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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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.

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.

“Bosom Buddies” Brings Healing to Breast Cancer Survivors

Published in the Woonsocket Call on November 26, 2017

Sometimes a personal health-related issue and one’s professional life experiences blend together almost seamlessly to create an opportunity to help others in similar situations. It took over 20 years for Mary Jane Condon Bohlen, a Cranston resident, professional photographer, artist, former teacher and breast cancer survivor, to do just that, achieving her dream of publishing her book, “Bosom Buddies.”

Each photograph of the 29 women posing in “Bosom Buddies” reveals the scars of breast reconstruction and the coffee table book also features an essay, poem, or other writing from the model on the opposite page, providing further insight into the journey through breast cancer.

“I chose the name “Bosom Buddies” as the title of this book and photographed my “buddies” kayaking, riding horses, working in their gardens, singing, doing yoga and other loves,” says Bohlen. “I sought to reveal the thoughts, fears, inner spirit and especially the hopes of those brave enough to bare their bodies and show their beauty,” in a book that took two years to complete.

In May of 2008, after living with a mastectomy of her right breast for 16 years, she was told that cancer had returned to her left side. Now with two mastectomies, breast cancer gave her the insight and wisdom to photograph women in a very vulnerable health state that appear in “Bosom Buddies.” The women photographed are typical of women who “battle breast cancer every day.”

“They have taken their bravery one step further by allowing themselves to be photographed in subtle and delicate settings,” says Bohlen.

The Inspiration

As a fourth grader, Bohlen began taking pictures with a camera that her parents gave her. In later years, as a medical photographer working in hospitals all over the City of Boston, she photographed artificial hearts being implanted in pigs and cows, cutting edge surgeries on humans, a 16mm movie of a lung transplant in a rat photographed through a microscope, social events that included dignitaries, film, TV, and Broadway stars, weddings, Bar Mitzvahs, PR work, in addition to her own fine art photography, including the publishing of “Bosom Buddies.”

Bohlen, 73, remembers that her desire to publish “Bosom Buddies” began in 1993 in Ledyard, Connecticut, one year after she was diagnosed and treated for breast cancer. Standing by a magnificent tree over 400 years old, 90 feet high with a circumference of over 26 feet, where Native Americans gathered to vote on tribal issues, Bohlen began snapping photos of the remains of the dead tree damaged by gypsy moths over the centuries. Upon close inspection of the printed images she saw a one breasted figure and that immediately inspired her to create an aquatint etching, she would call “Bosom Buddy.”

“The Ledyard Oak became my “Bosom Buddy” and helped me to relate to my inner beauty that was so much more meaningful than what was found beneath my clothing,” says Bohlen.

Ultimately her etching would lead to the publishing of a coffee table book including photos and essays of breast cancer survivors expressing how breast cancer may have affected their lives. A short biography about what they are now doing with their life is also included. “I wanted the world to know that there is life after breast cancer. Life goes on and it isn’t always a death sentence,” she says.

Reflections from “Bosom Buddies”

Sharyn Vicente, 52, of Cumberland, was photographed at a spa in Arizona during a very special trip. In 2008, Vicente was diagnosed with cancer at the age of 41. Initially she did not wish to be photographed but went outside of her comfort level to participate in the project.

Vicente details in her essay in “Bosom Buddies” how breast cancer impacted her life. “It was a long road with many unexpected bumps along the way. In three short years, I had both breasts removed, half of my right kidney, my uterus and both ovaries. While I felt that my body was systematically being hollowed out, I thought that I really didn’t deserve yet another escape from the grim reaper. This all also made me feel as though I was no longer a woman.”

But, “Cancer did not and will not rule my life,” says a reflective Vicente in her biography, noting that she spends time fundraising for the Gloria Gemma Breast Cancer Resource Foundation (GGBCRF) and mentoring woman going through the diagnosis and treatment of breast cancer. Participating in this book project began the healing process

Nicole Bourget-Brien, 47, a two-time breast cancer survivor celebrating a decade of being cancer free was photographed lifting hand weights in her brother-in-law’s gym. The photograph captured how she felt that day, “strong”

The Woonsocket resident was warned that after the mastectomy she might not be able to exercise at the same level as before the surgery. But, “I have proven that to be false. I am working out more vigorously now than I did when I was in my twenties,” she says.

