaid, he nation’s two largest entitlement programs, health care, and programs benefiting veterans, students and working families. ‘

The budget titled, “A Brighter American Future,” calls for $8.1 trillion of deficit reduction while including reconciliation instructions for 11 House authorizing committees to enact at least $302 billion over nine years. Consistent with levels signed into law in February 2018, this budget sets topline discretionary spending at $1.24 trillion ($647 billion for defense spending and $597 billion for non-defense discretionary spending).

The budget blueprint cleared the House Budget Committee by a partisan vote of 21-13, with a vote, with a Democratic and Republican lawmaker absent from the vote. Political insiders Fortunately, Capitol Hill-watchers say the 2019 House GOP Budget proposal is unlikely to make it before the full House or pass this year. But, it sends a message out to voters about the Republican’s legislative priorities to rein in a skyrocketing deficits and debt by slashing entitlement and popular domestic programs.

Putting the Wealthy and Powerful Ahead

When unveiling the House GOP’s budget, Chairman Steve Womack of Arkansas, notes that it addresses “unsustainable mandatory spending, continues economic growth, encourages better government and greater accountability, and empowers state and local governments.”

During a CNBC interview on June 22, 2018, Womack said, “We have done our job and it is a reflection of what we believe is the stark reality of the fiscal condition of our country right, unstable deficits year over year and $21 trillion in debt that is going to continue to grow over time. We just felt like it was time to sound the alarm and do something about and this and this particular budget resolution does it.”
Democratic Policy and Communications Committee Co-Chair David N. Cicilline counters Womack’s rosy assessment of the House GOP budget. ““If a budget is a statement of your values, then this budget shows Republicans are putting the wealthy and powerful ahead of working people. Just a few months after passing a massive tax cut for billionaires and corporate special interests, Republicans are proposing to repeal the Affordable Care Act; cut funding for road repairs and other infrastructure projects; cripple Medicare and Social Security; make deep cuts to Pell grants; and repeal Dodd-Frank so the big banks can do whatever they want once again. In fact, this budget is so terrible, it’s hard to imagine Republicans will ever bring it to the floor,” says the Rhode Island lawmaker.

“But despite an extraordinary past and a booming economy thanks to tax reform, there are real fiscal challenges casting a shadow of doubt on the nation’s future, including $21 trillion of debt that is rapidly on the rise. We must overcome the challenges,” says Womack.

Womack says that his budget plan “offers a balanced and responsible plan to not only address the challenges but give rise to the nation’s prosperity.”

Medicare and Medicaid on Budgetary Chopping Block

Numerous federal programs affecting old Americans would be put on the budgetary chopping block, which includes another call for full repeal of the Affordable Care Act (ACA), leaving 23 million Americans without health coverage. $5.4 trillion of cuts would come from mandatory or automatic spending programs such as Medicare and Medicaid. The plan calls for raising the Medicare eligibility age to 67, as well as combining Medicare Parts A and B, and allowing for privatization of the entitlement program. The projected cuts for Medicare alone add up to $537 billion.

The GOP’s efforts to privatize Medicare runs counter to what Americans want, preserving the program in its current form. The Kaiser Family Foundation released poll results in 2015, celebrating Medicare’s 50th Anniversary, the respondents by a margin of more than two to one, do not want to see their traditional Medicare privatized.

As to Medicaid, a joint federal and state program that helps with medical costs for some people with limited income and resources, the GOP budget plan limits per capita payments and allows states to turn it into a block grant. It also introduces stricter work requirements for beneficiaries and shifting to a capped system linked to medical inflation rates, these changes cutting about $1.5 trillion. Additionally, Womack’s budget would no longer allow people on Social Security disability to receive unemployment insurance at the same time, slashing $4 billion for the FY 2019 budget.

Outside of mandatory spending programs, the budget would cut trillions from “welfare,” federal retirement programs and veterans programs, while overhauling rules for medical liability lawsuits.

