Aging Groups: House GOP Tax Rewrite a Turkey

Published in the Woonsocket Call on November 19, 2017

Thanksgiving approaches the GOP-Controlled House has passed H.R. 1, “Tax Cuts and Jobs Act,” its tax reform legislation, on November 16, by a partisan vote of 227 to 206, with 13 Republicans siding with the Democrats. The House tax bill would dramatically reduce corporate and individual income taxes and would increase the deficit by $ 1.7 trillion over 10 years — — possibly offset by $ $338 billion saved by repealing the Affordable Care Act’s (ACA) individual mandate.

On Thursday, after four days of debate, members of the Senate Finance Committee voted 14 to 12 along party lines to approve their version of the tax package. Now the full Senate is expected to consider the bill after Thanksgiving hoping to quickly get it to President Donald Trump’s desk for his signature.

Medicare and ACA Takes a Hit

Matt Shepard, of the Center for Medicare Advocacy, warns that the GOP’s attempt to overhaul to nation’s tax code is an immediate threat to the Medicare program and healthcare coverage to millions of Americans covered by ACA.

According to Shepard, the nonpartisan Congressional Budget Office projects that the huge cost for the Republican tax plan would result in immediate, automatic and ongoing cuss to Medicare — $25 billion in 2018 alone.

After the GOP’s failed attempts to repeal the ACA, the Senate now uses a provision in its tax rewrite plan to finally repeal the ACA’s individual mandate to purchase insurance coverage in order to help pay for tax cuts, he says. If the GOP tax reform legislation becomes law, 13 million more people will be without health coverage and increasing premiums will disproportionately affect people age 50 who are not yet eligible for Medicare.

“These new dangers are on top of an already bad bill. Congress is engaged in a rushed effort to push through a massive tax cut for corporations and the wealthy, presenting a clear and present danger to health coverage, other vital programs, and families throughout the nation,” says Shepard.

“After adding $1.5 trillion to the federal debt, policymakers will use the higher debt – created by the tax cuts – to argue that deep cuts to Medicare, Medicaid, Social Security, and other bedrock programs are necessary,” predicts Shepard.

Responding to the House passage of its tax reform bill, just days ago, in a statement AARP Executive Vice President and Chief Advocacy & Engagement Officer Nancy LeaMond expressed disappointment in passage, warning that the legislation is harmful to millions of Americans age 65 and over.

Older Tax Payers Get Financial Hit with GOP Tax Code Fix

“AARP estimates H.R. 1 will raise taxes on 1.2 million seniors next year alone. Millions more older Americans will see tax increases in the future, or at best, no tax relief at all,” says LeaMond.

As Congress continues its debate to hammer out tax reform, LeaMond calls on lawmakers to retain the medical expense deduction at the 7.5% income threshold for older tax filers. “Nearly three-quarters of tax filers who claim the medical expense deduction are age 50 or older and live with a chronic health condition or illness. Seventy percent of filers who claim this deduction have income below $75,000.,” she says, urging that Congress also retain the standard deduction for older taxpayers, which helps reduce tax liability and can help seniors avoid a tax increase.

AARP also urges Congress to assist working family caregivers in a new tax code that creates a new, non-refundable tax credit to offset the often high out-of-pocket costs associated with caring for a loved one.

Finally, LeaMond calls on Congress to reject adding a provision in the tax bill that will lead to higher premium costs in the individual insurance market, as well as 13 million Americans losing their health coverage, including 2 million Americans who would lose employer-sponsored coverage.

In a statement, Max Richtman, President and CEO, National Committee to Preserve Social Security and Medicare, calls the House passed tax rewrite, “Robin Hood-in-Reverse tax legislation.” Now, the House Republicans have sent out a “crystal-clear message “that the elderly, disabled, poor, and working class are no longer part of the GOP’s vision for America,” he says.

Blooming Deficit Might Trigger Raid Social Security

“This craven giveaway to the wealthy and big corporations at the expense of everyone else flies in the face of public opinion, basic decency, and good old common sense, says Richtman, “By ballooning the deficit, Republicans have teed up a raid on Social Security, Medicare, and Medicaid to make up the difference,” he warns.

“The repeal of the medical expense deduction will punish seniors paying out of pocket for treatment of chronic and serious diseases – or long-term care., says Richtman.

