A Crisis in Care. RI’s General Assembly must act now – Maureen Maigret, RN, BS, MPA

by: Maureen Maigret, RN, BS, MPA

The Supplemental Budget bill submitted by Governor McKee (H6494) includes needed
investments using American Rescue Plan Act (ARPA) funds for housing, children’s
services, child care and small businesses. Unfortunately, it fails to include funds to
address the immediate and growing direct care workforce crisis facing our health and
human services providers, including those providing home and community services.

Investments are urgently needed now to address the dire crisis faced by persons needing
care due to a crippling shortage of direct care workers. As someone who has followed
long term services for many years, this situation is the worst I have seen. Providers across
the system are challenged to find workers to fill vacancies, and the lingering pandemic has
exacerbated the situation. The general assembly should consider appropriating $100
million in ARPA or other available funds as recommended by the Coalition of Health and
Human Services to address this crisis.

As a long-time advocate for strengthening home and community care for older adults and
those with disabilities, I am especially concerned about the home care situation. People
want to be able to get needed care and supports at home if at all possible. In 2009, the
legislature set a state rebalancing goal of expending 50% of all long term care Medicaid
funds on home and community services. Progress in achieving this goal has been slow.
According to the state’s Long Term Service and Finance Performance report, in 2019
only 22% of Medicaid spending was for home and community services for older adult –
the same as in 2014.

ARPA guidance calls for using funds to address those impacted by the pandemic. We
know older Rhode Islanders have been significantly impacted by Covid-19 in terms of
deaths, hospitalizations, decreased access to healthcare and home care services, increased
depression and anxiety, and in myriad other ways.

The pandemic intensified an existing home care worker shortage. Since March of this
year, 46% of home care referrals for persons on Medicaid going to 31 providers have
gone unfilled. Close to 200 persons await service with 3,564 hours of needed care
unfilled — and this does not include persons eligible for the Office of Healthy Aging
@Home Cost Share program. 76% of client referrals have been waiting over two months
for service. The situation in some areas is particularly grim. Of the 30 referrals for
Newport County, only five have been processed. The wait list includes 46% of persons
with dementia diagnoses, and 80% with a developmental disorder.

We have a growing older population – by 2030 about one in four persons in the state will
be 65+ so the demand for home care services will only increase. Projections are that
between 56% and 70% of persons age 65+ will need some type of long term care at some
point. Helping persons with care needs to remain at home is cost effective. The average
cost to RI Medicaid for nursing home care for older adults is $65,000 vs. $17,600 for
home care.

The FY2023 Medicaid budget request proposes providing funds to bring 1,200 direct care
staff up to $15/hour next July – this is hardly a living wage and we know that inflation is
rampant with CPI at 6+% for the year. The state has proposed a worker retention and
recruitment program using some enhanced federal Medicaid funds which can be used by
home care providers to increase salaries and benefits. This is a good start, but it would
end next March. What would happen after that?

It is crucial for the general assembly to amend and quickly pass the Governor’s
supplemental budget bill to include funds to increase provider payments for our health
and human services and home care providers. These essential but undervalued workers,
many of whom are women and persons of color, need and deserve competitive, living
wages. Rhode Islanders of all ages with care and support needs should not have to wait or
entirely forego needed services.

Maureen Maigret, Policy Consultant, Member, Long Term Care Coordinating Council and Chair of its Aging in Community Subcommittee – [email protected]

A native Rhode Islander, Maureen Maigret began her professional career as a Registered Nurse and worked for twenty years in a variety of clinical settings in Rhode Island. In 1975 she was elected to the Rhode Island House of Representatives effectively combining her healthcare background with her work in public policy. A trailblazer for women entering politics, she was the first woman appointed to the position of Deputy Speaker of the House. Serving for ten years in the House she successfully sponsored numerous laws to improve health and human services, to foster women’s equality and to make government more transparent. She has served as an Executive Assistant to a former Speaker of the House and Chief of Staff in the Office of Lieutenant Governor. From 1991 to 1994 she served as Director of the State Department of Elderly Affairs and from 1999 through 2006 she served as Policy Director for Lt. Gov. Charles Fogarty working on a number of health care, long term care and government reform initiatives.

She has received numerous awards from organizations for her leadership in women’s rights, children’s services, healthcare and long term care policy and advocacy. She has provided consultant services on aging and long term care services for a number of entities including AARP RI, Age Friendly RI, the RI Assisted Living Association, the Senior Agenda Coalition of RI and the RI Alliance for Better Long Term Care. Maureen has presented at state and national conferences on issues relating to women in politics, aging and health and long term care. She has authored data reports on the Rhode Island Older Population and on older women in Rhode Island. She has served as Vice Chair of the state Long Term Care Coordinating Council and currently chairs it Aging in Community Subcommittee. She received her RN Diploma from the Memorial Hospital School of Nursing and holds a Bachelor’s degree from Rhode Island College and a Master of Public Administration degree from the University of Rhode Island. Maureen serves as a Trustee of the Nursing Foundation of Rhode Island. She is married and has grown sons and two adored grandchildren.