McKee to Unveil Updated State Alzheimer’s Plan

Published in Woonsocket Call on February 10, 2019

Seven months ago with the hiring of Michael Splaine and Kate Gordon of Splaine Consulting, a nationally recognized health policy firm that has provided content matter expertise to over two dozen state Alzheimer’s plans, Lt. Governor Daniel J. McKee, who serves as chair of the state’s Long-Term Care Coordinating Council, rolled up his sleeves to begin his legislative charge to update the 2013 state Alzheimer’s plan.

The hiring of the Columbia, Maryland-based consultants was made possible by two grants totaling $30,000 given by the Tufts Health Plan Foundation and Rhode Island Foundation. When announcing the successful fundraising effort to raise those monies, McKee observed, “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 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,” says McKee, noting that it is one of the most challenging public health issues facing Rhode Island today. “With the number of affected Rhode Islanders projected to rise to 27,000 by 2025, elected leaders, advocates, caregivers, clinicians and researchers must come together to take unified, targeted action,” he says.

The compilation of the plan is the result of collaboration between McKee, the Alzheimer’s Association Rhode Island Chapter and the state’s Division of Elderly Affairs (DEA). In 2012, the General Assembly directed the Long-Term Care Coordinating Council to serve as the organizational umbrella for a work group that would oversee the development of the plan. In 2013, the state’s five-year Alzheimer’s plan was published. Last year, efforts to update it began.

Last July under the leadership of McKee, Splaine and Gordon worked closely with the Alzheimer’s Association Rhode Island Chapter, DEA, researchers, advocates, clinicians and caregivers sitting on the Lieutenant Governor’s Executive Board on Alzheimer’s,to develop a community-focused strategy for the 2019 State Plan on Alzheimer’s disease and Related Disorders. Over a six-week period, that group held 23 town hall meetings, conducted 45 expert interviews and surveyed (in both England and Spanish) more than Rhode Islanders impacted by Alzheimer’s.

The Official Release…

On Feb. 26 at a press conference in the State Library at 3:30 p.m., McKee will join Sen. Cynthia A. Coyne (D-Barrington) to officially unveil the plan, Rhode Island’s official roadmap to combat the growing Alzheimer’s epidemic. Coyne will announce the introduction of a Senate resolution on behalf of McKee to officially adopt the plan. (House staff are still reviewing the updated plan. There is no House sponsor at this time)

Coyne’s resolution follows her introduction of legislation to create a Rhode Island program to address Alzheimer’s disease within the Department of Health (DOH). The bill would also create an advisory panel to review and make recommendations to improve the state policies, research and care.

Once the Rhode Island General Assembly approves the plan, the Long-Term Care Coordinating Council’s executive board will seek legislative and regulatory changes to carry out its bold set of recommendations for improving supports to those afflicted by Alzheimer’s and other dementias. More than 30 recommendations are detailed in the 35-page plan, which calls for the implementation of three main recommendations.
In order to keep the plan from sitting on a dusty bureaucrat’s bookshelf, the first recommendation calls for the creation of one director-level position within DOH to assist in the coordination of its recommendations. The second urges promoting Alzheimer’s disease and related dementia research opportunities of all types, including federal opportunities to a broad group of Ocean State researchers. Finally, the third calls for the inclusion of brain health in existing publicly-funded promotion and chronic disease management activities.
Many of the recommendation can be easily implemented without additional state funding or legislative approval, says McKee. But, for those that may require state funding, he plans to make it a priority to lobby for those monies.

Taking a Close Look

Maureen Maigret, co-chair, state’s Long-Term Care Coordinating Council, says, “It is terrific to have the plan update completed as it provides direction to our state government leaders and other persons in key positions to proceed with implementation of the recommendations, which can have such far-reaching impacts on the many thousands of individuals with neuro-cognitive conditions and their dedicated caregivers, both those who are unpaid and those in the paid work force.”

Maigret notes that the updated plan’s recommendations also call for assisting family caregivers who provide the vast majority of care for persons with Alzheimer’s and related dementias, expanding subsidies for home and community care services offered by the state’s Division of Elderly Affairs, and making family caregiver support services part of the Medicaid program.