With Senate Republicans gearing up their efforts to pass their version of the House’s “Tax Cuts and Jobs Act,” Richtman calls on Senators “to show courage and to do what House Republicans refused to [do]: stop the tax juggernaut before it does irreparable harm to our nation.”

If the GOP tax reform legislation is passed by Congress and signed into law by President Trump, we will quickly find out by Christmas if it a financial gift to America’s middle class or a lump of coal in their stockings. Aging groups already know this answer.

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New Report Charges that States Disfranchise Older Voters

Published in Woonsocket Call on November 11, 2017

Since 1948, Wisconsin resident Christine Krucki had voted in every presidential election, but effectively lost her right to vote when her state enacted a voter ID law in 2011. An old Illinois photo ID and proof of her residence in Wisconsin was just not good enough to allow her to cast a vote.

Krucki did not have a birth certificate and was forced to purchase one for $20. However, her last name on the document did not match her current last name, changed when she married. She then paid $15 dollars for a copy of her marriage certificate , but that document listed her list name differently than her birth name, as she was adopted a different name after moving in with her stepsister when she was in her early 20s. Changing her name on the Illinois marriage certificate to match her birth certificate to solve the problem would cost between $ 150 and
$ 300.

The obstacles Krucki faced when attempting to exercise her right to vote are encountered by millions of older Americans when they attempt to vote. With the 2018 mid-term elections less than a year away, two U.S. Senators release a report detailing Krucki’s problem at the polls, and notes how suppressive state laws and inaccessible voting locations disenfranchise older voters.

Pushing Older Voters Away from the Polls

Senators Bob Casey (D-PA), Ranking Member of the Special Committee on Aging, and Amy Klobuchar (D-MN), Ranking Member of the Committee on Rules and Administration’s 15 page report, “Barriers to Voting for Older Americans: How States are Making it Harder for Seniors to Vote,” finds that strict voter identification (ID) laws, closure of voting locations, inaccessible polling places and limits on early voting and absentee ballots are preventing seniors and people with disabilities from casting votes.

“The right to vote is one of the fundamental pillars of American democracy. But, that right is under threat for millions of older Americans and individuals with disabilities across the nation,” stated Sen. Bob Casey in a statement announcing the report’s release. “This report brings awareness to the unique challenges that seniors face in exercising their constitutional right. We must work to ensure that all Americans have equal access to the voting booth.”

“The right to vote is the foundation of our democracy, but exercising that right is becoming harder and harder for many Americans, especially our seniors,” add Sen. Klobuchar, noting that long lines, inaccessible polling places, and strict voter ID laws have become barriers to voting for older Americans. “This important report shines a light on the hardships these voters face and proposes common sense solutions to make voting easier for everyone. We need to do more to restore Americans’ confidence in our political system. Our first step should be making it easier for their voices to be heard on Election Day,” he says.

The report, released on Nov. 2, also includes new information from the U.S. Government Accountability Office (GAO), which found that only 17 percent of the polling places it examined during the 2016 election were fully accessible. Most polling places GAO examined had one or more impediments from parking to the voting area and had accessible voting stations that could impede private and independent voting.

According to the report, suppressive voting laws and issues of accessibility affect tens of millions of older Americans and people with disabilities. In the 2016 election, 30 percent of the voters were between the ages of 50 and 64-years-old and 13 percent were 65 and older. Sixteen million (11.5 percent) of the 139 million votes were cast by people with disabilities. As the baby boomer population continues to age, these restrictions and barriers are likely to adversely impact more Americans.

In order to protect the voting rights of older voters and persons with disabilities, the report calls on Congress to ensure the full authorization and empowerment of all federal voting laws, which will make polling places accessible to older voters. Access to polls can also be increased by allowing opportunities for accessible early voting and absentee voting. Finally, it calls on limiting restrictions on voting and ensure that election laws fully consider the needs and abilities of older Americans.

Reflections from Rhode Island

“The depth of this issue varies from state to state,” says AARP State Director Kathleen Connell, who herself is a former Rhode Island Secretary of State. “I believe that older Rhode Islanders are well protected here, but we must be vigilant. Older Rhode Islanders are traditionally the most engaged voting group. Their voices are important and should not be silenced in any way.”

