Testimony: State Assembly Aging Committee Hearing on Community-Based Services for Seniors

New York State Assembly
Assembly Standing Committee on Aging
December 6, 2017
Examination of Non-Medical Programs that Support Seniors in the Community

Thank you to Chairperson Assemblywoman Lupardo and to the entire Assembly Committee on Aging for the opportunity to highlight the cost-effective and exemplary work of the non-medical programs statewide that support a senior’s ability to age with dignity and grace in their communities. Further, we want to particularly recognize Chairwoman Lupdaro’s support and efforts last fiscal year to prevent the devastating Title XX cuts that would have closed 65 senior centers in NYC alone. We also recognize and thank Senator Sue Serino, Chair of the Senate Standing Committee on Aging for her leadership on these issues as well.

DQZ5qtRUQAAkWWn.jpg

LiveOn NY’s members provide these core, non-medical services that allow older adults to thrive in their communities. With a base of more than 100 community-based organizations serving at least 300,000 older New Yorkers annually, our members provide services ranging from senior centers, congregate and home‐delivered meals, affordable senior housing with services, elder abuse prevention services, caregiver supports, transportation, NORCs and NY Connects.  LiveOn NY members also provide the crucial Expanded In Home Services for the Elderly Programs (EISEP) which include case management and homecare. LiveOn NY advocates for increased funding for these vital services to improve both the solvency of the system and the overall capacity of community-based service providers.

LiveOn NY also administers a citywide outreach program that targets seniors in communities where benefits are most underutilized.  This program helps to educate thousands of older adults, including those who are homebound, about food assistance options, as well as to screen and enroll those who are eligible for SNAP and SCRIE/DRIE.

LiveOn NY is also proud to administer the Senior Medicare Patrol (SMP) program for the entire state. A grant project funded by the U.S. Administration for Community Living (ACL), this program is aimed at preventing Medicare fraud. SMP is modeled around recruiting and actively engaging senior volunteers to promote peer counseling, education, and assistance. This provides seniors opportunities to not only educate themselves on Medicare issues, but also to get involved and give back to their community. SMPs educate Medicare beneficiaries on how to protect, detect, and report Medicare fraud, through this, SMPs are able to empower beneficiaries to reduce healthcare costs caused by errors, abuse, and fraud.

The topic of today’s hearing surrounds non-medical programs that support seniors in their community. We would like to open by acknowledging that while programs such as senior centers, NY Connects or home-delivered meals are non-medical by definition, their impact most certainly has a positive effect on the overall health of a senior and even a reduction in costs that would otherwise be imposed on the healthcare system. The work of these non-medical community based services can certainly have health impacts, from lowering rates of depression, to preventing isolation, to even reducing hospitalization rates for seniors. It is important to challenge our current framework used to think about community-based services to one that represents their reality: a network of programs in every community working together to holistically improve a senior’s quality of life and their overall health.

The work of the non-medical community-based service sector must be seen as a viable partner and compliment to the overall healthcare system in New York. Funding and policy is needed to enable community-based organizations to expand their data collection and analytics capacity in order to fully and appropriately integrate with the healthcare system. While the community-based service providers have decades of experience in improving outcomes for their senior participants, articulating this fact has been near impossible due to these funding and data limitations. It is our desire to work with the State Office for the Aging, the Department of Health, the legislature, Governor Cuomo, and all interested parties to find ways to come together to continue to improve the quality of life of seniors throughout the state.

DQZ4KlTX0AAl94r.jpg

Further, this network of community based services, from senior centers, to transportation services, to elder abuse prevention programs help enable seniors to tap into the unquestionable momentum that is accumulated in later life. After years of working to build families, careers, and communities, Older New Yorkers throughout the state use this momentum to even further power up the economy, the political system, and their communities.  In the 2017-18 city and state budget cycles, seniors sent over 40,000 letters to elected leaders to advocate for increase funding for senior services, a shining example of this point.

Beyond the aforementioned health impacts, New York state benefits an estimated $32 billion annually from unpaid caregiving services alone. This $32-billion-dollar impact is thanks to the over 4 million family caregivers providing unpaid care, the estimated 125,000 grandparents raising grandchildren throughout New York, and the multitude of kinship caregivers supporting their loved ones. Beyond economic gains stemming from caregiving, seniors contribute an estimated 119 million hours of volunteerism in the state at an economic value of $3.35 billion.

This incredible economic impact is likely to grow as the number of caregivers and older adults is projected to increase dramatically in the coming years. By 2040, it is estimated that the 60-plus-population will rise to an estimated 5.6 million individuals. These are 5.6 million individuals that should have the opportunity to be supported by a fully-funded network of community-based services in their community.

Unfortunately, this cost-effective system is at risk of insolvency due to inadequate funding and outdated capital investments, which in-turn creates extreme difficulty in retaining quality staff. Seniors are falling through the cracks due to stagnation in the overall SOFA budget and at times, even dramatic cuts to these important programs. There’s a human impact of this unfair budget - growing waiting lists, staff burnout, and a lack of a safety net for seniors. 

For the workforce associated with these community-based aging service providers, the need for increased funding could not be clearer. A 2017 report by the Human Services Council (HSC) found that human services workers make less than what is needed to cover expenses, with the annual pay throughout New York averaging less than $30,000, with up-state New York earnings averaging significantly less. Further, 60% of these workers reported having a family member utilize public assistance benefits such as SNAP, formerly known as food stamps, to make ends meet. Given these realities, it is not difficult to conject as to why staff recruitment and retention can be so difficult for aging service providers.