According to Maigret, one issue not mentioned in the updated plan is the need for increasing state funding for the DEA’s respite care program, which has a waiting list. “This is an important program that gives caregivers small subsidies to purchase ‘care breaks.’ Our Aging in Community Subcommittee and the AARP and Senior Agenda Coalition will all be advocating to restore state funds to this program (in the upcoming legislative session),” she says.

“The Alzheimer’s State Plan is a thorough blueprint to address the growing Alzheimer’s crisis by creating an infrastructure and accountability that will help build dementia-capable programs,” said AARP Rhode Island State Director Kathleen Connell. “We applaud the work that has gone into the report and the continuing efforts to address Rhode Island’s growing needs. We are especially encouraged to see that the plan supports community education about caregiver health and caregiver rights under the CARE Act, which is legislation that AARP championed in the General Assembly. AARP also encourages and supports age-friendly communities, which includes dementia-friendly awareness and resources so that people of all abilities can thrive as they age.”

Sen. Coyne added, “Alzheimer’s impacts tens of thousands of Rhode Islanders, and we need a coordinated strategy to improve education among the public and training for providers, and to promote research opportunities. This plan provides a strategic framework for moving forward to bring positive policy change where it is needed.”

See you at the press conference.

For details about the press conference and the Alzheimer’s State Plan, contact Andrea Palagi, Communications Director, Office of Lt. governor Daniel J. Mckee at
Andrea.Palagi@ltgov.ri.gov.

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Funding for Seniors in Raimondo’s FY 2020 Budget Blueprint

Published in the Woonsocket Call on January 27, 2019

By Herb Weiss

Almost two weeks ago, Democratic Governor Gina Raimondo formerly unveiled her $9.9 billion budget proposal to the Rhode Island General Assembly. The House and Senate Finance Committees then begin the task of holding hearings on budget plan, getting feedback from the administration and the public. Once the revised estimates of tax revenue and social-services spending is available in May, negotiations seriously begin between Raimondo, the House Speaker and Senate President to craft the House’s budget proposal. Lawmakers will hammer out and pass a final state budget for the fiscal year that begins July 1.

Local media coverage of Raimondo’s ambitious spending initiatives zeroed in on her call for expanding free tuition to Rhode Island College and adding some public pre-kindergarten, increasing minimum wage from $ 10.50 to $ 11.10 per hour, allowing mobile sports betting and legalizing recreational marijuana.

But, Raimondo’s budget proposal gives state lawmakers a road map for what programs and services are needed for a state with a graying population.

According to Meghan Connelly, DEA’s Spokesperson, a nearly 60 percent increase in the State’s population of residents aged 65 and older from the years 2016 to 2040 highlights the need for continued investments in programs servicing Rhode Island’s older adults and their family caregivers.

Connelly says Raimondo’s budget proposal, released on January 17, elevates Elderly Affairs from a division under the Department of Human Services to an Office within the Executive Office of Health and Human Services. The governor shifts financing for the office and 31.0 FTE positions to EOHHS to accomplish this recommended action.

“The projected increase in the state’s senior population – from 174,000 in 2016 to 265,000 by 2040 – coupled with the proven impact of community-based supports and services, highlights the need for continuing to invest in helping our seniors remain home, connected to their families and networks. Support of aging-related health-promotion initiatives are essential to maintain a high quality of life for Rhode Island seniors while minimizing aging-related healthcare costs,” says Connelly

“We are focused on making it easier for older adults to live independent, fulfilling lives for as long as possible,” said Michelle Szylin, Acting Director of the Division of Elderly Affairs. “The Co-Pay expansion [in the governor’s proposed budget] enables additional older adults to age-in-place, remaining safely in their homes and engaging in their communities.”

The Co-Pay expansion enables additional older adults to age-in-place, remaining safely in their homes and engaging in their communities. The governor’s proposal to expand the state’s Co-Pay program [by $ 550,000] will allow more seniors to reside in their communities, staying connected to their family and network of friends and neighbors.

Providing access to the Co-Pay program to individuals earning up to 250% of the Federal Poverty Level will allow more seniors to age-in-place with a better quality of life and delay nursing home admission. The DEA Co-Pay program was established in 1986 as an option for elders who would otherwise be ineligible for subsidized home and community care assistance because they did not qualify for the Rhode Island Medical Assistance program.

