Courtesy of AARP: Long-Term Care Data at Your Finger Tips

Published in the Woonsocket Call on September 2, 2018

Across the States 2018: Profiles of Long-Term Services and Supports, by Ari Houser, Wendy Fox-Grage, Kathleen Ujvari, of AARP’s Public Policy Institute, was released days ago. The jampacked 84-page AARP reference report gives state and federal policy makers comparable state-level and national data culled from a large number of research studies and data sources, some of the data gleaned from original sources.

AARP considers the 10th edition of Across the States, published for the past 24 years, “the flagship publication” to assist policy makers make informed decisions as they create programs, and policies for long-term services and supports (LTSS). State-specific data “is easily found, “at your fingertips,” claims AARP.

Across the States, released August 27, 2018, includes a myriad of aging topics include: age demographics and projections; living arrangements, income, and poverty; disability rates; costs of care; private long-term care insurance; Medicaid long-term services and supports; family caregivers; home- and community-based services (HCBS); and nursing facilities. Each state profile is a four-page, user-friendly, print-ready document that provides each state’s data and rankings.

Looking at Trends

AARP Public Policy Institute researchers have identified four trends in reviewing state data. Of most importance to Congress and state legislatures, Across the States gives a warning that America’s population is aging. The nation’s age 85 and over population, those most in need of aging programs and services, is projected to triple between 2015 and 2050, a whopping 208 percent increase.

But, by comparison, the population younger than age 65 is expected to increase by only 12 percent. The under age 65 population, currently, 85 percent of the total population, is projected to be 78 percent in 2050. Bad news for propping up the Social Security system with the worker-to – beneficiary ratio declining.

Across the States researchers say that the demographic shift of an increasing older population will have an impact on family caregiving. “The caregiver support ratio compares the number of people ages 45–64 (peak caregiver age) to the number ages 80+ (peak care need),” notes the report. Today, there are about 7 people ages 45–64 for every person age 80. By 2050, that ratio will drop to 3 to 1.

America’s older population is also becoming more diverse, reflecting overall trends in the general population. Across the States researchers note that the Hispanic population age 65 and over is projected to quadruple between 2015 and 2050.

Finally, Across the States report notes that State Medicaid LTSS systems are becoming more balanced due to the increase of state dollars going to fund home and community-based services (specifically to care for older people and adults with disabilities). But, this trend varies in level of balance, say the researchers, noting that: “The percentage of LTSS spending for older people and adults with disabilities going to HCBS ranged from 13 percent to 73 percent in 2016. While 40 states became more balanced, 11 states became less balanced for older adults and people with physical disabilities in 2016 compared with 2011.”

Taking a Closer Look

Across the States notes that the age 85 and over population is projected to significantly outpace all other age groups when the aging baby boomers begin turning age 85 in 2031. In 2015, people ages 85 and older made up 2 percent of the US population. By 2050, they are projected to represent 5 percent. By contrast, in the Ocean State the age 85 and over population was 2.7 percent of the state’s population. By 2050, look for the oldest-old population to inch up to 5.4 percent.

Throughout the nation the cost for private pay nursing facility care is well out of reach of most middle-income families. Across the States notes that in 2017 the annual median cost for nursing facilities is $97,455 for a private room and $87,600 for a shared room. But, in Rhode Island the annual cost is higher, with a private room costing $ 104,025 and $ 101,835 for a shared room. The researchers say that for the cost of residing in a nursing facility for one year, a person could pay for three years of home care or five years of adult day services.

Because of the high costs, most people go through their life savings paying for costly care and ultimately have to rely on the state’s Medicaid program. Nationally, the percent of Medicaid as primary payer in 2016 was 62 percent (61 percent in Rhode Island).

According to Across the States, family caregivers provided $470 billion worth of unpaid care in 2013, more than six times the Medicaid spending on home and community-based services. In Rhode Island, 134,000 provided 124 million hours of care annually with an economic value $ 1.78 billion. But, AARP’s report warns federal and state policy makers about the stark demographics in America’s future that will for the nation’s “Oldest Old” to scramble to find a caregiver, due to a shortage. Will state’s have the financial resources to fund programs and services to make up for this demographic reality.

