PROVIDENCE – The Oct. 2, 2017, ConvergenceRI article, “The Challenges of Speaking Up When It Comes to Challenging Policy,” reported that at a recent policy conference hosted by Leading Age RI and the R.I. Assisted Living Association, the audience refrained from challenging the speakers about state Medicaid policy.

For example on the topic of UHIP, keynote speaker Ted Nesi reportedly wondered, “What he could have done differently in his reporting, to challenge what state officials were saying.”

In its coverage, ConvergenceRI also asked: “What those in the audience could have done to speak out more forcefully about what happened with UHIP in advance of the botched rollout.”

In fact, however, long-term care stakeholders raised vehement concerns about UHIP prior to its implementation in September of 2016 – particularly with respect to the state’s accumulation of a substantial backlog of cases during the previous year [relying on the notion that UHIP would make short work of them]; and the state’s extraordinary decision to reassign or lay off nearly all of its experienced LTC eligibility workers in the month before UHIP was launched.

ConvergenceRI is well aware of those protests, having reported extensively on them.

However, readers lacking that familiarity might misunderstand the question to mean that no effort was made by the LTC profession to express our concerns. In fact, strenuous efforts were made. The problem was that nobody was listening.

The article also reported that Chris Koller, president of the Milbank Memorial Fund and former Rhode Island Health Insurance Commissioner, reminded the attendees that Rhode Island ranks 32nd among the states on the AARP’s “Long Term Services and Supports Scorecard.”

According to the article, Koller challenged attendees to make an honest assessment of how our LTC service providers could do better.

Of course the Scorecard does not focus on the performance of our long-term care providers. Rather, it focuses on the availability and affordability of home and community-based services as a preferable alternative to nursing home care.

Toward that end the Scorecard uses such measures as the percent of state long-term care funding that goes to home care rather than nursing home care; how quickly our elders are discharged from nursing homes after being admitted; the number of “low care” patients in nursing homes who could theoretically be cared for in community-based setting instead; and the availability of subsidized housing.

The reality is that Rhode Island’s home health agencies and nursing homes furnish a demonstrably high quality of care by any measure, [although as with any other endeavor there is always room for improvement].

An honest assessment of our unimpressive ranking on the Scorecard would reveal two immediate issues: that our state has been unable or unwilling to make the necessary but expensive investments in home and community-based care that would elevate our ranking; and that our elderly population is skewed sharply in favor of the “old old,” who are three times as likely to need nursing home care as younger seniors. [We rank first in the country on the obscure statistic of the percentage of our senior population, aged 65 and older, who are aged 85 and older.]

Perhaps Koller was challenging state policymakers, rather than providers, but if not, that would have been an appropriate challenge from the audience.

Virginia M. Burke, J.D., is the president and CEO of the Rhode Island Health Care Association