Recognizing the importance of the state’s Elderly Transportation Program to keep older Rhode Islander’s independent, Raimondo’s budget proposal calls for additional funding of $1.8 million from general funds to support the State’s elderly transportation program. This program provides non-emergency transportation benefits to Rhode Islanders age 60 and over who do not have access to any means of transportation. The program provides transportation to and from medical appointments, adult day care, meal sites, dialysis/cancer treatment and the Insight Program.

Raimondo’s proposed budget also increases Health Facilities regulation staffing to increase the number of inspections to state-licensed health care facilities. The governor recommends a $327,383 increase in restricted receipt funds for 3.0 FTE positions. These positions will bolster existing staffing to increase the number of inspections to state-licensed healthcare facilities.

The Governor’s proposed FY 2020 budget also through the Rhode Island Public Transit Authority continues to subsidize the transit of elderly and disabled Rhode Islanders through the Rhode Island Public Transit Authority.

Raimondo’s proposed budget also continues the support for the Independent Provider model P model with almost $200,000 in general revenue funds budgeted (about $770,000 all funds) to cover implementation costs. The goal of this model is to increase workforce capacity and create a new option for delivery of direct support services for both seniors and people with developmental disabilities.

Finally, the governor’s FY 2020 budget also allocates funding to an array of programs and services for seniors. Here’s a sampling: $800,000 to support the state’s senior centers through a grant process (the amount was doubled last year); $ 530,000 to support Meals on Wheels; $ 85,000 to implement security measures in elderly housing complexes; $ 169,000 for the long-term care ombudsman through the Alliance for Better Long Term Care, which advocates on behalf of residents of nursing homes, assisted living residences and certain other facilities, as well as recipients of home care services; and $ 500,000 funds the state’s Home Modifications program at Governor’s Commission on Disabilities.

Nursing Facility Provides Take a Hit

Raimondo’s proposed budget plan seeks to freeze the state’s Medicaid payment rates to hospitals, slashing funding by an estimated $15 million overall for the year, and to limit the rate increase for nursing homes to 1%, costing them nursing home providers about $4 million.
“We are beginning the budget process with a 1 percent increase in the COLA (Cost of Living Adjustment), says Scott Fraser, President and CEO of Rhode Island Health Care Association (RIHCA), warning that “this is not enough.”

“Since 2012, nursing facility costs have risen 21.6 percent while Medicaid payment rates have only gone up by 9.6 percent, adds Fraser, noting that by statute, rates are supposed to be adjusted annually for inflation. “We will be advocating for additional funding for nursing facilities throughout the remainder of the budget process,” he warns.

Jim Nyberg, Director LeadingAge RI, an organization representing not-for-profit providers of aging services, joins with RIHCA in calling on Rhode Island lawmakers to restore the full inflation adjustment. “Ongoing increases in minimum wage (up 42 percent since 2012) make it harder for publicly funded providers to compete for skilled workers,” says Nyberg, noting that most of his nonprofit nursing homes have 60 percent to 70 percent of their residents on Medicaid. “A rate increase is needed help nursing homes recruit and retain the direct care workers that are so critical to providing quality care,” he says.

“Since 2016, our nursing homes and consumers have been severely disrupted by UHIP, financially and operationally. The ongoing problems with Medicaid application approvals and payments has resulted in significant increases in staff workload just to maintain operations, let alone the impact on cash flow and financial stability, adds Nybrg.

Nyberg’s group is also advocating to expand the CoPay program for individuals under the age of 65 with dementia. “This has been proposed in the past but not included in this budget. We think that such an expansion will help this at-risk population for whom no publicly-funded programs and services currently exist,” he says.

Lawmakers, AARP Rhode Island Gives Comments

AARP Rhode Island is encouraged to see that the Governor placed an increase in the State Budget for the Department of Elderly Affairs home healthcare Co-Pay program,” said AARP Rhode Island Advocacy Director John DiTomasso. “By increasing the income eligibility from 200% of the poverty level to 250%, more older Rhode Islanders will be able to obtain home care services at reduced hourly rates,” he added. “This will help large numbers of people to extend the time they can age in place in their home and in their community rather than in more costly state-paid long-term care facilities,” says DiTomasso.