For a copy of Across the States report and Rhode Island specifics, go to: http://www.aarp.org/content/dam/aarp/ppi/2018/08/across-the-states-profiles-of-long-term-services-and-supports-full-report.pdf.

Advertisements

Senate Spending Bill Increases Research Dollars to Combat Alzheimer’s disease

Published in the Woonsocket Call on August 26, 2018

Last Wednesday evening, the US Senate overcame political gridlock by passing a 2019 fiscal “Minibus” spending bill that allocates funding for the Department of Defense; and Labor, Health and Human Services, Education, and Related Agencies (accounting for 65 percent of all discretionary spending). Within the Health and Human Services appropriation, the National Institutes of Health’s budget increased by $2 billion to $39.1 billion, a 5.4 percent increase over the agency’s current funding level.

The Labor, Health & Human Services, Education and Related Agencies Appropriations bill passed on Augusts 23 by a broad bipartisan vote of 85 to 7, the spending bill combining the Senate Appropriations Committee-passed FY 2019 Labor-HHS spending bill (S. 3158) with the text of the Senate committee-passed Defense spending bill (S. 3159). The Senate-passed appropriations bill, with both Rhode Island Senators supporting, adds an additional $425 million for Alzheimer’s research at the National Institutes of Health (NIH) for a total of $2.3 billion. The increases in Alzheimer’s funding surpasses the $2 billion research goal of the National Plan to Address Alzheimer’s Disease. If signed into law, this would mark the fourth consecutive year of historic action by the U.S. Congress to address the growing Alzheimer’s epidemic through funding research.

As to other NIH health initiatives, the 2019 fiscal spending bill also allocated $429.4 million for the BRAIN initiative to map the human brain, (a $29 million increase), and $376 million for the All of Us precision medicine study, this was $86 million more than in FY 2018.

The Senate Labor, Health and Services, and Education appropriations subcommittee first recommended the Alzheimer’s funding increases in June, with the full Senate appropriations committee later giving its support.

Bipartisan Support for Combating Alzheimer’s Disease

Ahead of the Senate floor vote, U.S. Senator Roy Blunt (Mo.), chairman of the Appropriations Subcommittee on Labor-HHS, called for increased federal dollars to invest in research to find a prevention and cure for Alzheimer’s disease. “Treating those with Alzheimer’s costs taxpayers $21 million every hour and, without a treatment or cure, will top $1.1 trillion by 2050 – about twice as much as the annual defense budget,” the Senator calculated.

Blunt warned his Senate colleagues that the nation must get serious with confronting the Alzheimer’s epidemic and finding a cure through research. The Senator stated: “Every hour, Alzheimer’s disease costs taxpayers at least $21 million. Every single hour. Someone in the United States is developing Alzheimer’s every 65 seconds,” noting that $277 billion in tax dollars are spent a year on Alzheimer’s and dementia-related care. It’s hard to talk about this without giving numbers, but numbers are not the most riveting thing, particularly when you talk about millions, or billions, or even trillions.

“What does that really mean? That really means that we’re spending basically an amount equal to half of the defense budget on Alzheimer’s and dementia-related care. Just the overwhelming impact of that, if we don’t do something differently than we’re doing right now, just because of the projected long life and demographics of the country, in 2050, which is 32 years from now, we’ll be spending, in today’s dollars, $1.1 trillion on Alzheimer’s and dementia care. $ 1.1 trillion… That’s twice the defense budget of last year, twice the defense budget. …,” says Blunt

“If we could just delay onset of Alzheimer’s, if we could figure out how to come up with something that would slow down the onset of that disease. If we could delay onset by an average of five years, we’d cut that $1.1 trillion by 42 percent, almost in half. If we could have the average person that gets Alzheimer’s, get it five years later than they are getting Alzheimer’s today, almost half, 42 percent of that $1.1 trillion would go away,” said Blunt.

