Imagine all the people living life… re-imagine, if you can…

By Nancy Thomas, editor and publisher

“It’s time to totally reimagine how we care for seniors…” – Gov. Raimondo

It has not been that unusual for the smallest state in the country, with about 1 million stable (not mobile) people, with measurable media, and little overlap to be the site of something new – something bold – something to be tested. The items have mostly been products – such as the 2-liter bottle – or a new flavor of Coca-Cola. A nitro system for Dunkin’ Donuts. But campaigns such as the Women’s Heart Health Study and some tobacco control programs were also tested here.

But imagine this – what if the smallest state in the union tested something new on a human scale – how to care for each other when we age, and when that age brings a frailty or chronic disease, rehabilitation need, or conditions that need a level of expertise beyond that of a spouse or family members being able to handle alone.

Said softly in the middle of a regular “presser”, the idea was floated by Rhode Island’s Governor Raimondo at yesterday’s availability. “It’s time to totally re-imagine how we care for our seniors”. Challenging the existing care groups to think about redoing their medical and business model so that every senior in a nursing home had a single room and a single bathroom. She talked about specialty care and compensating those who do this work, mainly women and mainly minority women. Those of us who spend some time in nursing homes and see the farming of our loved ones into “congregate care” settings sat up straight when we heard those words. It doesn’t work that way – it would half the census of a home – but how more humane would it all be?

Reimagine, indeed.

And there is money behind this grand idea. This human idea. This idea whose time came generations ago. It will come from the federal money given to states to fight COVID19. RINewsToday rushed to find information on a website – information that allows long term care settings, nursing homes, group homes, assisted living centers, home health groups, to apply – now – for these re-imaging ideas. Soon a press release came out, making the idea a little more formal, but there it was, nonetheless, an imagining moment put into a real project – with enormous potential for all of us.

The release:

Time to Consider Changes to RI’s Long-Term Care System

Investments to Create More Home-Based Care Options Amidst Spread of COVID-19 in Congregate Living Facilities

Governor Gina Raimondo announced a plan to expand home-based care options in Rhode Island as the state continues to grapple with the spread of COVID-19 in congregate living facilities. Before COVID-19, 61% of the state’s long-term care recipients lived in nursing facilities, which have struggled to contain the spread and impact of COVID-19 on residents and staff.

“This is the right direction for Rhode Island,” said Governor Gina M. Raimondo. “We have been in response mode, and our facilities and staff are doing their best, but as we continue to fight this virus, we need to reduce our reliance on nursing facilities and expand home-based care options. We also need to make sure that our direct care workforce is valued in institutions and in the community with training, support and good wages.”

Raimondo’s $25M plan includes investments in nursing facility supports to implement infection control, investments in capital and program changes to fundamentally re-orient the delivery of care in nursing facilities, and targeted investments to expand home-base care options, through home-based workforce incentives, training and supports. The state will also invest to assist families in better understanding long-term care options and accessing home-based care options when discharged from hospitals.

“The pandemic exposed structural and organizational weaknesses within the long-term care system — inadequate staffing, high turn-over, low pay and lack training” said Patrick Quinn, Executive Vice President of SEIU 1199 New England, “We need to build a more resilient long-term care system that gives consumers and their families more independence when choosing a long term care setting and creates a living wage for caregivers as we rebalance our long term care system and drive more investment to direct care of the elderly and individuals living with disabilities. The status quo in nursing homes and home care is failing Rhode Island residents and families which is unacceptable.”

“COVID-19’s impact on older adults and persons living with disabilities with long term care needs has been dramatic,” said Maureen Maigret, co-chair of the State’s Long-Term Care Coordinating Council. “I am pleased the Governor has announced this long term supports and services resiliency plan. We need to reimagine how we deliver and finance long term care. To make home and community-based services – where persons overwhelmingly prefer to receive care — more accessible and to support our families in assisting their loved ones to remain at home. Our nursing homes provide essential services to those with high care needs. This plan will address the resources and workforce needed to better provide high quality, resident-centered care and nursing home care.”

“Historically, we’ve discharged thousands of hospital patients to nursing facilities every year. Times have changed now. Our colleagues are talking about this across the country. We need to build a system of home-based workforce and care that can work with us as we discharge patients safely to their homes to recover with the supports they need.” said Tim Babineau, CEO of Lifespan.