Senate President Dominick J. Ruggerio says, “Upon a first look at the budget, I am very pleased that some of the Senate’s top priorities are incorporated. The Governor had to close a significant deficit, and difficult choices had to be made. However, the budget is a statement of priorities, and initiatives like the no-fare bus pass program for low-income seniors and disabled Rhode Islanders are a priority for us in the Senate. I am very pleased to see this program funded in the budget, along with many other services for seniors, and I look forward to deeper analysis of all aspects of the budget in the months ahead.”

AddsD House Speaker Nicholas Mattiello, “The House Finance Committee will soon begin holding public hearings and reviewing every aspect of the Governor’s budget proposal. We will make certain that the level of care and services to older adults will be maintained and hopefully enhanced. We are facing significant budget challenges this year, but we will always keep the needs of our seniors at the forefront of the discussions.”

Older Rhode Islanders and aging groups must continue to push the House to at a minimal maintain the governor’s senior agenda. Hopefully, as Mattiello said, senior programs and services can be enhanced.

For a Senate Fiscal Analysis of Raimondo’s FY 2020 budget, go to http://www.rilegislature.gov/sfiscal/Budget%20Analyses/FY2020%20SFO%20Governor’s%20Budget%20-%20First%20Look.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.

“First They Came for the Jews…”

Published in Woonsocket Call on April 29, 2018

On April 26, 2018, the Senate Judiciary Committee held a hearing on Senate Resolution No. 2696, urging law enforcement officials to recognize white nationalists and neo-Nazi groups as terrorist organizations. The Senate Resolution would enable law enforcement to pursue such groups’ activities and whereabouts with the resources and attention devoted to domestic terrorist groups. It would be tragic for the Senate panel to not pass this resolution introduced by Senators Goldin, Miller, Nesselbush, Quezada, and Crowley. Representative J. Aaron Regunberg introduced the House companion measure (H.B. 8131).

In response to last year’s racially-charged violence in Charlottesville, state legislatures across the nation have considered similar legislation. Roger Williams, founder of the Colony of Rhode Island and Providence Plantations, was a staunch advocate for religious freedom and tolerance. With that commitment, it is important for Rhode Island lawmakers to not send Senate Resolution No. 2696 to legislative purgatory but to pass it to strongly denounce the white nationalist and neo-Nazi ideologies of racial, social and religious intolerance that terrorize the state’s racial, ethnic and religious minority communities.

Anti-Semitic Incidents Increasing in Rhode Island

Last month, the Anti-Defamation League (ADL) reported that the increase in anti-Semitic incidents in the Ocean State have nearly doubled from 2016 to 2017, with the number of reports jumping from 7 to 13. Let’s put a face on these incidents. According to the Jewish Alliance of Greater Rhode Island, it was reported by media that just one day after an anti-Semitic act of vandalism in the City of Pawtucket, on May 23, 2016, Stebbins Stadium in Cranston was spray painted with graffiti, including swastika symbols as well as hate messages directed to Muslim and African American communities. Among the incidents reported in 2017 by the media: a swastika burned into a sign located on a bike path in Barrington, anti- Semitic graffiti spray painted on Warwick Vets High School and a swastika made from human waste found in RISD dorm bathroom.

But, white nationalists and neo-Nazi hate ideology is also increasing throughout the nation. The increase is reflected nationally with the ADL reporting a nearly 60 percent increase.

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 to Rhode Islanders and to millions of Americans last year 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, chanting “Jews will not replace us”, “Blood and Soil” (a Nazi rallying cry), “White Lives Matter,” along with homophobic, racists and misogynistic slurs.

It’s Time for Rhode Island to Speak Out

While both GOP and Democrat Congressional lawmakers lambasted President Donald J. Trump’s choice of words for laying the blame of violence at the Charlottesville rally at the feet of 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, and with President Trump failing to use his position and moral authority to strongly condemn the ideology of hate groups, the Rhode Island General Assembly is now positioned to take on this responsibility.

In response to the violent weekend in Charlottesville, Va., the Illinois Senate adopted a similar resolution, sponsored by Sen. Don Harmon, D-Oak Park, urging law officials to recognize white nationalists and neo-Nazi groups as terrorist organizations. As a state founded on the principle of religious freedom, Rhode Island can follow.

It is 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.”

For Rhode Island lawmakers, it is time for you to speak out.