Greater Investment in Alzheimer’s Funding Still Needed

With the Senate appropriations bill pumping more federal dollars into Alzheimer’s research, UsAgainstAlzheimer’s Chairman George Vradenburg issued a statement
saying: “We believe that Alzheimer’s is the second inconvenient truth of the 21st century. Alzheimer’s is the century’s most fearsome — and inevitable — health and social economic threat to the baby boom and future generations, including, in particular, to women and communities of color. Even with this strong commitment from the Senate, greater investment is still needed if we are to deliver meaningful progress in care and treatment to the six million Americans, 50 million globally, living with this disease and their more than 16 million caregivers. In addition to supporting research, we must elevate brain health as an important part of the path to a cure through regular primary care physician assessments of cognitive health — and early and accurate diagnosis of the cause of any cognitive impairment. The Concentrating on High-value Alzheimer’s Needs to Get to an End (CHANGE) Act, comprehensive legislation aimed at overcoming barriers to a faster cure for Alzheimer’s disease, does just that and we urge Congress to pass the CHANGE Act immediately.”

The Chicago-based Alzheimer’s Association and the Alzheimer’s Impact Movement (AIM) also applauded the Senate’s 2019 spending bill that puts more money into Alzheimer’s research. “Every 65 seconds someone in the U.S. develops the disease,” said Harry Johns, Alzheimer’s Association and Alzheimer’s Impact Movement (AIM) President and CEO. “But, thanks to increased NIH funding American scientists are now advancing basic disease knowledge, ways to reduce risk, new biomarkers for early diagnosis and drug targeting, and developing the needed treatments to move to clinical testing,” he says.

The Senate appropriations bill now goes to conference negotiations with the House and must be signed into law by President Donald Trump. The 2019 Fiscal Year begins October. 1.

Midterm Elections Can Impact Social Security’s Long-Term Survival

Published in the Woonsocket Call on August 19, 2018

After just weeks celebrating the 53rd Anniversary of Medicare to score political points, Democrats, aging groups and Social Security Advocates put 83 candles on a cake to celebrate President Franklin D. Roosevelt’s signing of Social Security Act into law on August 14, 1935. The new Act created a social insurance program designed to pay retired workers age 65 or older a continuing income after retirement.

With the midterm elections looming, less than three months away, the Democrats are gearing up their efforts to recapture the House and Senate. Polls tell us that Social Security is being positioned as a key issue to energize voters, especially in competitive races, to control both legislative chambers.

According to the Washington, DC-based AARP, recent polling suggests Social Security and Medicare will be key issues for 50-plus voters. Recent
AARP/Politico polls found a significant majority of age 50 and over Arizona voters report Social Security (78 percent), health care (76 percent) and Medicare (75 percent) are “very important” issues to them as they head to the polls in November. Also, significant majorities of older Florida voters age 50 and older say Social Security (82 percent) and health care (78 percent) will be very important to their vote for Congress this fall. In this swing state, nearly three-quarters of Florida voters cite the future of Medicare as an important election issue.

Social Security Checks Prime States and National Economic Engine

AARP, the National Committee to Preserve Social Security and Medicare (NCPSSM) and Social Security advocates say it’s a great time to remind political candidates for House and Senate races of the popularity of Social Security and Medicare and both programs impact on the nation’s fiscal health. The Washington, DC-based NCPSSM calls Social Security and Medicare an economic generator, annually paying out more than $ 800 billion in benefits to over 57 million beneficiaries who put this money back into their local, state and federal coffers.
In the Ocean State, there are 222,851 Social Security beneficiaries, including 152,898 Retired Workers, 37,133 Disabled Workers, 11,680 Widow(er)s, 5,810 Spouses and 15,330 Children Social Security benefits that pump $3 Billion each year to state’s economy, says NCPSSM, its figures taken from the nonprofits state-by-state analysis of how much revenue Social Security contributes to the economy of every Congressional District in each state.

“Social Security has a very big footprint in Congressional districts across the country, which is a tremendous benefit not only for beneficiaries, but for entire communities,” says Max Richtman, NCPSSM’s president, and CEO. “Yet, in the face of clear evidence of Social Security’s effectiveness, conservatives want to cut and privatize the program. Candidates in this year’s mid-term elections must ask themselves whether their communities can afford to lose billions of dollars in economic stimulus – not to mention the baseline financial security that these earned benefits provide retirees and their families. The answer for anyone who seeks to represent the people should be a resounding ‘No,’” he says.