“This budget proposal is a direct attack on the quality of life of America’s seniors,” said Robert Roach, Jr., President of the Alliance of Retired Americans. “We must hold our elected officials accountable for their actions. We predicted cuts to our hard-earned benefits after the GOP passed their unfunded tax cuts for billionaires and corporations. Unfortunately, that reality is now staring us in the face,” he says.

Adds Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, “Speaker Ryan is obviously making good on his promise to come after safety net programs to pay for the reckless Trump/GOP tax reform. In so doing, he and his party are sending a clear message: older, poorer, and disabled Americans are not as important as the billionaires and big corporations who are the main beneficiaries of a tax scheme that is blowing up our nation’s debt.”

Before the House Budget Committee vote, Joyce A. Rogers, AARP’s Senior Vice President Government Affairs, urged that Medicare not be cut. She called for good changes such as “reducing prescription drugs costs, enhancing payment and delivery reforms, and addressing the widespread fraud, waste, and abuse in the program.”

According to Rogers, “The typical senior, with an annual income of approximately $26,000 and already spending one out of every six dollars on health care, counts on Social Security for the majority of their income, and on Medicare for access to affordable health coverage.”

Finally, Rogers notes that the Supplemental Nutrition Assistance Program (SNAP) plays vital role in providing nutritional assistance to millions of eligible, low-income individuals and families, many seniors. “In 2016, 8.7 million (over 40 percent of) SNAP households had at least one adult age 50 or older. Proposals to block grant the program, or expand work requirements, will make SNAP less responsive and accessible in times of need,” she says.

Educate Yourself About the Issues

With the upcoming Rhode Island primary on September 12, and midterm elections just 135 days, AARP Rhode Island State Director Kathleen Connell urges all registered Rhode Island voters to review candidates’ positions on the issues and go to the polls and cast your ballot. “The 2018 midterms will be among the most historic elections in a generation,” she said.

Nationwide, the balance of power in both houses of Congress, as well as in many state legislatures and governorships, could shift because of the results in the fall’s general elections, says Connell.

While the most common way to vote is for registered voters to go to their local polling place on Election Day, Connell said that many family caregivers and others who may have difficulty voting on that day may be eager to take advantage of other methods of casting a ballot.

“With all that unpaid family caregivers have on their plates each day, it can often be hard for them to get to the polls on Election Day,” said Connell. “If a caregivers’ loved one is voting, it can be even harder, especially if their loved one has mobility issues. When available, alternative methods of casting a ballot (a mail ballot) are essential to allowing our state’s family caregivers and others to participate in this important election.” To learn more about mail ballots, visit https://vote.sos.ri.gov/

To mobilize it’s 35 million members, AARP has launched “Be the Difference. Vote,” a campaign designed to maximize the political influence of over age 50 voters. The initiative seeks to get the largest possible turnout of older voters to the polls during the ongoing primaries and in the November general election. It will also put front and center issues like Medicare security and family caregiving, along with other topics of particular interest to older voters.

To learn more about “Be the Difference. Vote,” check out aarp.org/vote to see how to get involved and state informed.

Bipartisan Fix Needed to Ensure Solvency of Social Security, Medicare

Published in the Woonsocket Call on June 10, 2018

On June 5, 2018, the Social Security and Medicare trustees released their annual report to Congress providing a snapshot of the long-term financial security of Medicare and Social Security, two of the nation’s two large entitlement programs. It was not good news for lawmakers. Nor for the 67 million people who receive retirement, or disability benefits from Social Security and for 58.4 million on Medicare.

The 2018 Social Security Trustee’s Report to Congress, prepared by nonpolitical actuaries and economists, warned that the combined asset reserves of the Old-Age and Survivors Insurance and Disability Insurance (OASDI) Trust Funds are projected to become depleted in 2034, the same as projected in last year’s Annual Report, with 79 percent of benefits payable at that time.

According to the Annual Report’s findings, the OASI Trust Fund is projected to become depleted in late 2034, as compared to last year’s estimate of early 2035, with 77 percent of benefits payable at that time. The DI Trust Fund will become depleted in 2032, extended from last year’s estimate of 2028, with 96 percent of benefits still payable.’