Efforts to Revise State Alzheimer’s Plan are in Full Swing

Published in Woonsocket Call on February 25, 2018

By Herb Weiss

Lt. Governor Dan McKee is gearing up Rhode Island’s fight against the skyrocketing incidence of Alzheimer’s disease, called by some as one of the ‘biggest epidemics in medical history.’ Last Wednesday, he announced $30,000 in grants secured by his office and the Rhode Island chapter of the Alzheimer’s Association to hire a consultant to update the state’s five-year plan on Alzheimer’s Disease and Related Disorders. Tufts Health Plan Foundation and the Rhode Island Foundation each pledged $15,000 to support the rewriting of the initial State Plan.

Updating the State’s Alzheimer’s Plan

The updated State Plan, to be created by 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, will provide state lawmakers with a road map for the state, municipalities and the health care system, to confront the continuing Alzheimer’s crisis. It will take a look at the current impact of Alzheimer’s disease on a growing number of Rhode Islanders and outlines what steps the state must take (legislatively and regulatory) to improve dementia-capable programs and services for people with Alzheimer’s and their family caregivers.

Lt. Governor McKee and the Executive Board of the Alzheimer’s Disease and Related Disorders, a working group of comprised of distinguished researchers, advocates, clinicians and caregivers, are now beginning their efforts to meet their deadline by the end of 2018 of having a completed state plan to submit to the Rhode Island General Assembly.

With financial support provided by the Rhode Island Foundation and Tufts Health Plan Foundation, the Alzheimer’s Association, Rhode Island Chapter, as fiscal agent, can now hire a consultant to assist in updating the initial state-five-year plan approved by the Rhode Island General Assembly in 2013. Once the updated report is completed and approved by the Rhode Island General Assembly, the Executive Board can 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.

“Rhode Island has been a national leader in 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 momentum in the fight against Alzheimer’s,” said Lt. Governor McKee.

“A Living Document”

“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,” says Donna McGowan, Executive Director of the Alzheimer’s Association, Rhode Island Chapter.

“Communities have greater interest in age-friendly initiatives. There’s a growing understanding of the critical role older people play. They are an asset to community, and their voices and insights are invaluable to the public discourse on what communities need,” said Nora Moreno Cargie, vice president, corporate citizenship for Tufts Health Plan and president of its Foundation.

“A coordinated, strategic approach to Alzheimer’s will lead to better outcomes and healthier lives. Working with generous donors, we’re proud to partner with Tufts to fund this crucial work,” said Jenny Pereira, the Rhode Island Foundation’s vice president of grant programs.

Put Older Woman, Older Veterans on the Radar Screen

The updated state plan must address the growing needs of older woman and the state’s aging veterans population.

Maureen Maigret, Vice Chair of the Long Term Care Coordinating Council and Chair of its Aging in Community Subcommittee, suggests zero in on the special needs of older woman. “Alzheimer’s disease and related dementias is of special concern for older women as the they are more likely to suffer from the debilitating disease due to greater longevity, more likely to need long term care services and supports and are more often than men to be caregivers either unpaid or paid of persons with Alzheimer’s disease. The Aging in Community Subcommittee of the LTCCC has several pieces of legislation to strengthen support for caregivers and to enhance home and community based services,” says Maigret.

Last year, the USAgainstAlzheimer’s, (UsA2), released the issue brief, “Veterans and Alzheimer’s Meeting the Crisis Head on,” with data indicating that many older veterans will face a unique risk factor for Alzheimer’s as a direct result of their military career.

“Forty nine percent of those aging veterans age 65 ((WW2, Korea, Vietnam and even younger veterans, from the Iraq and Afghanistan conflicts in the coming decades), are at greater risk for Alzheimer’s compared to 15 percent of nonveterans over age 65,” say the authors of the issue brief.

UsA2’s issue brief pulled together research findings released by the U.S. Department of Veteran’s Affairs (VA). On study estimates that more than 750,000 older veterans have Alzheimer’s disease and other dementias, another noting that the number of enrollee with Alzheimer’s grew 166 percent from roughly 145,000 in 2004 to 385,000 in 2014.

The minority communities are at even greater risk for Alzheimer’s and minority veterans are predicted to increase from 23.2 percent of the total veteran population in 2017 to 32.8 percent in 2037, says a cited VA study.