“I would add, however, that deliberate voter suppression is a threat to voters of all ages and the implications are as serious as they are obvious.

“When Voter ID legislation was passed in Rhode Island, we worked with then Secretary of State Ralph Mollis to set up photo booths to create ID cards for voters who did not have proper photo IDs. It was well received, but transportation was identified as a barrier to reaching some potential voters. Fortunately there were other remedies in place and, I have to say, no one contacted us saying they were prohibited from voting.”

Adds, Secretary of State Nellie Gorbea, this report presents a troubling situation across our country. The right to vote is sacred. I have spent the past three years modernizing our elections so that we can engage and empower all Rhode Islanders. Civic participation at all age levels is critical to our success as a state. I will continue to work to remove barriers so that eligible Rhode Islanders can have easier access to the ballot.”

Joe Graziano, Gorbea’s Communication Coordinator, notes that the GAO findings cited in this “Barriers to Voting” report is based on Council on State Governments research that his Department did not have a chance to review. “While it is not called “early voting”, Rhode Island does have an emergency mail ballot period that allows Rhode Islanders to cast their ballot ahead of Election Day without an excuse, says Graziano, noting that older voters have been able to use this system, in fact, 45 percent of the emergency mail ballots cast last year were by Rhode Islanders 65 and older.

Graziano admits that the GAO report shines a light on some of the barriers to voting across the nation. “Secretary Gorbea agrees that access to voting is critical and has successfully strived to improve it in the last three years including the introduction of online voter registration, automatic voter registration and the implementation of new, easier to use elections technologies (voting machines and ePoll books). Additionally, she has redesigned the ballot and the voter information guide to make them easier to read and understand. She also introduced legislation to update and expand opportunities for early, in-person voting,” he says.

“As a way to mitigate the negative impact of the photo ID requirement for voting, the Rhode Island Department of State has made sure that free photo Voter IDs are available to people in the communities where they live,” says Graziano, noting that last year alone, the Secretary of State staff held 51 events at senior centers and retirement facilities to ensure that eligible, older voters had proper voter identification, were introduced to new voting technologies and had any of their elections related questions answered by our Elections Division staff.

Looking to the upcoming General Assembly Session, Graziano says that Secretary Gorbea will once again introduce legislation for early in-person voting. “The legislation would eliminate the need for emergency mail ballots by allowing voters to cast their ballot at their local city or town hall, up to 20 days prior to an election, including the Saturday and Sunday prior to Election Day,” he says.

For more details about the Senate voting obstacle report, go to http://www.aging.senate.gov/imo/media/doc/Voting%20Rights%20Report.pdf.

Assistance to Employee Caregivers Good for Everyone’s Bottom Line

Published in Woonsocket Call on June 11, 2017

Days ago, AARP and the Respect a Caregiver’s Time Coalition (ReACT) released a report detailing innovative practices and policies of 14 organizations to support their employees with caregiver responsibilities. With the graying of America, supporting caregiver employees should be considered “a potentially new weapon” to attract or retain talented employees, say the researchers, by flexible work arrangements and paid leave policies. And there will be a need for this support.

It is estimated that of the 40 million unpaid family caregivers in the U.S., 60 percent are employed. According to the National Alliance for Caregiving (NAC) and AARP Public Policy Institute, nearly 25 percent of all family caregivers are millennials, and 50 percent are under the age of 50. This means that the growing number of family caregivers in the workforce is an issue that all employers will face. The NAC/AARP research also revealed that 61 percent of working caregivers must make workplace accommodations including modifying hours, taking a leave of absence, choosing early retirement or turning down a promotion.

Report Cites Best Practices to Support Employee Caregivers

The 14 case studies in the new report, “Supporting Working Caregivers: Case Studies of Promising Practices,” include well-known organizations from both the for-profit and nonprofit sectors, and both large and small employers. They represent a broad set of industries, including financial services, health care, higher education, home care, management consulting, media, and technology.

There is “no one size fit all” solution to meeting the needs of employee caregivers, say the researchers. But, even with the diversity of the 14 participating organizations “there is clear evidence of promising practices” identified through these interviews, they note.