Yet, throughout the years, GOP lawmakers sought to ensure the solvency for the Social Security program by cutting benefits, raising the retirement age and
to privatize the program. Democrats call for the raising or eliminating the payroll cap on taxable wages, now $ 118,500 a year, to bring more revenues into Social Security from the nation’s wealthy. They say Social Security must be considered an earned benefit rather than an entitlement because working Americans pay into the system each paycheck, and receive benefits when they retire or become disabled.

Key Congressional Races to Watch

And there are a lot of Congressional races to watch during the upcoming mid-term elections. According to fivethirtyeight.com, a website that focuses on
opinion poll analysis and politics, “… 39 Republicans and 18 Democrats are not running for re-election. That includes 13 Republicans and 10 Democrats who are leaving to seek another office, such as governor. Excluding them, 26 Republicans and eight Democrats are walking away from their political careers at the end of the 115th Congress. That’s the most “pure” retirements by Republicans — and the fewest by Democrats — since the 2008 election.”

NCPSSM is closely monitoring both House and Senate races, calling for voters to support candidates who commit to strengthening and expanding Social Security. “These Social Security champions can be found across the country, in both red and blue states,” says the Social Security advocacy group.
Here are just a few campaigns to watch.

NCPSSM says one of these Social Security campaigns is Kathleen Williams, a water conservation expert, who is running for the House seat in Montana currently occupied by Republican Greg Gianforte. The Republican Congressman, elected in 2017, voted for the sweeping GOP tax plan, the Tax Cuts, and Jobs Act, increasing the national debt by $ 1.9 trillion between 2018 and 2028, according to the Congressional Budget Office. The skyrocketing deficit puts Social Security, Medicare and Medicaid on the GOP radar screen for cuts to the nation’s debt and deficits. Gianforte’s opponent pledges to “make sure that our seniors can retire with dignity by protecting Medicare and Social Security no matter what.”

Another, in Arizona, three-term Democratic Congresswoman Kyrsten Sinema, formerly serving in both chambers of the State Legislature, is running for retiring Republican Senator Jeff Flake’s seat, a race that could determine which political party takes control of the Senate. “Sinema says, “We can’t allow… Washington to threaten the Medicare and Social Security benefits Arizonans have earned through a lifetime of hard work.” Her likely opponent, Republican Congresswoman Martha McSally, like Congressman Gianforte, voted for the GOP tax plan and Sinema has accused her of wanting to privatize Social Security while her Congressional voting record does not reflect this charge.

Finally, in Illinois’ 12th Congressional district, where challenger Brendan Kell, serving as the state’s attorney for St. Clair County and earned a commission as an officer in the U.S. Navy opposes incumbent Mike Bost. The Republican voted for the GOP’s failed Balanced Budget Amendment – Democrats and NCPSSM considering this a backdoor strategy to slash Social Security. The Democratic challenger Kelly that “instead of cutting Social Security, Medicare and Medicaid, as those in Congress currently want to do… we have to fight against that and expand the access and coverage overall.”

You Can Make a Difference

With the outcome of the midterm elections, especially in battleground state, AARP’s voter engagement multifaceted campaign “Be The Difference. Vote” is mobilizing older voters to get them to vote in primaries and in the November general election. The “get out the vote” initiative will put issues of particular importance to aging baby boomers and seniors front and center— issues like Medicare, Social Security, financial security, prescription drug costs, and family caregiving.

AARP is tracking key races, sponsoring debates, and hosting candidate forums and tele-townhall events. Election information is provided through a full-scale digital effort, including aarp.org/vote, the AARP Now app, social media outreach, graphics, and news alerts. AARP is also using direct mail, phone banks and transportation assistance to help people get to the polls.

Social Security celebrates its 83 Anniversary this month. Older voters can send a message to Capitol Hill by casting votes for candidates to strengthen and expand the program instead of voting for those who call to privatize Social to replace the federal government-administered system.

A Final Note…

Congressman David Cicilline (D-RI) will release a new report from the U.S. House Democrats’ Seniors Task Force during an event at Rumford Towers in East Providence this Monday. The report outlines the history of Washington Republican efforts to attack Social Security and Medicare.

Cicilline, who serves in the House Democratic Leadership, also plans to outline the policies that Democrats will advance if they take control of the House this November. Democrats have outlined a series of proposals to lower the costs of prescription drugs and health care premiums.