As to Medicare, the Medicare trustee’s report predicted that the Medicare hospital program will not be able to pay full benefits in 2026. The Trustees, for a second year in a row, issued a Medicare funding warning due to general revenue funding expected to exceed 45 percent of total Medicare outlays within 7 years, triggering a requirement for the President to submit to Congress in 2019 legislation to address warning to be considered on an expedited basis.

Released Report Triggers Discussion on Social Security, Medicare, Solvency

Media across the country reported the Social Security and Medicare trustees warning about long-term financial issues facing Social Security and Medicare. Just read the New York Time’s headline: “Medicare’s Trust Fund is Set to Run Out in 8 Years. Social Security.” Here’s CNN’s take: “Social Security Must Reduce Benefits in 2034 if Reforms Aren’t Made.” Or take a look at the New York Daily News’s attention-grabbing headline, “Social Security and Medicare Head Toward the Skids.”

With the release of the 2018 Annual Report, the powerful House Ways and Means Committee Chairman Kevin Brady (R-TX), called for ensuring the financial solvency of Social Security and Medicare. “The time is now to come together in a bipartisan manner to address these real challenges, he said.

Health Subcommittee Chairman Peter Roskam (R-IL) also gave his two cents. “The Medicare Trustees paint an even bleaker picture than last year, pointing to the need for commonsense reforms to ensure this critical safety net program continues to deliver health care to our nation’s seniors and individuals with disabilities,” said Roskam. “The solutions are not elusive as was demonstrated in part earlier this year when Congress acted on key Medicare reforms contained in the Bipartisan Budget Act of 2018 to improve access and quality in the Medicare program, but more work remains to be done. This warning from the Trustees is a sobering marker of the work ahead to ensure this program is around for our children and grandchildren,” he said.
Looking at the Glass Half-Full, not Half-Empty

Even with the bleak findings, the National Committee to Preserve Social Security and Medicare and other aging advocacy groups have their take.

Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM), notes the released Annual Report confirms that the Social Security’s trust fund is “still very much intact, with $2.89 trillion in assets – or $44 billion more than last year.”

There is still time for Social Security fixes, says Richtman. “The Trustees have confirmed that Congress has ample time (16 years) to enact modest and manageable changes to Social Security to address the fiscal shortfall. Most Americans agree that raising the payroll wage cap is the easiest and most effective way to strengthen Social Security’s finances, negating the need for harmful benefit cuts like means testing or raising the retirement age,” he said.

According to NCPSSM, since 2013 there has been a growing number of aging groups [along with Democratic lawmakers] calling to lift the wage cap and increase Social Security benefits. The Washington, DC-based NCPSSM’s Boost Social Security Now campaign endorses legislation in Congress introduced by Senator Bernie Sanders (I-VT), Rep. John Larson (D-CT) and others, which keeps the Social Security Trust Fund solvent well into this century, while boosting benefits and cost-of-living adjustments (COLAs).

On Medicare, the Trustees report shows that the Part A Trust Fund will be able to pay full benefits until 2026, at which point payroll taxes are estimated to be sufficient to cover 91% of benefits – if nothing is done to bolster the system’s finances, says Richtman, noting that NCPSSM supports several measures to keep Medicare financially sound, including a genuine push to allow the program to negotiate drug prices with pharmaceutical companies.

NCPSSM calls for restoring rebates the pharmaceutical companies formerly paid the federal government for drugs prescribed to “dual-eligibles” (those who qualify for both Medicare and Medicaid), in addition to innovation in the delivery of care and in the way, care is paid for – to keep Medicare fiscally sound for future beneficiaries.

AARP CEO Jo Ann Jenkins urges Congress to work “in a bipartisan manner to strengthen these vital social insurance programs to ensure they can meet their benefit promises for current and future generations.” She agrees with Richtman about the need to rein in rising Medicare pharmaceutical costs. “In particular, we need to take further steps to lower the cost of health care, especially the ever-rising price of prescription drugs. No good reason exists for Americans to continue paying the highest brand name drug prices in the world. High-priced drugs hurt Americans of all ages, and seniors, who on average take 4.5 medications a month, are particularly vulnerable,” she said.