In her biography in the book, Bourget-Brien says, “I have made a choice to live and not just exist after my cancer diagnosis. I have learned to breathe- to remember that the rearview mirror is smaller because it is where we have been and to look thru the windshield to enjoy what lies ahead.”

Tracey Donahue Henebury, 48, sits on a rock by a pond sunning herself. She urges readers of “Bosom Buddies” to “look beyond the scars and nudity and read each and every heartwarming story which describes the strength, sacrifices, and fears each one of us has faced.” The book is just “breathtaking,” she says.

Over the last couple of years, she has been on “an emotional roller coaster due to the complications of her mastectomy,” admits Henebury. In “Bosom Buddies,”she states “Nothing has knocked me down where I don’t get back up on my feet.” Support from family and friends and The Gloria Gemma Foundation “enhanced my scars as beauty and strength.”

Of course, you will find a self-portrait showing Bohlen wearing boxing gloves, ready to fight a battle against cancer. After her second mastectomy, neither her friends nor her family “got it.” “No one to tell me they knew what I was going through, no one to ask questions about what to expect. I knew no one else with breast cancer, it was a lonely journey,” she says in her essay in “Bosom Buddies.”

Relocating to Rhode Island and connecting with the Pawtucket-based GGBCRF changed her life, providing her with a support system and friends. She supports the nonprofit by donating 50 percent of the profits of her $40 book to the Foundation.

Bohlen now resides with her husband of almost 47 years, Bob, in Cranston, her daughter, Nie and 8-year-old grandson, Sam, along with her youngest son, Patrick live close by while her older son, Bobby lives in Portland, OR.

There is a real need for this book to find its way to women recently diagnosed with breast cancer and to their families and friends. In 2017, Breast cancer will claim the lives of 40,610 woman throughout the nation, predicts the American Cancer Society, a nationwide voluntary health organization dedicated to eliminating cancer. More than 300,000 women in the U.S. will become breast cancer survivors.

“Bosom Buddies” has allowed the breast cancer survivors participating in this unique book project to come to terms with their inner and exterior scars, and has enhanced their body image after a mastectomy. Bohlen knows that this healing will take place in the readers as well.

At the 2016 National Indie Excellence Awards, Bohlen’s book, “Bosom Buddies” was one of three Finalists in the Photography division and the winner in the Cancer books division.

To purchase, call Mary Jane Condon Bohlen at 401-474-8903 or email to bosombuddies1@verizon.net.

On Taking a Stand Against Racism and Antisemitism

Published in Woonsocket Call on August 27, 2017

Morris Nathanson, an 89-year-old who served in the United States Navy in World War II, was outraged for President Trump’s failure to strongly speak out against the hateful philosophy of neo-Nazis, white nationalists, Ku Klux Klan (KKK) and militia groups exhibited at a violent protest that escalated out of control in the streets around the University of Virginia campus in Charlottesville, Va.

Growing up Jewish, Nathanson is horrified about the growing racism and antisemitism so visibly flaunted at the Charlottesville rally and seen throughout nation. Before the Second World War, his parents had escaped the violent pogroms in Russia, ultimately settling in a three decker house with relatives in Pawtucket. Family members who remained in Europe were killed, victims of the Holocaust, he said.

“It’s is indefensible,” says Nathanson, an Eastside resident who in an internationally acclaimed artist and semi-retired restaurant designer, for Trump to not outright denounce the neo-Nazi groups. He warns, “We must recognize the growth of the neo-Nazi movement for what it is, a terrible disease that must be eliminated.”

The jarring historical imagery of the torchlight procession of supporters of Adolf Hitler moving through the Wilhelmstrasse in Berlin on the evening of January 30, 1933, came to life for Nathanson and millions of Americans last weekend when hundreds of neo Nazis, white nationalists, KKK, militia members and other right-wing groups gathered for a “Unite the Right” rally in Charlottesville, Va. Carrying tiki torches, flags with swastikas and confederate flags, they came to the City’s Emancipation Park to ostensibly support a protest against the removal of a statue of Civil War confederate General Robert E. Lee. But it was really an opportunity to display their strength.