“Republicans are on the side of powerful special interests. Democrats are for the people,” Cicilline told me. “When Democrats take the majority, we’re going to pass legislation giving Medicare the ability to negotiate the cost of prescription drugs. We’re going to make Social Security and Medicare a priority by requiring the wealthy to pay into the system as much as everyone else and improving cost-of-living adjustments.”

AARP Takes A Look at ‘Value of Experience’ of Older Workers

Published in the Woonsocket call on August 12, 2018

Given employers’ need for talent and experience, Oak Hill resident Henry Rosenthal, 67, with five decades in the workforce, readily agrees with AARP views that it’s a sound business decision to hire experienced workers, as supported by the findings of AARP’s recently released survey, The Value of Experience: AARP Multicultural Work and Jobs Study. The AARP report includes insights on workers, employers, and age bias, a hurtle Rosenthal had to overcome in finding reemployment after being unemployed for two years in his sixties.

AARP’s in-depth survey was conducted online in September 2017 to a national sample of 3,900 adults ages 45+ who were working full-time, part-time, or looking for work.

According to the results of AARP’s survey of experienced workers released on August 2, 2018, nearly 9 in 10 continue to work for financial reasons, but approximately 8 in 10 either enjoy or feel useful doing their job. And among those who plan to retire, over 1 in 4 plans to start a business or earn money in some independent way, including freelancing and contract work, teaching others, selling hand-made goods, and providing home services such as house cleaning and cooking.

“With rich work histories, varied experiences and expertise, older workers want to work, they’re ready to work, and they need to work,” said AARP Vice President of Financial Resilience Susan Weinstock. “More employers are looking for qualified candidates and experienced workers should have the opportunity to be judged on their merits, rather than their age,” says Weinstock.

To highlight job opportunities among 50-plus workers, AARP launched an employer pledge for companies who hire workers based on ability, regardless of age. Since 2013, 650 employers have signed AARP’s pledge. AARP also continues to educate employers about the value of older workforce and the positives of having multigenerational employees.

“According to government data [from the U.S Department of Labor Statistics,] workforce participation rates for older workers exceed participation before the Great Recession, while younger worker participation is below pre-recession numbers,” added Weinstock. “While employment trends for older workers are favorable, with 27.9% of 55-plus workers suffering long-term unemployment compared to 18.1 percent of 16-54 workers, the long-term unemployment disparity suggests that entrenched age-bias still exist too often in the workplace,” she says.

Age discrimination Still Around

Findings from AARP’s survey, The Value of Experience, show that many experienced workers still face the barrier of age discrimination in their job hunt or at their place of employment. More than 9 in 10 workers see age discrimination as somewhat or a very common occurrence.

Specifically, the AARP survey found that at work, more than 6 in 10 older workers (61 percent) report they’ve seen or experienced age discrimination in the workplace, and of those concerned about losing their job in the next year, one-third (34 percent) list age discrimination as either a major or minor reason. But only 3 percent of the survey respondents say that they had made a formal complaint to their supervisor, to Human Resources or a government agency

Age discrimination becomes more noticeable to those turning age 50 and over. Fifty four percent of those surveyed believe that age discrimination starts on that major age milestone, 28 percent at age 60. Ageist comments from either a boss or coworker are the most visibly frequent type of discrimination reported by the survey respondents.

According to the AARP survey, both employed workers and those who were unemployed looking for work viewed age discrimination as the key reason why they did not think they could find employment within three months.

On the job hunt, almost half (44 percent) of older job applicants say they have been asked for age-related information, such as birth date and graduation date, from a potential employer.

Over 90% of older Americans surveyed by AARP supported strengthening the nation’s age discrimination laws— nearly 6 in 10 (59 percent) strongly support a change and 32 percent somewhat agree they should be improved.

With 2017 marking the 50th Anniversary of the nation’s Age Discrimination Act of 1967, AARP’s new survey findings are timely as America’s workforce is aging and an increasing number of older workers report their age keeps them from becoming gainfully employed or underemployed.

A Personal Note:

Looking back, Rosenthal, says of his two-year job search, in 2015 after being laid off, he experienced age discrimination. “Having been interviewed by numerous Human Resource professionals, they just seem incapable of understanding that the years of experience someone has gained is an asset. They seem unable to appreciate that knowledge, experience, and even skills acquired over a lifetime can be transferred and used in virtually any organization or business,” he says.