The issue brief also cited one study findings that indicated that older veterans who have suffered a traumatic brain injury (TBI) are 60 percent are more likely to develop dementia, Twenty-two percent of all combat wounds in Afghanistan and Iraq were brain injuries, nearly double the rate seen during Vietnam – increasing these younger veterans’ lifetime Alzheimer’s risk.

The Rhode Island Foundation and the Tufts Health Plan Foundation grant funding was key to the Lt. Governor McKee being able to update its state’s plan to battle Alzheimer’s disease. It provides state policy makers with a roadmap o effectively utilize state resources and dollars to provide care for those afflicted with debilitating cognitive disorder. It is money well spent.

The Alzheimer’s Association will shortly issue a Request for Proposal (RFP) seeking a research consultant to assist in revising and updating e the State Plan. For details about the RFP of the State’s Alzheimer’s Plan, email Michelle La France at mlafrance@alz.org.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, healthcare and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Fifth Time a Charm for Direct Care Worker Raises?

Published in Woonsocket Call on November 6, 2016

When the Rhode Island General Assembly wraps up its session many times the stars are not in political alignment for passage of a particular legislative proposal or budget amendment, even if many lawmakers considered these to be worthy of passage. Sen. Louis P. DiPalma understands this very well.

During the past four legislative sessions he has unsuccessfully pushed to increase pay for direct care workers serving persons with intellectual and developmental disabilities by boosting the state’s budget funding for these workers.
DiPalma, a Middletown resident who as a senator has represented Little Compton, Middletown and Tiverton for over 8 years, has come back for a fifth time, hopefully the last, to see his efforts succeed in providing a living wage to these providers, enhancing the quality of life of their lives.

A Call for a ’15 in 5’ Pay Increase

At a news conference held on Friday, Oct. 28, at Warwick-based West Bay Residential Services, DiPalma along with fellow Senators, announced their support for his proposal: ’15 in 5’ pay increase for workers serving persons with intellectual and developmental disabilities. The Democratic senator envisions annual, incremental increases in compensation to reach $15 an hour in five years, and tying the pay rate to inflation thereafter.

A 2015 survey by the Community Provider Network of Rhode Island paints a picture of Rhode Island’s direct care workers. The majority of these individuals are women of households. Many receive state assistance from programs geared towards low-income workers, such as SNAP benefits, WIC, heating assistance, day care assistance, and housing aid. More than 40 percent of the workers hold more than one job to financially survive.

At the 53-minute press conference, DiPalma urged Rhode Island Governor Gina Raimondo to include his funding proposal in her 2017 budget submission. He also plans to submit legislation in the 2017 session to address the compensation system for these direct care workers, providing annual increases so that the pay rate of direct care workers reaches $15 in five years, and tying future wage increases beyond five years to inflation.

“The minimum wage has increased by 30 percent since 2012, but the rate paid to these essential direct care providers has remained stagnant,” charged DiPalma, at the press event. “The pay is now barely more than minimum wage, which is having a detrimental effect on staff retention, training costs, and, as a result, quality of care [for persons with intellectual and developmental disabilities],” he says.

DiPalma noted that the need for this pay increase is obvious. “The facts and data show that our direct care workers love their jobs and want to stay in the field. They genuinely care about the population they serve. Yet, 62 percent of respondents to a recent survey indicated that low salary was a factor that may make them leave their jobs. We need to act to address this urgent situation,” he said.

According to DiPalma, the average annual staff turnover rate in the private provider network is approximately 33 percent. “This is three times as high as the approximately 11 percent staff turnover rate for comparable positions with the state-run providers through the Rhode Island Community Living and Supports (RICLAS) at the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, according to providers and RICLAS,” he says.

The average private-sector direct care worker makes $10.82 per hour, or about $22,500 a year, says DiPalma, noting that entry level provider positions at state RICLAS pay $17.15 per hour. When considering longevity, the average wage for all RICLAS direct care workers is approximately $42,278. RICLAS workers also receive state employee benefits.

Jumping on the Band Wagon

Two days before DiPalma’s press conference, Secretary of Health and Human Services Elizabeth Roberts penned her endorsement of his wage increase proposal. In her Oct. 26 correspondence, she strongly endorsed his efforts to implement multiyear wage increases to Rhode Island’s direct service providers. “These workers are critically important to realizing the goals set forth in our clients’ person-centered plans,” she adds, noting that these workers provide services necessary for ensuring that persons with disabilities are integrated in Rhode Island communities.