Nancy Altman, President of Social Security Works and the Chair of the Strengthen Social Security Coalition, calls for strengthening and expanding Social Security not cutting it.

The Social Security program is “fully affordable,” says Altman, noting that “poll after poll shows that the American people overwhelmingly support expanding the program’s benefits.” Politicians are listening, too, she said.

“Social Security is a solution to our looming retirement income crisis, the increasing economic squeeze on middle-class families, and the perilous and growing income and wealth inequality. In light of these challenges and Social Security’s important role in addressing them, the right question is not how we can afford to expand Social Security, but, rather, how can we afford not to expand it,” says Altman.

It’s Time for a Bipartisan Fix

As the mid-term election approaches, it’s time for the Republican congressional leaders to work with their Democratic colleagues to craft bipartisan legislation to make permanent long-term fixes to Social Security and Medicare to ensure these program’s fiscal solvency for future generations.

It is projected roughly 10,000 Baby Boomers will turn 65 today, and about 10,000 more will cross that threshold every day for the next 19 years. By the time the last of this generation approaches retirement age in 2029, 18 percent of the U.S. will be at least that age, reports the Pew Research Center.

With the graying of American, the hand writing is on the wall. With the release of this year’s report by the Social Security and Medicare trustees, Congress must decisively act now to ensure that Social Security and Medicare are strengthened, expanded and benefits not cut. As Chairman Brady, of the House Ways and Means Committee, says, it is now time to address these real challenges. Hopefully, his House colleagues and lawmakers in the upper chamber will agree.

AARP Gives Us a Snapshot of the Millennial Caregiver

Published in the Woonsocket Call on June 3, 2018

AARP’s latest caregiver report places the spotlight on the Millennial generation, those born between 1980 and 1996, ages 22 to 38 in 2018. “Millennials: The Emerging Generation of Family Caregivers,” using data based primarily from the 2015 Caregiving in the U.S. study, notes that one-in-four of the nearly 40 million family caregivers in America is now a Millennial.

The 11-page report, released by AARP’s Public Policy Institute on May 22, 2018, takes a look at the Millennial’s generational experiences and challenges as they support an aging parent, grandparent, friend or neighbor with basic living and medical needs.

“Caregiving responsibilities can have an impact on the futures of younger family caregivers, who are at a particular time in their lives when pivotal social and professional networks are being formed,” said Jean Accius, PhD, Vice President, AARP Public Policy Institute, in a statement with the report’s release. “We must consider the unique needs of millennial family caregivers and ensure that they are included in programs and have the support they need to care for themselves as well as their loved ones,” she says.

The Millennial Caregiver

According to the AARP report, Millennial caregivers are evenly split by gender but also the most diverse group of family caregivers to date, notes the report. More than 27 percent of the millennial caregivers are Hispanic/Latino, or 38 percent of all family caregivers among Hispanic/Latinos.

The AARP report notes that Millennials are the most diverse generation of family caregivers when compared to other generations. Eighteen percent are African-American/Black, or 34 percent of all African-American/Black family caregivers. Eight percent are Asian American/Pacific Islander, or 30 percent of all the AAPI family caregivers, says the report, noting that less than 44 percent are white, or 17 percent of all white family caregivers. Finally, twelve percent self-identify as LGBT, which makes them the largest portion of LGBT family caregivers (34 percent) than any other generation.

About half of the Millennial caregivers (44 percent) are single and never married while 33 percent are married. If this demographic trend continues a smaller family structure will make it more likely to have a caregiver when you need one.

More than half of the Millennial caregivers perform complex Activities of Daily Living (ADLs), including assisting a person to eat, bath, and to use the bathroom, along with medical nursing tasks, at a rate similar to older generations. But, nearly all Millennials help with one instrumental activity of daily living including helping a person to shop and prepare meals.

While Millennial caregivers are more likely than caregivers from other generations to be working, one in three earn less than $30,000 per year. These low-income individual’s higher out-of-pocket costs (about $ 6,800 per year) related to their caregiving role than those with higher salaries, says the AARP report.