Researchers gleaned best practices from 14 nonprofits and for profits (from very large employers with over 200,000 workers to ones with less than 200 workers), detailing in the report released on June 8, 2017, how these organizations assist their caregiver employees. These companies provide a broad array of information resources and referrals, flexible work arrangements, paid time off for caregiving, emergency backup care, and, in some cases, high-touch counseling and care management advice.

“Family caregivers juggle their loved one’s needs with their own personal and professional goals every day. AARP hopes this report will encourage more employers understand caregiving and support their employees’ success,” said Nancy LeaMond, executive vice president and chief advocacy and engagement officer in a statement. AARP sponsored the 49-page report.

According to researchers, interviews with business and human resources executives from the profiled organizations indicated that time and flexibility are what matter most to employees when it comes to balancing work and caregiving. Close to half of the employers interviewed provide paid time off for caregiving as well as emergency backup care and flexible work arrangements.

All offer employee caregivers a combination of information resources, referral services and advice by phone. Most provide resources online, typically through an employee assistance program (EAP) or an intranet portal. More than half offer phone consultations or 24/7 expert hotlines. Several interviewees stressed the value of providing on-site, independent eldercare consultants, noting that employees appreciate both the convenience and the respect for their privacy.

“ReACT represents a cross-sector employer effort to raise awareness of and spur action to meet the challenges millions face every day while taking care of an older loved one,” said Drew Holzapfel, convener of ReACT, in a statement. “It’s exciting to see how leading organizations are showcasing the value of employee caregivers’ dual roles at home and in the office.”

Organizations Give Thumbs Up to Assisting Employee Caregivers

Interviewees at the participating organizations were not shy in explaining the importance of offering caregiver assistance to employees.

Michelle Stone, Fannie Mae’s Work-Life Benefits Senior Program Manager, says, “We have been asked, ‘How can you afford to do this?’ Our response is, ‘How can we afford not to?’ The program helps our company and our employees save time and money, and the return on investment is substantial.”

Michelle Martin, Vice President, Human Resources Specialty Services, CBS Corporation, states, “Our hope is to fill the gaps in support along the continuum of care so that employees not only have what they need to care, but also the peace of mind to do so without worrying about their job.”

“At Allianz Life, we like to say, ‘we’ve been keeping promises to our employees and customers since our founding.’ Nothing matters more than our employees and we work every day to provide them with benefits that allow for work-life balance and peace of mind,” says Suzanne Dowd Zeller, Chief Human Resources Officer.

Adds Audrey Adelson, manager of work-life, Emory University, “Our program is based on a continuum of care model, designed to support not only entrenched caregivers, but also those who anticipate becoming a caregiver and those whose caregiving responsibilities have ended and are beginning to move beyond caregiving.”

AARP Rhode Island Champions Caregiving Temporary Disability Insurance

Most employers recognize that some of their best workers are not at their best when they are caregivers in crisis for feeling the onset of burnout,” AARP Rhode Island State Director Kathleen noted. “One of the reasons is that most employers and their human resources managers respond to the needs of caregivers is because they are not far removed from caregiving if not caregivers themselves. They know that caregiving responsibilities sometimes must take precedence over work. And they understand that what is good for the caregiver is also good for their business.

“In Rhode Island, caregiving temporary disability insurance – legislation championed by AARP – gives caregivers paid leave to attend to caregiving tasks or as respite when a break from work benefits all concerned. Employers should assess their policies and give thought to the importance of supporting their caregiving employees’ success. This is true of businesses large and small and non-profits as well. These bosses can start by simply asking themselves what their expectations would be if they were an employee.”

Rhode Island CEOs might consider obtaining a copy of this report, passing the document to Human Resources for review and ultimate implement of eldercare policies. Stressed employee caregivers will appreciate any assistance they can get to help them in their caregiving responsibilities. But, this makes good business sense, too. Assisting employee caregivers will increase employee productivity, improving the company’s bottom line.

To read the full report, go to:
http://respectcaregivers.org/wp-content/uploads/2017/05/AARP-ReAct-MASTER-web.pdf

Report Links Improved Brain Health to Sleep

Published in Pawtucket Times on January 16, 2017

Seven to eight hours of sleep per day may be key to maintaining your brain health as you age, says a newly released consensus report issued the Global Council on Brain Health (GCBH). The report’s recommendations, hammered out by scientists, health professionals, scholars and policy experts working on brain health issues at meeting convened by AARP with support of Age UK, in Toronto, Canada in late July 2016 Toronto, translates the scientific research evidence compiled on sleep and brain health into actionable recommendations for the public.