At the press conference, S came to give DiPalma his blessings. “Increasing wages to private direct care workers addresses an important part of the wage inequity problem, and helps improve outcomes for the individuals they serve. At the same time, we need to continue to review the methodology for compensating all those direct care workers who serve our children, homebound elderly, and individuals with disabilities through other types of provider agencies,” says Da Ponte.

Like other speakers at the press conference, Donna Martin, executive director of Community Provider Network of Rhode Island, called initial salaries for direct service workers “woefully inadequate” for the work they perform. “They are working nights and holidays leaving their families behind to support individuals under their care.,” says Martin. “These individuals serve as mentor, friend, confident and even some serve in the role of family to their clients,” she adds.

Adds speaker Anthony Antosh, Director of the Paul V. Sherlock Center on Disabilities: “The field of developmental disabilities has dramatically changed in the past two decades as have the responsibilities and expectations for direct support staff. The outcomes achieved by adults who have a developmental disability are directly connected to the quality and stability of direct support staff. Developing a career ladder built on quality training and fair wages will go a long way towards stabilizing the direct support workforce and improving quality of services.”

Marie Carroll, a direct service provider employed by ARC of Blackstone valley, a
Pawtucket-based agency employing over 200 employees, sat in the audience to support DiPalma in his efforts to increase funding for direct care workers. She sees Rhode Island’s lower wages pulling her colleagues into Massachusetts for higher incomes.
Carroll hopes to see the Rhode Island General Assembly in the upcoming session value the work she and 3,500 direct care workers provide. “People who care for the state’s disabled should not be paid poverty wages. You can’t expect people to work in an emotional and sometimes physically demanding job for $11 per hour,” she said, stressing that low wages keep these workers from taking adequate care of their own families.

Boosting Wage Payments in Next Year’s Budget

At press time, DiPalma’s wage increase proposal has received a seal of approval from President of the Senate M. Teresa Paiva Weed and Senate Finance Committee Chairman Da Ponte. Roberts, as Secretary of Health & Human Services, who oversees the state’s disability programs and services, gives her enthusiastic support for boosting funding of direct services workers in the upcoming 2018 budget. But, press secretary Larry Berman says that House Speaker Nicholas A. Mattiello is studying DiPalma’s proposal and has not yet taken a position on this issue.

Even with early political support of DiPalma’s ’15 in 5’ Pay Increase proposal, its ultimate passage lies with either Governor Raimondo boosting direct car worker wages in her FY 2018 budget proposal or in the state’s final budget crafted by the House with the sign off of the Senate. For DiPalma and those working with persons with intellectual and developmental disabilities, the Governor, House Speaker and President of the Senate must be on the same page to move DiPalma’s proposal forward. Hopefully, the “fifth time is the charm.”

Rhode Island Lawmakers Can Say Never Again

Published in the Woonsocket Call on May 22, 2016

On October 15, 2015, anti-Semitic and racist leaflets were distributed on Providence’s East-side. Just months ago a Brown student discovered anti-Semitic messages on the walls directly across from his dorm room, where he had a mezuzah on his door. And the Joint Distribution Committee’s International Centre for Community Development released a survey that reported that “two in five Jewish leaders across Europe believe the rise in anti-Semitism represents a “major threat” to the future of their communities.”

Rhode Island lawmakers are pushing legislation to use education as a way to stamp out future holocausts and genocide.

On May 5, 2016, the House passed House Bill 7488A, which requires all middle and high school students to receive instruction in holocaust and genocide studies. Following introductory remarks from Rep. Katherine S. Kazarian (D-Dist. 63), the East Providence lawmaker’s measure passed the House unanimously with every member present seconding the motion for passage. Of note, the House approved the measure on Holocaust Remembrance Day.

The passage of House Bill 7488A follows the Rhode Island General Assembly successful efforts in 2011 to enact a law entitled “Genocide Education in Secondary Schools” that emphasized a need to make genocide curriculum materials available including, but not limited to, the Holocaust of WWII, and the genocides in Armenia, Cambodia, Iraq, Rwanda, and Darfur. If the measure is passed by the Senate and signed into law by Governor Gina Raimondo, it would officially empower the Department of Education to require school districts of the state to teach about these important events in history. The requirement would commence with the school year beginning in September 2017.