As to education, Millennial caregivers have a high school diploma or has taken some college courses but not finished. But, one in three have a Bachelor’s Degree or higher.

According to the AARP report, 65 percent of the Millennial caregivers surveyed care for a parent or grandparent usually over age 50 and more than half are the only one in the family providing this support. However, these young caregivers are more likely to care for someone with a mental health or emotional issue — 33 percent compared to 18 percent of older caregivers. As a result, these younger caregivers will face higher emotional, physical and financial strains.

The AARP report notes that Millennials are the most likely of any generation to be a family caregiver and employed (about 73 percent). Sixty two percent of the boomers were employed and were caregivers. On top of spending an average of more than 20 hours a week (equivalent to a part-time job) in their caregiving duties, more than half of the Millennials worked full-time, over 40 hours a week. However, 26 percent spend more than 20 hours of week providing family care.

Although most Millennial caregivers seek out consumer information to assist them in their caregiving duties, usually from the internet and from a health care professional, the most frequent source of information is from other family members and friends.

While Millennial caregivers consume information at a higher rate, most (83 percent) want more information to supplement what they have. The tope areas include stress management (44 percent) and tips for coping with caregiving challenges (41 percent).

A Changing Workforce

Millennials are encountering workplace challenges because they are less understood by supervisors and managers than their older worker colleagues. More than half say their caregiving role affected their work in a significant way, says the AARP report. The most common impacts are going to work late or leaving early (39 percent) and cutting back on work hours (14 percent).

As we see the graying of America, it makes sense for employers to change their policies and benefits to become more family friendly to all caregivers, including Millennials, to allow them to balance their work with their caregiving activities.
It’s the right thing to do.

To read the full report, visit: https://www.aarp.org/ppi/info-2018/millennial-family-caregiving.html.

Visit http://www.aarp.org/caregiving for more resources and information on family caregiving, including AARP’s Prepare to Care Guides.

Trump Signs Legislation to Undo Nation’s Banking Rules

Published in the Woonsocket Call on May 27, 2017

On May 22, 2018, The Senior Safe Act, a bipartisan bill authored by U.S. Senators Susan Collins (R-ME) and Claire McCaskill (D-MO) to help protect older American’s from financial exploitation and fraud, passed the House of Representatives by a vote of 258-159 as part of a bipartisan banking reform package after previously passing the Senate in March by a vote of 67-31. President Donald J. Trump’s signed the bill into law rolling back regulatory oversight of the nation’s financial industry.

The Senior Safety Act is part of S. 2155, the “Economic Growth, Regulatory Relief and Consumer Protection Act,” a bill that modified the provisions of the Dodd-Frank Act, which was passed by Congress in 2010 to oversee the financial industry after the financial crash and recession of 2008-09.

Protecting Older Investors from Financial Exploitation

Through the watchdog efforts of the Senate Aging Committee, financial exploitation of seniors was identified as a top senior issue to combat. According to the Government Accountability Office, financial fraud targeting older Americans is a growing epidemic that costs seniors an estimated $2.9 billion annually. These frauds range from the “Jamaican Lottery Scam,” to the IRS impersonation scam, to the financial exploitation of seniors through guardianships. Earlier this year a hearing was held to update the public about the committee’s efforts to combat scams targeting older Americans as well as unveil its 2018.

As the Chairman and former Ranking Member of the Senate Special Committee on Aging, Senators Collins and McCaskill introduced the Senior $afe Act last year. Existing bank privacy laws can make it difficult for financial institutions to report suspected fraud to the proper authorities. The Senior $afe Act address this problem by encouraging banks, credit unions, investment advisors, broker-dealers, insurance companies and insurance agencies to report suspected senor financial fraud. It also protects these institutions from being sued for making reports so long as they have trained their employees and make reports in good faith and on a reasonable basis to the proper authorities.

“As Chairman of the Senate Aging Committee, I have been committed to fighting fraud and financial exploitation targeted at older Americans,” said Senator Collins. “The Senior $afe Act, based on Maine’s innovative program, will empower and encourage our financial service representatives to identify warning signs of common scams and help prevent seniors from becoming victims.”

