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Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.” “NOW, more than ever!!!” RI ARA 2017© All Rights Reserved

Publication 2018 Issue 04 Published in house by the RI ARA

January 28, 2018 E-Newsletter

Rhode Island Women’s March 1st Anniversary Event Was A Call To Action Coalition of Labor Union Women Makes an Action Plan By Maureen Martin, RI AFL-CIO Secretary-Treasurer

Thousands of activists gathered on the lawn of the Rhode Island state house on January 20, the anniversary of Donald Trump’s inauguration, to protest his views on immigration, women’s reproductive rights, LGBTQ rights, and labor and human rights. Intent on building on the momentum of last year’s Women’s March, the 2018 RI March organizers were determined to have this year’s demonstrators leave the event with a plan of action. The myriad of speakers from community organizations included the Maureen Martin, voices of immigrant women and women of color, LGBTQ activists, RI AFL-CIO Secretary-Treasurer labor, and several women’s organizations and supporters of the #MeToo and TimesUp campaigns. In their address to the crowd, each speaker urged the activists to take action this year, to run for office or support a women candidate, to call their legislator on an issue, to reach out to women and girls in need, and they challenged the crowd to look within themselves and to question their own racism. The plan of action adopted by the RI Chapter of the Coalition of Labor Union Women (CLUW) is to run a voter registration campaign starting with union members. The national CLUW has initiated a yearlong campaign “Power to the Polls” aimed at harnessing the collective power of women in their unions. The Chapter plans to register union members, have them think about running for office, and get them to the polls.

Rhode Island may be the smallest state, nobody, nobody, beats our enthusiasm!!

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Paul Ryan Collected $500,000 In Koch Contributions Days After House Passed Tax Law percent, slashes estate taxes and includes a special deduction for oil and gas investors — is expected to save the Koch brothers and their businesses billions of dollars in taxes. Just 13 days after the tax law was passed, Charles Koch Paul Ryan David Koch Charles Koch and his wife, Elizabeth, Just days after the House passed its donated nearly $500,000 to Ryan’s joint version of the federal tax law slashing fundraising committee, according to a corporate tax rates, House Speaker Paul campaign finance report filed Thursday. Ryan collected nearly $500,000 in Five other donors, including billionaire campaign contributions from billionaire businessmen Jeffery energy mogul Charles Koch and his wife, Hildebrand and William Parfet, each according to a recent campaign donor contributed $100,000 in the last quarter of report. 2017, according to the records. Koch and his brother David spent millions “It looks like House Speaker Ryan is of dollars to get the tax law passed and are quickly being rewarded for passing this spending millions more in a public relations legislation that overwhelmingly benefits the campaign in an attempt to boost Kochs and billionaires like them,” Adam support for the law, The Wall Street Journal Smith, spokesman for campaign finance reported. reform nonprofit Every Voice, told Koch Industries, one of the largest private the International Business Times, which corporations in the nation, operates first reported the Koch contributions. refineries and manufactures a variety of The Koch donations were paid into Team products. The new tax law — which slices Ryan, which raises money for the corporate tax rates from 35 percent to 21 speaker, the National Republican

Congressional Committee and a PAC run by Ryan. On the same day, Charles and Elizabeth Koch also each donated $237,000 to the NRCC. The Koch brothers, worth an estimated $100 billion together, have become the gorillas of dark money contributions distorting American democracy since the Supreme Court’s decision in Citizens United v. FEC lifted campaign contribution restrictions. The brothers are using their massive wealth to push a political agenda that’s the “most hard-line libertarian philosophy” in Amer ica, accor ding to Jane Mayer, author of Dark Money: The Hidden History of the Billionaires Behind the Rise of the Radical Right. Ryan has indicated that he won’t run again when his term is up this year, Politico reported, though he hasn’t made an official announcement. If he doesn’t run, his contributions would be redirected.

Congress Urged to Remember Mine Workers who Risked Their Lives as New Budget Deadline Looms Statement of Robert Roach, Jr., President of the Alliance for Retired Americans, on the critical need to address the pensions of the United Mine Workers of America as plans are made to fund the government before the next deadline of February 8: “As Congress works to develop legislation to fully fund the government, it is critical that the pension rights of thousands of retired United Mine Workers of America (UMWA) covered by the 1974 Pension Plan are addressed. “Since 1946, the United States government has lived up to the promise it made to retired miners: ‘If you will bring out the coal that provides the foundation for the American economy, then the