Battle Lines Drawn

On the evening of Friday August 11 at 10:00 p.m., the torch bearing marchers, some wearing Nazi-style helmets, carrying clubs, sticks and round makeshift shields emblazoned with swastikas and other Fascist symbols, and others entered the one-block square in downtown Charlottesville, the site of the controversial monument, chanting “Jews will not replace us”, “Blood and Soil” (a Nazi rallying cry), “White Lives Matter,” along with homophobic, racists and misogynistic slurs. Heavily armed militia members, carrying semi-automatic weapons and dressed in camouflage military fatigues came to support and embolden their fellow extremist groups that identify as the “alt-right”.

At the site of the controversial monument in the City’s park and surrounding streets, throughout Friday evening and Saturday, August 12, members of alt-right groups opposed counter-protestors including Antifa, a far-left militant political movement that opposes fascist groups, members of Black Lives Matter, and church groups along with others who oppose racial bigotry and antisemitism. During the weekend rally, it was reported that 15 people were injured. On Saturday, James Alex Fields Jr., a 20- year-old, drove his gray Dodge Challenger into a group of counter-protesters, killing 32 year old Heather Heyer and injuring 19 other counter-protestors. Two Virginia State Police officers, monitoring the protests, died when their helicopter crashed.

Immediately following the rally on Saturday and the death of Heyer, Trump went to Twitter and posted an opened ended statement, calling the nation to “condemn all that hate stands for.” Following this tweet, on Sunday, August 13, he issued a statement at his golf club in Bedford New Jersey, stating, “We condemn in the strongest possible terms this egregious display of hatred, bigotry and violence on many sides.”

Trump Vacillates on Who’s to Blame

On Monday, August 14, intense political pressure would force Trump to make a statement at the White House to strongly condemn KKK and neo-Nazi groups after he blamed violence at the Charlottesville, Va., two days earlier in a tweet on “many sides”

By Tuesday August 15, Trump had backed off his public scolding of America’s hate groups At an impromptu press conference held at Trump Tower, he cast blame for Charlottesville’s violence equally on the “alt-right” and “alt-left” counter- protestors. “You had a group on one side that was bad, and you had a group on the other side that was also very violent,” Trump said, noting that “Nobody wants to say that, but l say it.”

“Not all of those people were neo-Nazis and white supremacists, believe me,” says the president, noting that some protestors wanted to stop the removal of the Robert E. Lee statue. Some were “nice people” he stated.

“So this week, it’s Robert E. Lee, I noticed that Stonewall Jackson’s coming down. I wonder, is it George Washington next week? And is it Thomas Jefferson the week after. You know, you really do have to ask yourself, where does it stop?” said Trump.

Trump’s comments that not all rally marchers were neo-Nazis or white supremacists caused a political tsunami, with critics pointing out that these individuals marching with the neo-Nazis were not “nice people”. It was guilt by association.

The two former Bush Presidents joined world leaders, GOP and Democrat Senators, Governors, and rank-and-file Republicans, Democrats, and Fortune 500 Executives to chastise Trump for his failure to speak out against Nazi and white supremacist ideology and that his comments trivialized the antisemitism and racism of these extremist alt-right groups.

Even the members of the Joint Chiefs of Staff, the senior uniformed military leaders in the United States Department of Defense who advise the President, posted tweets denouncing the alt-right extremists and blaming them for Saturday’s bloody violence in Charlottesville.

However, white supremacists took Trump’s Charlottesville statements as an endorsement to their legitimacy and acceptance to allow their members to become more visible in society. David Duke, a white nationalist and former Imperial Wizard of the KKK, tweeted, “Thank You Mr. President Tamp; God Bless You for setting the record straight for All Americans.” The Daily Stormer, a neo-Nazi website, quickly called Trump’s statements on blaming both sides a sign that he implicitly supported their goals and objectives.

The Increasing Visibility of Racism and Antisemitism

Ray Rickman, 65, Executive Director of the nonprofit Stages of Freedom, says, “I am deeply worried about the piercing images of men marching with Nazi torch lights on the University of Virginia campus. These men were screaming “Jews won’t replace us.” It was Nazi Germany all over again. The idea of seeing a Nazi flag, the most vicious symbol of antisemitism on American soil, is almost unbelievable to me. All of this is followed by the deeply divisive comments from Mr. Trump”, says the long-time Rhode Island activist.

“This man in the White House has shown total disrespect for the millions of American soldiers both living and dead who died to save the world from the Nazis,” adds Rickman, noting that “It’s the first time since Woodrow Wilson that a president has refused to condemn racism after such an act of violence.”