An AARP consumer survey released this month [in conjunction with GCBH’s report] found that 99 percent of age 50-plus respondents believe that their sleep is crucial to brain health, but over four in 10 (43 percent) say they don’t get enough sleep during the night. More than half (about 54 percent) say they tend to wake up too early in the morning and just can’t get back to sleep.

As to sleep habits, the adult respondents say that the most frequently cited activity that they engage in within an hour of bedtime are watching television and browsing the web. One-third keep a phone or electronic device by their bed. Nearly 88 percent of the adults think a cool bedroom temperature is effective in helping people sleep. Yet only two in five (41 percent) keep their room between 60 and 67 degrees. Finally, the most common reason people walk up during the night is to use the bathroom.

“Although sleep problems are a huge issue with older adults, it’s unfortunate the importance of sleep is often not taken seriously by health care professionals,” said Sarah Lock, AARP Senior Vice President for Policy, and GCBH Executive Director. “It’s normal for sleep to change as we age, but poor quality sleep is not normal. Our experts share [in GCBH’s report] the steps people can take to help maintain their brain health through better sleep habits,” said Lock, in a statement released with the report.

Sleep Vital to Brain Health

The new GCBH recommendations cover a wide range of sleep-related issues, including common factors that can disrupt sleep, symptoms of potential sleep disorders, and prescription medications and over-the-counter (OTC) sleep aids. The consensus report is jam-packed with tips from experts, from detailing ways to help a person fall asleep or even stay asleep, when to seek professional help for a possible sleep disorder, and the pros and cons of taking a quick nap.

Based on the scientific evidence, the GCBH report says that sleep is vital to brain health, including cognitive function, and sleeping on average 7-8 hours each day is related to better brain and physical health in older people.

The 16-page GCBH consensus report notes that the sleep-wake cycle is influenced by many different factors. A regular sleep-wake schedule is tied to better sleep and better brain health. Regular exposure to light and physical activity supports good sleep, says the report.

According to the GCBH report, people, at any age, can change their behavior to improve their sleep. Persistent, excessive daytime sleepiness is not a normal part of aging. Sleep disorders become more common with age, but can often be successfully treated. People with chronic inadequate sleep are at higher risk for and experience more severe health problems, including dementia, depression, heart disease, obesity and cancer.

“A 2015 consensus statement of the American Academy of Sleep Medicine and the Sleep Research Society mirrors the recently released GCBH report recommending that a person sleep at least 7 hours per night, notes Dr. Katherine M. Sharkey, MD, PhD, FAASM, Associate Professor of Medicine and Psychiatry and Human Behavior who also serves as Assistant Dean for Women in Medicine and Science. “Seven to eight hours seems to be a ‘sweet spot’ for sleep duration,” she says, noting that several studies indicate that sleeping too little or too much can increase risk of mortality.

More Sleep Not Always Better

Sharkey says that individuals with insomnia sometimes use a strategy of spending more time in bed, with the idea that if they give themselves more opportunity to sleep, they will get more sleep and feel better, but this can actually make sleep worse. “One of the most commonly used behavioral treatments for insomnia is sleep restriction, where patients work with their sleep clinician to decrease their time in bed to a time very close to the actual amount of sleep they are getting,” she says, noting that this deepens their sleep.

Sleep apnea, a medical disorder where the throat closes off during sleep, resulting in decreased oxygen levels, can reduce the quality of sleep and is often associated with stroke and other cardiovascular diseases, says Sharkey. While sleep apnea is often associated with men (24 percent), it also affects nine percent of woman and this gender gap narrows in older age, she notes.

Many older adults who were diagnosed with sleep apnea many years ago often times did not pursue medical treatment because the older CPAP devices were bulky and uncomfortable, says Sharkey, who acknowledges that this technology is much better today.

“We know how many questions adults have about how much sleep is enough, and the role that sleep plays in brain health and cognitive function,” said Marilyn Albert, Ph.D., GCBH Chair, Professor of Neurology and Director of the Division of Cognitive Neuroscience at Johns Hopkins University in Baltimore, Maryland. “This [GCBH] report answers a lot of these questions and we hope it will be a valuable source of information for people,” she says.