Rosenthal says, “there is a higher probability of age discrimination occurring when company management, human resource professionals, and recruiters interview applicants older than themselves.” Like many older job seekers, he believes that decision-making executives are uncomfortable with overseeing older workers and rather than deal with them, they don’t just hire them.

Rosenthal, now gainfully “under employed,” views his older contemporaries as being “more stable, reliable, have better work ethics and generally make great employees, in line with AARP’s philosophy that Corporate America should value the experience of older workers. With the difficulty in finding employment Rosenthal believes that companies have not figured this out yet. “What a terrible waste of human capital,” he says.

AARP says its survey findings reveal that “older workers believe that age discrimination should be taken just a seriously as other forms of discrimination, and support strengthening the laws to ensure that it is.”

But, Rosenthal says that while combating age discrimination by strengthening the laws, real change can only occur by changing “our cultural attitudes.” Other cultures value their elders but here in America’s we don’t,” he says.

For a copy of AARP survey findings, go to http://www.aarp.org/content/dam/aarp/research/surveys_statistics/econ/2018/value-of-experience-chartbook.doi.10.26419-2Fres.00177.003.pdf.

Calls for Strengthening Medicare as it Hits 53

Published in the Woonsocket Call on August 5, 2018

Just before Summer recess House Democratic Leader Nancy Pelosi (D-CA) joined Seniors Task Force co-chairs Congresswomen Jan Schakowsky (D-IL) and Doris Matsui (D-CA), Democratic Policy and Communications Committee co-chair Congressman David Cicilline (D-RI) and seniors’ advocates gathered in the historic Rayburn Room of the U.S. Capitol, one of the largest rooms on Capitol Hill, to celebrate the 53rd anniversary of Medicare and Medicaid being signed into law by President Lyndon Johnson.

“We usually celebrate Medicare’s anniversary at the U.S. Capitol with balloons and cake. This year, the 53rd anniversary, was a more solemn occasion because of relentless attacks on the program by the Trump administration and Congressional Republicans, says Max Richtman, President and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare, one of the advocacy groups in attendance.

When signing the landmark legislation into law on July 30, 1965, President Lyndon B Johnson said, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime. No longer will young families see their own incomes and hopes eaten away simply because they are carrying out their deep moral obligations to their parents.”

At the July 25 birthday commemoration, Leader Pelosi called Medicare and Medicaid “the pillars of health and security for the nation,” noting that for years these two programs have been under unrelenting and constant attacks from Republicans.

“For years, Republicans have sought to deny seniors and working families the healing miracle of medicine. Republicans want Medicare, in their words, to ‘wither on the vine.’ They want to cut and cap Medicaid into oblivion. They want to give massive tax handouts to big pharma who are denying seniors lower prescription drug prices,” says Pelosi.

According to Pelosi, the Democrats plan, A Better Deal, provides a legislative strategy for lowering the price of prescription drugs. “Our plan calls for tough new enforcement of drug price gauging, allowing Medicare part D to negotiate drug prices,” she said, noting that President Donald Trump had promised that during his presidential campaign, “We’re going to negotiate like crazy.”

Echoing Pelosi, at the press conference Rhode Island Congressman Cicilline also called for the reining in of prescription drug costs to put the brakes on rising Medicare expenditures. “Democrats believe that seniors shouldn’t have to cut pills in half to afford prescription drugs. We need a president who will work with us to allow Medicare to negotiate drug prices, to compel drug makers to justify cost increases, and to crack down on price gougers,” said Cicilline.

Cicilline reminded those attending that the President once promised to take on the drug companies but now has decided to appoint a former drug company executive as his Secretary of the Department of Health and Human Service. “And right now, he’s pretty much letting the pharmaceutical lobby have the run of the place,” he charged.

At the press conference, the Democratic lawmakers were joined by ten yellow t-shirted senior volunteers from the National Committee to Preserve Social Security and Medicare’s Capitol Action Team (CAT), who demanded that the program be strengthened. One of the CAT members, Patricia Cotton, gave a powerful personal testimonial about the importance of Medicare in her life. Cotton, a Medicare beneficiary who suffers from a blood cancer known as Myelofibrosis, said she wouldn’t be alive today without the health care program.