Rickman says that the neo-Nazi groups used the Charlottesville gathering as a public show of force and to promote hatred. “Maintaining the Robert E. Lee Monument was just an excuse to attack Jews and Blacks,” he says, noting that the three-day protest was planned as a “hateful rally by people who hate people of color and Jews. It is as simple as that.”

One of the most interesting aspects of beliefs held by General Lee was that he was not in favor of raising Confederate monuments, says Rickman, noting that in 1869 he wrote that it would be wiser “not to keep open the sores of war but to follow those nations who endeavored to obliterate the mark of civil strife.”

Combating Intolerance and Hatred

While both GOP and Democrat lawmakers lambasted Trump’s choice of words for laying the blame of violence at the Charlottesville rally on both the far right demonstrators and counter protestors, there were some who remained silent or defended his comments, saying his words were adequate.

With the increased public visibility of the neo-Nazis, white supremacist and other hate groups, if Trump fails to use his national bully pulpit, and the moral authority of the Office of the Presidency to steadfastly condemn hate groups, national and state elected officials and Americans of all walks of life must take on this responsibility.

In response to the violent weekend in Charlottesville, Va., the Illinois Senate adopted a resolution, sponsored by Sen. Don Harmon, D-Oak Park, urging law officials to recognize white nationalists and neo-Nazi groups as terrorist organizations.

Nathanson, who in 1965 marched with Martin Luther King in Selma, Alabama to fight racism, calls for organizing rallies at the state and national level to “reduce the damage of Trump’s comments.”

It would be an appropriate time to remember the speech given by Martin Niemoller, a German Lutheran minister who opposed the Nazis and was sent to several concentration camps. He survived the war and explained:

First they came for the Jews. I was silent. I was not a Jew.
Then they came for the Communists. I was silent. I was not a Communist.
Then they came for the trade unionists. I was silent. I was not a trade unionist.
Then they came for me. There was no one left to speak for me.

 

Social Security, Medicare Are Solvent…at least for Now

Published in Woonsocket Call on July 16, 2017

Just days ago, a released annual federal report, the 2017 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds, says the nation’s Social Security and Medicare programs continue to work, are fiscally solvent, but future fixes will be needed to maintain their long-term actuarial balance.

The Social Security Administration’s (SSA) annual snap shot of the fiscal health of Social Security and Medicare, two of the nation’s largest entitlement programs, released on July 13, is important to millions of beneficiaries. According to the federal agency, in 2017 over 62 million Americans (retired, disabled and survivors) received income from programs administered by SSA, receiving approximately $955 billion in Social Security benefits.

The Good News

The trustee’s report projects that Social Security will be financially solvent until 2034 (unchanged from last year), after which SSA can pay 77 percent of benefits if there are no changes in the program. The 269-page report also noted that the Medicare Trust Fund for hospital care has sufficient funds to cover its obligations until 2029, one year longer than projected last year, then 88 percent afterward if nothing is done to strengthen the system’s finances

The trustees report says that there is now $2.847 trillion in the Social Security Trust Fund, which is $35.2 billion more than last year — and that it will continue to grow by payroll contributions and interest on the Trust Fund’s assets.

Social Security Administration efficiently manages its entitlement program, says the trustee report. The cost of $6.2 billion to administer to program in 2016 was a very low 0.7 percent of the total agency’s expenditures.

The trustee’s project a 2.2 percent cost-of-living adjustment (COLA) for Social Security beneficiaries in 2018, the largest increase in years. In addition, Medicare Part B premiums will also remain unchanged next year. Most beneficiaries pay a monthly premium of $134 (this amount increases for those with higher incomes.)

Social Security is “Stable and Healthy for Now”

According to the National Committee to Preserve Social Security (NCPSSM), the recently released trustee’s report confirms that the federal entitlement program is “stable and healthy for now,” while acknowledging there will be future challenges if “corrective action is not taken.”

“Forty percent of seniors (and 90 percent unmarried seniors) rely on Social Security for all or most of their income. The average monthly retirement benefit of $1,355 is barely enough to meet basic needs, and the Trustees’ latest projected cost-of-living increase of 2.2 percent will not keep pace with seniors’ true expenses. Under these circumstances, any benefit cuts (including raising the retirement age to 70 as some propose) would be truly painful for our nation’s retirees,” says Max Richtman, NCPSSM’s president and CEO, in a statement responding to the release of the federal report.

