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Five Questions With: Bill Flynn

By Marion Davis
Contributing Writer

Nearly 1 in 7 Rhode Island residents is over 65, and almost 1 in 40 is over 85, according to the U.S. Census Bureau. For six years now, the Senior Agenda Coalition has been one of the most powerful, high-profile and respected voices advocating for those Rhode Islanders.

Now, with the state seeking a global Medicaid waiver that would, among other things, transform the long-term care delivery system, and budget cuts looming that could dramatically reduce services to all seniors, the coalition is as busy as ever.

Bill Flynn, the group's executive director, described some of the issues he faces to Providence Business News.

PBN: What is the Senior Agenda Coalition, and what are some of your main areas of concern?

FLYNN: The Senior Agenda Coalition is a diverse coalition of activists and groups that advocate for a common agenda of elder issues. It includes individuals, advocacy and service organizations, and community and long-term care service providers, and it seeks to empower people and organizations to move issues, promote legislation, and influence policies of both public and private institutions. The goal is to help elders retain their dignity and independence through what is called "aging in community." This means they must not only have access to services that will enable them to stay in their own homes (or community) safely, independently and comfortably, regardless of age, income, or ability level, as long as possible, but also to remain active and engaged in the community through activities such as volunteering, lifelong learning, and part-time work.

PBN: You've been vocal in the discussion of the proposed Medicaid global waiver. What is your position on the waiver?

FLYNN: The coalition has been working to reform the state's long-term care system for a number of years. The state continues to spend the bulk of public long-term care dollars (89 percent in 2006, according to the AARP) on nursing homes as opposed to home and community services; our goal is to re-balance the system so that over a period of five years or so we will reach "50-50" spending.

The coalition applauds and supports those components of the waiver that would help achieve our reform goals, but we have a number of concerns and believe reform could occur through a separate [limited-scope] waiver. . The coalition is deeply concerned that frail, low-income seniors who today would be eligible for nursing home, home or community care would be placed on waiting lists if budget targets are not met. . We are also concerned that there be adequate capacity in the home and community system.

PBN: The Medicaid waiver would affect only the poorest and frailest seniors, but Rhode Island has a very large senior population beyond that. How is the state doing by them?

FLYNN: Medicaid serves only slightly more than 1 in 10 of the state's elders. Estimates are that 11 percent of Rhode Islanders age 65 and over are on Medicaid, and 32 percent of those are 85 years and over. For those elders not eligible for Medicaid, a number of support programs offered by the R.I. Department of Elderly Affairs and various community agencies such as senior centers provide a range of essential services that help thousands of elders to stay living at home. . Recently many of these programs have been cut by 50 percent or more, and elders have seen major increases in the copayments or new cost sharing. In fact, this past spring, at one point, about 200 persons were on a waiting list for home and community services. As we look to re-balance the long-term care system, it is important to keep these cost-effective senior support programs funded and functioning.

PBN: You recently put out a factbook on the state of Rhode Island's seniors. What were some of the most striking findings for you?

FLYNN: This was the second edition of the Factbook. We believe it is the most comprehensive data source for Rhode Island seniors. We do not plan to publish the full report annually, but plan to do a series of briefings highlighting some of the data topics between full publications. Some of the most striking findings include the very modest incomes of our state's seniors, the high level of transportation need among elders, the amount of money seniors spend on health care despite almost universal access to Medicare, and the projected growth in the total elder population and substantial growth in minority elders.

PBN: In October, the coalition hosted a conference on "Aging in a Senior-Friendly Community." How senior friendly is Rhode Island, and what are some of the main things we could do to become more senior friendly?

FLYNN: While Rhode Island's state government and municipalities have had a history of strong support for programs such as the R.I. Department of Elderly Affairs, senior centers and subsidized senior housing, in recent years it has become decidedly less senior friendly. The Department of Elderly Affairs has had funding reduced drastically, state budget cuts may result in closing of some senior centers, and the last subsidized senior housing was built in the 1980s. A hopeful sign was the enactment in 2006 of the Sullivan-Perry legislation mandating a major shift in state Medicaid funding from nursing home beds to services that would keep seniors longer in their own homes. However, the R.I. Department of Human Services has moved at a snail's pace to implement policies that would make that goal a reality. Immediate action on "re-balancing" Medicaid toward home and community-based services is the most important step that Rhode Island must take. We must also protect the array of support programs serving non-Medicaid elders from further erosion as we anticipate a growing elder population.

Higher cost of living at home
By Steve Peoples

Providence Journal, February 5, 2009

The state's new arrangement with Medicaid might mean higher copayments for the elderly who use adult daycare.

PROVIDENCE -- Irene Wiggin wants to stay in her home. And Governor Carcieri says he wants to grant her wish.

The alternative -- a nursing home -- would probably be far less comfortable for the 86-year-old Warwick woman than her home of the last 50 years, and far more expensive for the state.

But Wiggin's family says that the governor is pushing her into institutional care, despite his high-profile plans to help seniors and disabled Rhode Islanders stay at home. The "rebalancing of the state's long-term care system" away from nursing homes is among the top priorities in Carcieri's recently sealed agreement with federal Medicaid officials. Read More . . .