government will make sure you have a secure retirement.’ “Legislation is the only option that will prevent insolvency and preserve benefits for these retired mine workers. They earned their pensions by risking their lives in a dangerous line of work to meet the country’s energy requirements. Their average pension is just $586 per month. Many pension recipients are widows who depend on that pension to meet their most basic needs. “It is not the workers’ fault that their pension plan is in trouble. In fact, just ten years ago the plan was 93% funded, and on a path to 100% funding. However, the 2008-09 recession and a series of bankruptcies in the coal industry over the

last six years have decimated the fund. Several coal companies were relieved of further pension obligations by bankruptcy courts and contributions were wiped out. “Our government Robert Roach, Jr must meet that commitment that was made generations ago. Preserve these pensions, so that thousands of our seniors can live in dignity.”

Official USA team Olympic merchandise is imported

I guess this is making America great again. This should make every American MAD!!!! Every item is IMPORTED! See for yourself Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

CMS Proposed Rule for Plan Flexibility Risks Consumer Confusion

This week, Medicare Rights Center submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) proposed rule for Medicare Parts C & D. The proposed rule contemplates many broad changes to the Medicare Advantage and prescription drug coverage programs, largely focusing on providing more flexibility and options for plan sponsors. CMS’s stated aim is to allow plans to use the proposed flexibility to better serve beneficiaries—by creating disease- or condition-specific sets of benefits, offering more plans, and altering

cost sharing arrangements. While Medicare Rights strongly supports getting people with Medicare the care they need, we are concerned about the potential for beneficiary confusion, inappropriate plan manipulation, and challenges related to assessing the impacts of different changes if they are all happening at once. In addition, some of the proposed changes overlap with or may interact with existing, carefully constructed demonstration programs that are testing how such flexible options affect care. Medicare Rights’ comments highlight the need for CMS to apply the crucial beneficiary protections in those demonstration programs if more flexibility is introduced.

CMS acknowledges that these changes will make the already difficult process of plan comparison and selection more difficult. To help tackle this challenge, CMS proposes to make changes and improvements to the Medicare Plan Finder tool. While Medicare Rights enthusiastically looks forward to needed updates and improvements to the Plan Finder—especially a useful integration of plan network information—such improvements alone are unlikely to be sufficient to make plan comparison transparent and easy and end beneficiary confusion. In addition, such improvements are long overdue and must be in place and thoroughly tested before changes that make the process even more confusing are implemented.

CMS Launches New Voluntary Bundled Payment Model Last week, the Center for Medicare & Medicaid Innovation (CMMI) within the Centers for Medicare & Medicaid Services (CMS) announced plans to test a new way of paying Medicare providers for many of the services they perform, including major joint replacement and some cardiac interventions. This model— the Bundled Payments for Care Improvement Advanced (BPCI Advanced)—is the first of its kind to be introduced by the Trump administration. Under traditional Medicare, providers are paid for each individual service. Under this new, voluntary payment

model, Medicare will make a single bundled payment for nearly all the services provided in a 90-day period to certain Medicare patients who are admitted to a hospital or have certain outpatient medical procedures. Medicare Rights is pleased that CMS is moving forward with a new opportunity to test bundled payments. We urge the agency to ensure that vital consumer protections are included in the design and implementation of this and future models. In partnership with AARP, we developed a checklistof pr otections that should be integrated into the design of all

Medicare models, to ensure that any changes to Medicare payment structures do not diminish access to care, care quality, or the overall consumer experience with the program. Read Mor e about the model and its requirements.

As Doctors Drop Opposition, Aid-In-Dying Advocates Target Next Battleground States When the end draws near, Dr. Roger Kligler, a retired physician with incurable, metastatic prostate cancer, wants the option to use a lethal prescription to die peacefully in his sleep. As he fights for the legal right to do that, an influential doctors group in Massachusetts has agreed to stop trying to block the way. Kligler, who lives in Falmouth, Mass., serves as one of the public faces for the national movement supporting medical aid in dying, which allows terminally ill people who are expected to die within six months

to request a doctor’s prescription for medication to end their lives. Efforts to expand the practice, which is legal in six states and Washington, D.C., have met with powerful resistance from religious groups, disability advocates and the medical establishment. But in Massachusetts and other states, doctors groups are dropping their opposition — a move that advocates and opponents agree helps pave the way to legalization of physician-assisted death. The American Medical Association, the dominant voice for doctors nationwide, opposes allowing doctors to prescribe life-

ending medications at a patient’s request, calling it “fundamentally incompatible with the physician’s role as healer.” But in December, the Massachusetts Medical Society became the 10th chapter of the AMA to drop its opposition and take a neutral stance on medical aid in dying. Most of those changes occurred in the past two years. program officer for Compassion & Choices, an advocacy group that supports legalization efforts around the country. (The practice is also legal in Washington, Oregon, Vermont and Montana.)...Read More