“Opponents of Social Security may once again try to use this report as an excuse to cut benefits, including raising the retirement age,” warns Max Richtman. “We must, instead, look to modest and manageable solutions that will keep Social Security solvent well into the future without punishing seniors and disabled Americans,” he says.

Depending on what the final Senate health bill looks like, the legislation could reduce the solvency of Medicare by two years, say Richtman. “The National Committee opposes the GOP health plan and rejects efforts to privatize Medicare. We advocate innovation and continuing efficiencies in the delivery of care, allowing Medicare to negotiate prescription drug prices, and restoring rebates the pharmaceutical companies used to pay the federal government for drugs prescribed to “dual-eligibles” (those who qualify for both Medicare and Medicaid) – in order to keep Medicare in sound financial health,” he says.

Safeguarding and Expanding Social Security Benefits

In a statement, Richard Fiesta, Executive Director of the Washington, DC-based Alliance of Retired Americans, notes that the Trustees project that the Social Security Disability Insurance (SSDI) trust will be fully solvent until 2028, five years longer than last year’s report. “In light of this data, it makes no sense that the President’s FY 2018 budget seeks to cut Social Security Disability Insurance funding by $63 billion,” he says.

Despite the trustees’ strong report, Fiesta believes that improvements can be made that would benefit all workers and retirees. His organization supports safeguarding and expanding Social Security benefits, providing a more accurate formula for cost-of-living adjustments, and lifting the cap on earnings for the wealthiest Americans.

Fiesta adds, “reining in the prices of prescription drugs would strengthen Medicare for the future and reduce costs to retirees.”

AARP CEO Jo Ann Jenkins, in a statement, calls for bipartisan action in Congress and the Trump administration to ensure the strong fiscal health of Social Security and Medicare programs. “Social Security should remain separate from the budget. Medicare can improve if we reduce the overall cost of health care, rather than impose an age tax, and if we lower prescription costs, instead of giving tax breaks to drug and insurance companies,” she says.

Finally, in a statement, Nancy Altman, President of Social Security Works, also chairing the Strengthen Social Security Coalition, says that this year’s trustee’s report clearly indicates that the nation can fully afford an expanded Social Security. Altman says that polling continues to show that Americans support expanding the program’s benefits.

Altman believes the Social Security program can solve the nation’s “looming retirement income crisis, the increasing economic squeeze on middle-class families, and the perilous and growing income and wealth inequality.” So, when confronting these challenges, she says, “the question is not how can we afford to expand Social Security, but, rather, how can we afford not to expand it.”

Ensuring the Long-Term Solvency of Social Security

Those nearing retirement or retired will be assured existing Social Security benefits, promises the 2016 Republican Party Platform. “Of the many reforms being proposed, all options should be considered to preserve Social Security. As Republicans, we oppose tax increases and believe in the power of markets to create wealth and to help secure the future of our Social Security system,” says the Platform. Simply put, the GOP opposes the raising of payroll taxes on higher income taxpayers to stabilize or expand Social security and supports privatization, allowing Wall Street to control your Social Security benefits.

On the other hand, last year’s Democratic Party Platform opposed Social Security cuts, privatization or the weakening of the retirement program, along with GOP attempts to raise the retirement age, slash benefits by cutting cost-of-living adjustments, or reducing earned benefits. The Democratic Platform called for taxing people making above $250,000 will bring additional funding into the entitlement program.

Congressional gridlock has not blocked legislation from being introduced to fix the nation’s Social Security program. According to Social Security Works, over 20 Social Security expansion bills have been introduced in the House and Senate since 2015. Recently, the Social Security 2100 Act, introduced by Rep. John Larson (D-CT), has 162 House cosponsors —around 85 percent of all Democratic representatives. Similarly, around 90 percent of Senate Democrats are on record in favor of expanding, not cutting Social Security.

Many consider Social Security to be the “third rail of a nations politics.” Wikipedia notes that this metaphor comes from the high-voltage third rail in some electric railway systems. Stepping on it usually results in electrocution and the use of the term in the political arena refers to “political death.” With the Social Security and Medicare programs now on firm financial footing, it is now time for Congress to seriously consider legislative actions to ensure the longevity and expansion of these programs. When the dust settles after the upcoming November 2018 elections, we’ll see if Social Security is truly “a third rail.”