Further information is available on the Executive Office of Health & Human Services’ website at www.eohhs.ri.gov.

A response from the RI Partnership for Home Care

Home Care Providers Respond to Raimondo’s Long-Term Care Resiliency Plan Release

Nicholas Oliver, Executive Director for the Rhode Island Partnership for Home Care, issues the following statement regarding today’s announcement by Governor Gina Raimondo (D-RI) concerning the release of the State’s new ‘Long-Term Care Resiliency Plan’:

“Home care providers have not benefited from the State’s allocation of COVID-19 related funding and personal protective equipment (PPE) needs in parity with our nursing home colleagues to date. Our association is looking forward to working with Governor Raimondo and her administration to address the issues identified within the ‘Long-Term Care Resiliency Plan’. While the plan’s content does not adequately address the immediate funding and resource needs of home care providers, it is our desire to continue the dialogue with the Governor’s leadership team on maintaining a sustainable network of home care providers during the ongoing public health emergency for all Rhode Islanders in need, including COVID-19 survivors requiring post-acute and sub-acute home care services. The Rhode Island Partnership for Home Care will continue to advocate for these needs, along with our proposals to save taxpayer dollars by rebalancing long-term care financing that shifts federal and state funds from costly nursing homes to strengthen home care operations and services, reduce taxpayer-funded duplication of state programs that provide lesser quality home care services, incentivize Rhode Islanders to choose home care as a career choice and a preferred healthcare setting to work, improve state case management of Medicaid beneficiaries and hold all home care providers accountable to the optimal healthcare delivery standards of the Rhode Island Partnership for Home Care.”

About the RI Partnership for Home Care

Established in 1990, the Rhode Island Partnership for Home Care (“The Partnership”) represents home care, home nursing care and hospice agencies licensed by the Rhode Island Department of Health to serve patients and clients in every Rhode Island community. As the only association in our state to promote access to quality home healthcare, The Partnership is committed to promoting quality home healthcare service delivery, ethical healthcare business practices and positive patient and client outcomes to ensure that access to home care and hospice remains an integral component of our post-acute and long-term healthcare system.

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Each week, RINewsToday drills down on the nursing home data and we publish the cases and deaths, as we hold a bright light on the fate of people we are losing – steadily – week in and week out – thankfully below 100 now – but we hear the stats every day – spoken by RIDOH’s Dr. Scott – “1 in their 70s, 2 in their 80s, 6 in their 90s, 2 over 100”.

This virus, it is said, “isn’t the big one” heading our way. Infectious disease sounds like it has come to stay as a concern. “Life may never return to normal,” the Governor said. So it’s time to blow up the system which seems pretty blown up anyway right about now – and get it as right as we can.

Disclosure – Aunt Alice, in the photo above, is 93 years old and lives in an average room in a nursing home. She and a roommate she never met live in this small room. Since the second week of March she has been restricted to her room because of the COVID19. There is about 2 feet of space on one side, a curtain on the other, right up against her bed, and a walkway with the bathroom door in front of her bed. She has had no visitors. She can’t eat with other residents, or have activities, or get her hair done, or walk to the windows. No one has come to visit. A month ago her roommate died. They’ve left her bed with a black plastic mattress on it – not made up, homelike. So far, no COVID-19, and for that we’re grateful. She calls often – midnight, 2am, 4am, 6am. She’s cold and wants a blanket. I call the nurse’s station at 4am because she can’t go out to ask them, and can’t figure out the call buzzer. And so it goes. She lived all on her own before this, in her own apartment, with more needs as time passed. A little fall landed her in the hospital – and now here. She had never even visited a nursing home before. And it’s one of the better ones. She takes no medication, and is about 100 lbs. She can be feisty.

One nursing home administrator in Warren, RI asked how he has kept the virus out of his facility. He said it was not some magic formula – it was two things – a small facility – and being in a community that isn’t dense and that has a small number of cases that draws its workforce from there.

We will go back to the words Gov. Raimondo spoke at the “presser” because these words have spirit behind them – they have a re-imagining behind them – and we encourage whatever groups begin to plan for this that they begin by some exercise every single time they meet, that gives them a moment to realize the greatness of the task before them. There’s $25Million to start – let’s not blow this, Rhode Island. We could change the world for our country, for the people we love, for the years that we have to look forward to as well. We are 1 million people. We’re a test site. We can do it.