Simple Tips to Better Sleep

Getting a goodnights sleep may be as easy as following these tips detailed in the 16-page GCBH report.

Consider getting up at the same time every day, seven days a week. Restrict fluids and food three hours before going to bed to help avoid disrupting your sleep to use the bathroom. Avoid using OTC medications for sleep because they can have negative side-effects, including disrupted sleep quality and impaired cognitive functioning.
·
The GCBH report notes that dietary supplements such as melatonin may have benefits for some people, but scientific evidence on their effectiveness is inconclusive. Be particularly cautious of melatonin use with dementia patients.

Naps are not always a cure to enhancing your sleep. Avoid long naps; if you must nap, limit to 30 minutes in the early afternoon.

“There has been such a steady stream of revealing brain-health reports that it would seem people would change their habits accordingly,” said AARP Rhode Island State Director Kathleen Connell. “Taking active steps is what’s important – and the earlier the better,” she added.

“The personal benefits are obvious, but we should be aware of the cost savings that better brain health can produce. If people in their
50s get on board, the impact on healthcare costs and a reduced burden of caregiving 20 years down the road could be significant,” Connell added. “At the very least, those savings could help cover other rising costs. We owe it to ourselves and to each other to assess and improve aspects of diet and exercise. And we should not overlook the importance of sleep.”

The full GCBH recommendations can be found here: http://www.globalcouncilonbrainhealth.org. The 2016 AARP Sleep and Brain Health Survey can be found here: http://www.aarp.org/sleepandbrainhealth.

Housing Report Supports Push to Approve Question 7

Published in Woonsocket Call on October 30, 2016

Earlier this year, Rhode Island Housing (RIH) released a 44 -page report detailing the Ocean State’s current and future housing needs. One thing was clear to those attending this event: over the next decade the state will need more affordable housing for its residents.

Over the last 7 months, RIH’s Executive Director Barbara Fields has crisscrossed the Ocean State calling for increased housing opportunities for working Rhode Islanders. During this period of time she has presented the study’s findings to more than a dozen civic and government groups, including AARP Rhode Island, the Providence City Council and United Way.

During the last legislative session Rhode Island housing advocates were successful in their push for the enactment of a bond initiative that would make a significant state investment in affordable housing. As part of the omnibus statewide budget package, a $50 million Housing Opportunity Bond initiative for housing programs was passed by the House and Senate chambers, ultimately to be signed into law by Governor Gina Raimondo (D) and put to voter approval on the November ballot.

With the November election fast approaching, Fields has not let her report, compiled by HousingWorks RI, a research program at Rogers Williams University, sit on a dusty shelf but is using it to push for passage of the housing bond initiatives.

RIH Releases its Comprehensive Housing Study

On April 6, Fields gathered with state housing advocacy groups at the Rhode Island Commerce Corporation to unveil RIH’s landmark housing study, Projecting Future Housing Needs. Fields warned that the state’s economic comeback must be tied to new and existing housing that stays within the financial reach of Rhode Islanders. “Today in Rhode Island, the demand for housing is high while the supply is much too low. This imbalance simply makes the cost of housing too expensive for what our residents earn. This report provides critical insight into what the future needs of Rhode Islanders will be and that information will allow us to develop a plan to address those needs,” she said.

At this event, Rhode Island Commerce Secretary Stefan Pryor tied adequate housing for working Rhode Islanders as key to bringing businesses to the Ocean State. “Companies looking to expand or relocate consider how well they will be able to retain and attract their workforce, and a key part of doing so is ensuring that employees of all income levels have high quality housing opportunities,” said Pryor. “It’s vital to our state’s economic success and our quality of life that we preserve and produce high quality housing options for our residents,” he added.

The RIH report’s findings indicate that Rhode Island’s population is projected to grow between 3 and 5 percent from 2015 to 2025. Researchers warn that new housing demand will outpace population growth, and anticipate a 12 to 13 percent increase in the number of households, driven by a growing population and simultaneous decline in household size tied to both lower birth rates and an aging population. Researchers also predict housing demand will be driven by a large population growth in two demographic groups that tend to have lower incomes – namely aging baby boomers and seniors and young millennials.