“My cancer meds started at $10,000 every 30 days and have gone up twice in two years. Cancer meds are very expensive. My Medicare Part B and D premiums have gone up, and that is coming out of my Social Security check. That is why, without Medicare and Social Security, the rich will live and the poor will die,” said Cotton.
.
Democratic Report Spotlights GOP’s Ongoing Attacks on Medicare

At this event, the House Democratic Seniors Task Force unveiled a new 24 page report, “The Republican Record on Medicare, Medicaid and Social Security: Attacks on Benefits Seniors Have Earned and Deserve,” detailing years of Republican’s attacks on seniors and demanded the GOP take action on lowering pharmaceutical prices.

“This report shows how the passage of the GOP tax bill was just one step in a long line of Republican attacks on seniors,” says Congressman Matsui (D-CA). “In budget after budget, year after year, Republicans have reaffirmed their commitment to gutting Medicaid, scaling back Medicare, and cutting seniors’ earned Social Security benefits. Democrats are focusing on efforts that help seniors and families, like lowering drugs prices, and fighting to ensure that these vital programs are here for current and future generations.”

“The House GOP budget proposal includes more than $500 billion in Medicare cuts, a higher eligibility age, and privatization of the program through a voucher system,” the National Committee’s Max Richtman explains. “The President’s 2019 budget would inflict similar harm on Medicare. The Trump administration is undermining the program through skillfully worded enrollment information that favors private Medicare Advantage plans over traditional Medicare. These actions are contrary to the mission of Medicare so eloquently stated by President Lyndon Johnson is when he signed it into law 53 years ago,” says Richtman.

AARP Calls Medicare an Economic Engine for Rhode Island

Last year, Medicare, which helps pay the health care costs of 56 million beneficiaries, is a critical part of the country’s economic infrastructure, investing about $ 710 billion in the national economy that year, says AARP.

On July 25th, the same day that House Democratic Leadership and aging groups celebrated the 53rd anniversary of the signing of Medicare, AARP released fact sheets illustrating Medicare’s contribution to the economies of each state and the District of Columbia.

Let’s take a close look at the Ocean State.

Medicare contributes $2.5 billion to Rhode Island’s economy, equivalent to 21% of state and local government spending in the state, according to the released AARP Rhode Island fact sheet, noting that the program also covers 192,186 beneficiaries in the state. In polls, older Americans have said Medicare is one of their top issues in the 2018 mid-term elections, and AARP Rhode Island is working to encourage older Rhode Island voters to participation this election season.

“Medicare is a major economic engine in our economy security, as well as a key part of, providing health security to Rhode Islanders,” said AARP State Director Kathleen Connell in a statement. “Older Americans have said Medicare is one of their top issues in this election, yet too many politicians fail to recognize the contributions Medicare makes to the economy and our residents. Any candidate who fails to talk about how they would strengthen Medicare for future generations does so at their peril,” says Connell.

Below the AARP fact sheet breaks down some of Medicare’s spending in Rhode Island:
• $1.1 billion for hospitals
• $551 million for doctors
• $338 million for prescriptions and medical supplies
• $198 million for skilled nursing facilities
• $159 million for home healthcare agencies
• $92 million health professionals
• $24 million for medical equipment

Also, businesses in Rhode Island receiving Medicare dollars use them to pay employees’ salaries, rent, state and local taxes, and buy equipment, and make capital improvements to their facilities, says the AARP fact sheet.

With the mid-term elections looming, it is now time to send a clear message to Congress and President Donald Trump, “Stop Attacking Medicare.” Lawmakers on both side of the aisle must work to craft a bipartisan solution to strengthen the program for the benefit of America’s retirees. Consider sending this message when you vote…

AARP’s “Be The Difference. Vote” campaign includes a one-stop online portal – aarp.org/vote – to provide people with information (about Social Security, Medicare, Medicaid and aging issues} they need to. know about before voting in the upcoming November elections.

To see the House Democratic Senior Task Force report, “The Republican Record on Medicare, Medicaid and Social Security: Attacks on Benefits Seniors Have Earned and Deserve,” go to
http://www.schakowsky.house.gov/uploads/Seniors%20Task%20Force%20Report%207.24.18.pdf

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.

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.