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Big Pharma Greets Hundreds Of Ex-Federal Workers At The ‘Revolving Door’ .Alex Azar’s job hop from drugmaker Eli Lilly to the Trump administration reflects everdeepening ties between the pharmaceutical industry and the federal government. A Kaiser Health News analysis shows that hundreds of people have glided through the “revolving door” that connects the drug industry to Capitol Hill and to the Department of Health and Human Services. Azar was confirmed Wednesday as HHS secretary, joining other former drug industry alumni in top positions. Nearly 340 former congressional staffers now work for pharmaceutical companies or

their lobbying firms, according to data analyzed by KHN and provided by Legistorm, a nonpartisan congressional research company. On the flip side, the analysis showed, more than a dozen former drug industry employees now have jobs on Capitol Hill — often on committees that handle health care policy. “Who do they really work for?” said Jock Friedly, Legistorm’s president and founder, who called that quantity “substantial.” “Are they working for the person who is paying their bills at that moment or are they essentially working on behalf of the interests who have funded them in the past and may fund them in the future?” In many cases, former congressional staffers who now work for drug companies

return to the Hill to lobby former coworkers or employees. The deep ties raise concerns that pharmaceutical companies could wield undue influence over drugrelated legislation or government policy. “You’ll take the call because you’ve got a friendly relationship,” said Diana Zuckerman, president of the nonprofit National Center for Health Research and a former congressional staffer. “You’ll take the call because these people are going to help you in your future career [and] get you a job making three times as much.” A 2012 Sunlight Foundation investigation found that, on average, a chief of staff on the Hill could increase his or her salary 40 percent by moving to the private sector….Read More

A Push To Get Older Adults In Better Shape For Surgery Surgery can be hard on older adults, resulting in serious complications and death far more often than in younger patients. But many seniors aren’t adequately prepared for the risks they might face. Innovative hospitals such as Duke University Medical Center, the University of California-San Francisco Medical Center and Michigan Medicine are working to change that. In the week leading up to surgery, they prescribe exercise to seniors, make sure they’re eating healthy foods and try to minimize anxiety and stress, among other initiatives. Research suggests these interventions can enhance seniors’ readiness for surgery and potentially lead to improved outcomes.

“Changing how we approach older patients is really an imperative,” said Dr. Emily Finlayson, dir ector of the Center for Surgery in Older Adults at UCSF. In that vein, next year the American College of Surgeons (ACS) plans to launch a national effort to improve surgical care for seniors, after defining a broad array of standards that hospitals should meet. The goal is to promote and recognize “centers of excellence in geriatric surgery” across the U.S., said Dr. Ronnie Rosenthal, chair of ACS’ geriatric surgery task force. New evidence from Duke’s POSH (Perioperative Optimization of Senior Health) program demonstrates the value of prepping at-risk seniors for surgery, a

strategy endorsed by the newly published standards. In January, researchers reported that older adults who went through the POSH program before major abdominal operations spent less time in the hospital (four days versus six days for a control group), were less likely to return to the hospital in the next 30 days (7.8 percent vs. 18.3 percent), and were more likely to return home without the need for home health care (62.3 percent vs. 51.1 percent). They also had slightly fewer complications….Read More

U.S. Life Expectancy Drops The United States is one of the wealthiest nations in the world but it is far from the healthiest. Americans are living shorter lives than Rich Fiesta previous generations, and are dying earlier than similarly situated people in other parts of the world. The Centers for Disease Control (CDC) released a report recently detailing the troubling development. According to the CDC, life expectancy has fallen two years in a row. The average life expectancy at birth in the U.S. fell by 0.1 years in both 2015 and 2016, and is now at 78.6 years. This is the first time in 50 years that this drop has occurred in consecutive years.

Many blame the rising opioid epidemic, which is a major factor, but fail to recognize another culprit: shortcomings in the American healthcare system. U.S. physicians are more apt to prescribe opioids than physicians in other developed nations. This has sent the sales of opioids skyrocketing, and the number of addicts has risen simultaneously. Increased regulation of the pharmaceutical corporations would be one way to address the problem. The role of drug corporation practices in the opioid crisis is illustrated by the case of Purdue Pharma, which has been sued thousands of times over OxyContin, a prescription painkiller. The company settled one case for

$600 million after the federal government accused it of making false claims about the drug’s risk of addiction and denying its potential for abuse. New lawsuits by cities and states are currently pending, claiming that drug corporations have profited from a product they knew to be dangerous. “In order to reverse this pattern, we must put people before drug companies and stop prescribing opioids at such an outrageous rate,” said Richard Fiesta , Executive Director of the Alliance. “We also need stronger government health care programs, including Medicaid and Medicare, so that we can treat those who do succumb to addiction.”