According to the RIH report, cost burden problems of paying rent do not just impact older Rhode Islanders and Millennials, but have become more mainstream issues over the last ten years and now affect all income brackets. The findings found that Rhode Islanders already pay more than 30 percent of their income on housing costs, and that more than half of the increase in cost burden from 2000 to 2012 impacted households earning more than $57,700.

From 2000 to 2014, the researchers found that the state’s total population grew marginally at 0.11 percent, but the number of households grew by 0.28 percent. Rhode Island’s smaller household sizes are due, in part, to a larger proportion of older persons and a smaller proportion of persons of color when compared to national rates. Younger households are likely to have more people than those headed by people aged 65 and older, primarily because they are more likely to be family households with children. As this demographic shift continues, the future population will need more housing units to meet the increased household need caused by smaller household sizes typical of older householders.

Pushing for Passage of Question 7

Like Fields, Chris Hunter, campaign manager for the Yes On 7 Campaign, sees the RIH report’s findings as crucial information that voters need to know about the impending housing crisis. “As Rhode Island Housing’s recent report shows, we’re simply not creating enough new housing to meet projected population growth. At the same time we’re facing an affordability crunch as our young workers just starting their careers, families, veterans, and seniors are having a difficult time paying for housing while also making ends meet,” says Hunter.

“That’s why Question 7 and the $50 million Housing Opportunity bond is such a smart investment in housing and Rhode Island’s economy,” says Hunter, stressing that if approved by the voters the $50 million bond initiative will leverage an additional $160 million in federal and private investments.

According to Hunter, if approved, $40 million of the bond dollars will be allocated to the construction of affordable homes and apartments across Rhode Island, while the remaining $10 million will be used to help cities and towns revitalize blighted and foreclosed properties. The bond will also fund the construction of 800 affordable homes and apartments across Rhode Island and create 1,700 good paying local construction jobs.

Over 60 percent of Rhode Island voters passed housing bond initiatives in put on the ballot in 2006 ($50 million) and 2012 ($25 million), says Hunter. “Funding from these last two affordable housing bonds created 1,943 affordable units in 30 communities around the state, and leveraged more than $300 million in federal and private investment in these projects,” he says.

RIH‘s housing report has sounded the alarm, giving a stark warning to local and state officials that a housing crisis exists and will only get worse with the shifting of the state’s demographics. With the election looming, RIH’s Fields continues to push for passage on Question 7. Hunter works to mobilize his housing advocates and supporters of Question 7 to get the word out to every voter in Rhode Island’s 39 cities and towns that this bond initiative must be passed. Hopefully, their message will get across to Rhode Island voters. We’ll see when the votes are counted.

For more details on Question 7, visit http://www.yeson7ri.com.

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

New Study Looks at Better Ways to Instruct Caregivers

Published in Woonsocket Call on October 2, 2016

A new report released by United Hospital Fund and AARP Public Policy Institute, using feedback directly gathered from caregivers in focus groups, provides valuable insight as to how video instruction and training materials can be improved to help caregivers provide medication and wound care management.

AARP Public Policy Institute contracted with United Hospital Fund (UHF) to organize the discussion groups, which took place in March through December of 2015 and were conducted in English, Spanish, and Chinese. A new report, , released on September 29, 2016, summarizes key themes from the discussions and suggests a list of “do’s and don’ts” for video instruction.

Gathering Advice from Caregivers

In a series of six discussion groups with diverse family caregivers — 20 women and 13 men of varying ages and cultures (Spanish and Chinese) — in New York, participants reported feeling unprepared for the complex medical and nursing tasks they were expected to perform at home for their family member. The participants reported that educational videos lack instructional information and also failed to address their emotional caregiving issues. Stories about poor care coordination came up during the discussions, too.

“These discussion groups gave family caregivers a chance to describe their frustration with the lack of preparation for tasks like wound care and administering medication through a central catheter. But participants also demonstrated how resourceful they were in finding solutions on their own,” said Carol Levine, director of UHF’s Families and Health Care Project and a co-author of the report.