Judith M. Shaw, Maine Securities Administrator and chair of the North American Securities Administrators Association’s Committee on Senior Issues and Diminished Capacity, says that this legislation incentivizes financial service institutions, including those in the securities industry, to train key employees on the identification and reporting of suspected financial exploitation of seniors. “This is a significant and important tool in the ongoing efforts to protect senior investors,” she adds.

Adds Jaye L. Martin, Executive Director of Legal Services for the Elderly, “We know from our proven success with Senior Safe in Maine that education of financial services professionals is a key component to identifying and stopping financial exploitation of seniors. There is no doubt this bill will help prevent seniors all over the country from becoming victims.”

With the passage of S. 2155, Keith Gillies, President of the National Association of Insurance and Financial Advisors (NAIFA), said, “The Senior Safe Act provides “much needed protection for older investors and will allow advisors to better protect their clients’ interests.”

“Advisors are often the first line of defense for scammers looking to take advantage of investors,” says Gillies, noting that studies have found older Americans are often a prime target.

The Pros and Cons of S. 2155

Since the Dodd-Frank legislation’s passage eight years ago, 20 percent of small banks have been put out of business, said President Trump and a ceremony where he signed S. 2155 into law. He predicted that the roll back of the costly banking reform regulations, both “crippling” and “crushing” to community banks and credit unions, would stimulate the banking industry to increase lending to businesses.

Banking regulations made it virtually impossible for new banks to be established to replace those that had closed their doors, said Trump, denying small businesses with access to capital. “By liberating small banks from excessive bureaucracy — and that’s what it was: bureaucracy — we are unleashing the economic potential of our people,” said Trump.

Senator Jon Tester (D-Montana) calls the Economic Growth, Regulatory Relief, and Consumer Protection Act a jobs bill, saying “it is a much-needed solution for the folks who power our local economies.”

In an op-ed in the Greater Fort Wayne Business Weekly, Senator Joe Donnelly (D-Indiana) said, “This banking package is reasonable, balanced, and the result of thoughtful negotiation and compromise. It would take measured steps to encourage community financial institutions to boost lending and provide new protections for consumers. And it’s an example of what we can achieve when we work together to break the gridlock in Washington.”

But others strongly oppose passage of S. 2155.

Although S. 2155 has a provision to protect seniors from financial exploitation, Democratic Policy and Communications Committee Co-Chair David N. Cicilline, expressed strong concerns when the Houses passed S. 2155, he jokingly refers to as “the Bank Lobbyist Act.”

“Ten years ago, Wall Street’s recklessness brought our economy to the brink of collapse. It has taken Rhode Island years to recover. In many ways, we are still recovering.,” noted Rhode Island’s Congressman representing District 1. “The Dodd-Frank financial reform law ended the worst of the Big Banks’ excesses. It established the Consumer Financial Protection Bureau and gave working people a voice against the most powerful corporations in our country,” he said, noting that the passing of S. 2155 has reversed this progress.

It’s a massive giveaway to the wealthy and the middle class is getting screwed. This is a raw deal for working men and women. The American people deserve A Better Deal,” Cicilline said.

Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, warns that with the deregulation of banks, the GOP “are still gunning for Social Security under the guise of entitlement reform.”

Richtman predicts the passage of S. 2155 and it’s signing into law “makes another financial crisis more likely.”” He asks, “How fair is it to ask workers to be responsible and save when the government strips away protections intended to keep our savings secure?”

“Retirees’ Social Security benefits must be preserved because, at least for now, they are the only thing workers can depend on after the next financial crash,” says Richtman.

The Senior $afe Act was endorsed by organizations, including AARP, the North American Securities Administrators Association (NASAA), the Conference of State Bank Supervisors (CSBS), the Credit Union National Association (CUNA), the National Association of Federally-Insured Credit Unions (NAFCU), the National Association of Insurance Commissioners (NAIC), the National Association of Insurance and Financial Advisors (NAIFA), the Securities Industry and Financial Markets Association (SIFMA), the Insured Retirement Institute (IRI), Transamerica, and LPL Financial.