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RI ARA HealthLink Wellness News


The Quiet Epidemic of Senior Drug Abuse The elderly may be the last population you’d imagine would have issues with drugs and alcohol. Think again. New data shows the number of seniors with drug problems are on the rise. But the causes are complex and the solutions aren’t easy. Get educated about the scale and nature of senior drug abuse and misuse, signs of dependence and addiction in older loved ones, and how to get help for an older loved one with a drug problem.  The Increasing Prevalence of Drug Problems among Seniors  Drinking Problems and Seniors  Misuse vs. Abuse  Dependence vs. Addiction  Drugs of Misuse Among Seniors  Benzodiazepines

 Alcohol  Stimulants Signs of Drug Problems Here are some signs that can indicate that your older loved one may have a substance abuse problem:  Appearing over sedated, disoriented or impaired  Poor balance or unsteady gait  Requesting early refills  Reporting that their medications have been lost or stolen (particularly if this occurs more than once)  Poor hygiene or disheveled appearance  Appetite changes  Mood swings or major personality changes  Increased isolation  Demanding narcotic drugs at visit to the

doctor  Apparent doctor shopping It’s important to note that any of these signs and symptoms could be due to reasons besides drug problems, but they are definitely cause to investigate further. Help for an Older Loved One with a Drug Problem If you believe an elderly loved one may have a drug problem you should intervene. One option is alerting your loved one’s physician about your concerns. The right type of treatment will vary as well as the individual and the circumstances. A hopeful trend is the emergence of drug treatment programs especially for seniors, which was born out of the recognition that there are differences in the drug treatment strategies that are effective for seniors as compared to younger people….Read the complete article.

10 Early Symptoms of Dementia Overview Dementia is a collection of symptoms that can occur due to a variety of possible diseases. Dementia symptoms include impairments in thought, communication, and memory. SYMPTOMS Symptoms of dementia If you or your loved one is experiencing memory problems, don’t immediately conclude that it’s dementia. A person needs to have at least two types of impairment that

significantly interfere with everyday life to receive a dementia diagnosis.  In addition to difficulty remembering, the person may also experience impairments in:  language  communication  focus  reasoning 10 Early Symptoms of Dementia 1. Subtle short-term memory changes

2. Difficulty finding the right words 3. Changes in mood 4. Apathy 5. Difficulty completing normal tasks 6. Confusion 7. Difficulty following storylines 8. A failing sense of direction 9. Being repetitive 10. Struggling to adapt to change Read More on each of these 10 symptoms

Opioid commission member: Our work is a 'sham' The Republicanled Congress has turned the work of the president's opioid commission into a "charade" and a "sham," a member of the panel told CNN. "Everyone is willing to tolerate the intolerable -- and not do anything about it," said former Democratic Rep. Patrick Kennedy, who was one of six members appointed to the bipartisan commission in March. "I'm as cynical as I've ever been about this stuff." President Donald Trump declared the opioid epidemic a 90-day public health

emergency in October, but did not make any new funding available. In November the president said he would donate his third quarter salary to the Department of Health and Human Services to help fight the crisis. Critics say the declaration did virtually nothing to change the status quo and that overdose deaths have continued to mount in the months since. The pubic health emergency declaration was, in fact, set to expire on January 23, but as the government was headed toward a shut down on Friday, Acting Secretary of the Department of Health and Human Services Eric Hargan renewed the national public health emergency for another 90 days.