According to Levine, this initiative to study caregiver perspectives on educational videos and materials is an outgrowth of a 2012 report, Home Alone: Family Caregivers Providing Complex Chronic Care, released by UHF and the AARP Public Policy Institute. The findings of this on-line national survey of a representative sample of caregivers noted that 46 percent of family caregivers across the nation were performing complicated medical and nursing tasks such as managing medications, providing wound care, and operating equipment for a family member with multiple chronic conditions. These caregivers felt they were not being adequately prepared by the health care system to perform these tasks and they told researchers that they were often stressed, depressed, and worried about making a mistake. Most of these caregivers had no help at home.

The new caregiving report is an important resource for AARP’s broader national initiative known as the Home Alone AllianceSM which seeks to bring together diverse public and private partners to make sweeping cultural changes in addressing the needs of family caregivers. “The wealth of information we learned from these discussion groups has guided the development of our first series of videos for family caregivers on medication management, and will inform future instructional videos,” said Susan C. Reinhard, RN, PhD, Senior Vice President of AARP Public Policy Institute and co-author of the report. Specific segments of the first series of videos include Guide to Giving Injections; Beyond Pills: Eye Drops, Patches, and Suppositories; and Overcoming Challenges: Medication and Dementia. The videos are on the AARP Public Policy Institute’s website and United Hospital Fund’s Next Step in Care website. Additional video series will focus on topics including wound care, preventing pressure ulcers, and mobility.

In preparation for the discussion group (lasting up to 2 hours and held on different days and locations) ), UHF staff reviewed literature on video instruction and adult learning theory for patients and caregivers and selected several currently available videos on education management and wound care to show to caregivers to stimulate discussion and cull feedback on content and presentation style. Felise Milan, MD, an adult learning theory expert at Albert Einstein College of Medicine, was a consultant to the project.

A New Way of Teaching

For UHF’s Carol Levine, one of the biggest insights of this study was the resourcefulness shown by caregivers in “finding information [about managing medication and wound care] that they had not been provided, creating their own solutions when necessary.” “These are strengths that are seldom recognized,” she says.

“We found that caregivers were eager to learn how to manage medications and do wound care more comfortably for the patient and less stressful for themselves. Providers often use the same techniques they would use to train nursing students or other trainees, and are not aware how the emotional attachment of caregiver to patient affects the tasks, and how adults need learning based on their own experiences, not textbook learning,” says Levine, stressing that providers need more time to work with caregivers to provide follow-up supervision.

Existing teaching videos used for providing information to caregivers were generally found not to incorporate adult learning theory, says Levine, noting that they were intended to teach students, not caregivers. “In watching the videos, the caregivers clearly stated that they wanted to see people like themselves learning to do the tasks, not just a provider demonstrating them. They also didn’t respond well to attempts at humor. For them, these tasks are serious business, and they want information, not entertainment,” she added.

Levine says that she believes that videos and interactive online instruction can be a powerful tool in helping caregivers learn and practice at home. “We encourage other organizations to consider developing videos in the area of their expertise, and we encourage all who communicate with caregivers to look at the list of “Dos and Don’ts” for advice about presenting information in ways that caregivers can best absorb it [detailed in her recently released report].

“However, we strongly believe that good clinical advice and supervision are essential. Videos are not “instead of” they are “along with” clinical care,” adds Levine.

CARE Act Gives More Info to Rhode Island Caregivers

“The report reflects the need to make family caregivers more confident that they have the knowledge and instructions to provide the best possible care of their loved ones,” said AARP State Director Kathleen Connell. “This is why implementation of the CARE (Caregiver Advise, Record, Enable) Act will be so important here in Rhode Island, as it addresses some of the anxiety that accompanies a patient’s hospital discharge.

“In most cases, hospitals do their best to prepare patients for discharge, but instruction has not always been focused on preparing a designated caregiver for medical tasks they may be required to perform. The CARE Act is designed to provide caregivers with the information and support they need. As the report indicates, an instructional video may not always answer all their questions. Like physicians, caregivers feel they should abide by the ‘first do no harm’ approach. And that’s hard sometimes if there is uncertainty that comes from a lack of instruction. Caregivers also are especially tentative about treating wounds and managing medications.

“This can lead to some unfortunate outcomes: Patients can suffer when mistakes are made; caregivers feel increased or debilitating stress; and hospitals readmission rates go up.
“In short, we need to listen to caregivers and all work together to support the work they do.”

For a copy of the caregiver report, go to http://www.uhfnyc.org/publications/881158.