According to The Genocide Education Project, eleven states require the teaching of the Armenian genocide. Many of these states also require education on the Holocaust as well as other inhumane atrocities.

Adds, Marty Cooper, Community Relations Director of the Jewish Alliance of Greater Rhode Island, when passed the legislation will make Rhode Island the first New England state to require Holocaust and Genocide education in its schools.

“The study of this issue will provide much needed lessons on humanity and civilization. Hopefully, students will learn why it is important for them to not allow genocide [or another Holocaust] to take place and to call for an end of all intentional actions and systematic destruction, in whole or in part, of an ethnic, racial, religious or national group,” says Cooper.

“Although these are not pleasant topics to learn about in school, these events must be studied by our children in order to prevent further similar atrocities from happening in the future, says Kazarian, a fourth-generation Armenian-American. She said, “We should never allow the atrocities of the Armenian Genocide nor any form ethnic cleansing to be repeated.”

Rep. Kazarian noted that her great grandparents had survived the Armenian Genocide that took place between 1915 and 1923. According to the Armenian National Institute in Washington D.C., the genocide resulted in the death of 1.5 million Armenians. It is estimated that close to 2 million Armenians were living in the Ottoman Empire just prior to World War I when the Turkish government subjected its Armenian population to deportation, expropriation, abduction, torture, massacre and starvation.

“My family’s own history involving the Armenian Genocide has shown me that these events in history should never be forgotten and it is important that our children recognize and understand how such terrible events can occur in society, and more importantly, how to stop them from happening,” added Kazarian.

In the other chamber, Senator Gayle Goldin (D-District 03) of Providence has introduced a companion measure in the Rhode Island State Senate. The Senate Committee on Education heard testimony on March 30th and has held the bill for further study.

“As we look across the globe at atrocities committed in Syria and many other regions, and closer to home, where anti-Semitic graffiti appeared at Brown University as recently as March, it is clear how important it is to ensure students can place these actions into a historical context,” says Goldin. “We want to ensure that themes about genocide and the Holocaust are taught in more than an ad hoc manner, but included as part of a comprehensive curriculum. These important historical lessons should be woven into studies in ways that ensure students are gaining the appropriate perspective so that we learn from the past and never again stand idle witness to genocide or the hate and fear that lead to it,” she says.

Goldin continued, “When I was approached by the coalition to introduce this bill, it resonated with me personally. I’m named after my paternal great aunt and uncle, who perished in the Holocaust, along with the majority of my ancestors who died as a result of the pogroms leading up to and during the Holocaust. Those atrocities shaped my family’s identity. As a child, I was taught never to forget. This legislation ensures that children will continue to learn about impact of the Holocaust and genocides in general on our society.”

The lessons of the Holocaust are more relevant than ever before. Today, we see a rise in antisemitism worldwide, including in the lands where the Holocaust happened. Genocide continues to occur even in the wake of the promise of ‘Never Again.'” Bringing this history’s lessons to students is critical as their generation will be tomorrow’s leaders in confronting these challenges,” says Andy Hollinger, Director, communications, of the United States Holocaust Memorial Museum.

Hollinger adds, “The United States Holocaust Memorial Museum offers many free, online resources to educators seeking to bring Holocaust education to their students. (www.ushmm.org/educators) We also offer on-site training programs for educators and encourage Rhode Island educators to utilize these resources.”

As June approaches, Goldin’s companion measure is held for further study, this sometimes being legislative code for “bill will not see the light of day for a vote.” With the increasing incidents of anti-Semitic incidents and hate crimes in Rhode Island, throughout the nation and the world, Senate President M. Teresa Paiva Weed must send a strong signal to all– “Rhode Island says Never Again.” Hatred can proactively be stamped out by education. That’s exactly the intent of Kazarian and Goldin’s legislation.

Prime organizations managing the research and drafting of the legislation the Armenian community, Roman Catholic Diocese of Providence, the Rhode Island Council of Churches, the Community Relations Council of the Jewish Alliance of Greater Rhode Island and the Sandra Bornstein Holocaust Education Center.