"This and the administration's other efforts to address the epidemic are tantamount to reshuffling chairs on the Titanic," said Kennedy. "The emergency declaration has accomplished little because there's no funding behind it. You can't expect to stem the tide of a public health crisis that is claiming over 64,000 lives per year without putting your money where your mouth is." CNN sought to catch up with the six members of the opioid commission, including former New Jersey Governor Chris Christie who headed the panel, about their views on progress made and what more needs to be done….Read More

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Substance Abuse and Caregiving When to Ask for Help for your Own Health and Well-Being Whether you are a caregiver for an aging parent with the first signs of dementia or a client with debilitating chronic pain, caregiving is one of the toughest jobs there is. According to the National Caregiver Alliance, more than 40 million people have provided unpaid care to a child or an adult in the last year. Not only is this job physically demanding, but it can be emotionally challenging and mentally stressful as well. From physical exhaustion to feelings of guilt and depression, many caregivers suffer from burnout, which can lead some people to using drugs and alcohol as a way to cope with their pain. Caregiving can be a very rewarding experience and fulfilling career, but the high-stress lifestyle can put you at risk for alcohol and substance abuse. This not only hurts your health and well-being, but also the life of the person you are caring for. Using alcohol or drugs to cope with stress creates a cycle of negative emotions, leaving you constantly wracked with guilt

and frequently returning to those same substances to ease the pain. You may feel isolation (because you think there’s no one to talk to) or shame (because you believe you should be able to handle this), but this is just the pressure and the addiction talking. There is help, and there is hope. Anxiety, Depression and Asking for Help If what started as a harmless cocktail to ease your nerves after a particularly rough fit or episode has turned into relying on alcohol to get through the entire day, you are not alone. A study by Cornell University found that 34 percent of caregivers reported using alcohol as a coping mechanism, and that 2.3 percent reported using alcohol regularly to cope. If you feel like you are becoming dependent on drugs or alcohol to manage your caregiving burden, consider talking to friends, family or your patient’s medical professional about how to get help. You might feel scared at first, thinking they may judge you as weak or neglectful. Just remember: caregiving is often more than a job — it con consume most of your life in a way that can be stressful and difficult, no matter how good your

intentions. Well-meaning people sometimes get angry and do or say things they regret. Asking for help shows you deeply care about how your health impacts the person in your care. 34% of caretakers use alcohol to cope Some ways you can ask for help include:  Team Up Creating a caregiving team to share the burden of providing care so it doesn’t fall on just you.  Meet Up Attending substance abuse group meetings to start building a network of support you can rely on when you want to turn to alcohol or drugs.  Speak Up Understanding the underlying cause of addiction by speaking to a mental health professional.  Check In Checking into a substance abuse treatment facility so you can focus on your health without added stress or distractions.

Deprescribing Medications for Older Adults Many older adults take too many prescription drugs or take them at too-high doses. Prescriptions started long ago to treat temporary medical conditions somehow never get stopped. Other preventive drugs may offer little to no benefit after a certain age and bring unacceptable side effects for older users. A movement is underway to eliminate excess medications that are more likely to harm than help older patients. Known as deprescribing, it comes down to thoughtfully evaluating and rightsizing individual drug regimens that build up for patients in the course of their lives. Polypharmacy, or overmedication, is defined in a variety of ways. One commonly used threshold is a medication routine involving five or more different drugs. Patients may accumulate much higher drug totals, according to Cynthia Blevins, a certified registered nurse practitioner at Penn State Health General Internal Medicine of Lancaster. Blevins, a strong proponent of deprescribing, is also an adjunct professor with the nurse practitioner

program at Millersville University in Pennsylvania. It's not just a matter of counting pills. The larger issue is people taking medication they don't need. Blevins describes a patient who came in for admission to a nursing home where she practiced. Earlier in life, he was obese and had high blood pressure. But circumstances changed and he lost a significant amount of weight – yet he still was taking four antihypertensive drugs. As a result, his blood pressure was dangerously low. "Nobody was following up on or carefully tracking him," she says. Once these medications were cut, his blood pressure became stable. More than one-third of U.S. adults in their early 60s and beyond take at least five prescription medications, according to a review article in the July 2017 issue of the Journal of Family Practice. The study, led by Dr. Kathryn McGrath, a geriatrician and an assistant professor affiliated with Thomas Jefferson University Hospitals in Philadelphia, gives health care

providers a roadmap for deprescribing. An unintended but vicious cycle can lead to overmedication. "Polypharmacy often occurs when an adverse drug effect is misinterpreted as a new medical problem – leading to the prescribing of more medication to treat the initial drug-induced symptom," the authors explain. Drug interactions can worsen fluid retention for people with heart failure, increase stroke risk in people with dementia, further damage kidney function in people with kidney disease or worsen urinary problems such as retention or incontinence. Research on the health benefits of deprescribing is ongoing, but findings so far are promising. After deprescribing, patients have been shown to have fewer falls, improved cognition and greater satisfaction. Talk to your health care providers and pharmacist about trimming your medication list down to size. Here's how deprescribing works….Read More

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RI ARA January 28, 2018 E-Newsletter


RI ARA January 28, 2018 E-Newsletter