Organizationally, day-to-day realities have increasingly come to mirror the low-income clients that are served: while the participants live paycheck to paycheck, providers are living payroll to payroll. The HSC study also found that 60% of nonprofit service providers reported that state contracts rarely or never provided for the full cost of the contracted services. With 80% of budgets being funded almost entirely by governmental supports, it is clear as to why the solvency of the system is so at risk.

Despite these bleak findings, it is possible for New York State to turn the tide towards a more fair and equitable budget for seniors and the community-based services that support them. Respectfully, LiveOn NY offers the following recommendations to meet this objective and to support Governor Cuomo’s goal of making New York the first Age Friendly state in the nation:

LiveOn NY’s Recommendations

To achieve the success of the Governor’s Health Across All Policies Initiative, which coincides with the overall effort to make New York the first Age Friendly state, strategic investments must be made in the aging services network. Among these investments, priority should be placed on the solvency of:

  • New York Connects: No Wrong Door Initiative
  • Community Services for the Elderly
  • NORCs: Naturally Occurring Retirement Communities
  • Services within Affordable Senior Housing
  • Elder Abuse Prevention and Services
  • A Dedicated Commitment to Supporting New York State’s Nonprofit Human Services

NY Connects/No Wrong Door – funding request $33 million annually

iStock-155075277.jpg

NY Connects is a locally coordinated system of specialized information and assistance on long term services and support options for age 60+, individuals with physical disabilities, caregivers and providers. New York state has spent years building the multi-agency, cross systems approach to service access.  In New York City alone, the five agencies that serve as the NY Connects provider in each of the boroughs collectively served over 16,000 callers in fiscal year 2017, which was from July 2016- June 2017.  In summer of 2017, SOFA conducted a NY Connects public awareness campaign and those call volumes have increased event more.  In fact, the call volume from July 2017-October 2017 was 9,200 calls which was up from 5,504 calls in that same time period the year prior.  It should be noted that these calls were fielded with less staff due to the cuts.

With increased needs and awareness, the system remains woefully underfunded, and in fact experienced cuts in the past 6 months.  The 2016 Tentative Allocation was $33 million and the 2017 Final Allocation was $19.3 million, which is $14 million less than what was promised. This cut required NY Connects providers in New York city to cut staff, and leave positions unfilled. People are falling through the cracks as they are left on hold and ultimately hang up after no response.

LiveOn NY strongly urges the state to fully fund this program.

Community Services for the Elderly- Additional $24 million annually

Community Services for the Elderly (CSE) funding is a powerful funding tool throughout the state due to its flexibility, which allows counties to fund the most critical and appropriate programming for each area. These services may include transportation, social adult day care, home delivered meals, case management and other similar supports.

Unfortunately, an estimated 16,000 older New Yorkers are on waiting lists for these critical supports, a number that, without investment, is likely to grow due to increased awareness from New York Connects and the rapidly growing aging population.

To meet demand an additional $24 million on top of existing funding is needed. What is important to note is that the impact of this funding will be both local and powerful, serving seniors who have been desperately waiting to be served.

Naturally Occurring Retirement Communities (NORCs)

Naturally Occurring Retirement Communities are increasingly popular programs that assist residential complexes and neighborhoods with a notably large cohort of older residents. Support is aimed at allowing these seniors to age independently in their homes, as is now desired by most older adults. This creative approach to supporting the aging in place model helps to delay hospitalization or nursing home placement, as well as supports the overall health and wellbeing of the older adult.

Despite the critical nature of these supports, funding uncertainty has recently clouded the road ahead for many NORCs. The recent cancellation of the state’s Request for Proposal (RFA), has led to budgetary planning complications, implementation questions, and uncertainty around the statutory requirements set to begin January 1, 2018. Further, NYSOFA recently notified programs that funding will be set to FY2015-2016 levels for the 2018 calendar year, an effective cut for these programs. This notice comes in spite of the fact that the Legislature allocated an additional $2 million in funding to the program for the upcoming fiscal year.

Concerns remain around the stability of the funding source and the ability to meet the needs of a rapidly growing aging population. LiveOn NY requests that the Legislature examine the recent contractual changes and impacts of such on the NORC providers, and work to protect the current funding level for N/NORC programs. Without action, these programs that older adults rely on to remain stably housed and in good health will become limited and stretched beyond capacity.

Affordable Senior Housing with Services as a Pillar of Health Across All Policies Initiative

Service coordinators in senior housing residences have proven to reduce health care costs. In fact, LiveOn NY’s member Selfhelp Community Services just released a study of the residents in Selfhelp’s senior affordable housing program.  They study compared Medicaid data for residents in their housing in two zip codes and compared it to other seniors living in the same zip codes over two years.

The crucial research found that the seniors living in Selfhelp’s affordable housing had much more positive outcomes including:

  • 68% lower odds of being hospitalized
  • $1,778 average Medicaid payment per person, per hospitalization for Selfhelp residents, versus $5,715 for the comparison group
  • 53% lower odds of visiting an emergency room compared to a non-Selfhelp resident

In addition, a 2016 study of residents in affordable housing in Oregon showed that Medicaid costs declined by 16% just one year after seniors moved into affordable housing communities. Results also showed that primary care visits increased by 20%, while emergency room visits decreased by 18% and that properties with on-site health services produced the largest decrease in emergency room visits. A 2014 evaluation of the SASH program in Vermont revealed that growth in the annual total Medicare expenditures of program participants was lower by an estimated $1,756-$2,197 per person when compared to the growth of total Medicare expenditures in comparison groups.

housing pic.jpg

Thus, in addition to an ongoing investment in capital funding for affordable senior housing, LiveOn NY, along with a coalition of other affordable housing advocates, urges the Legislature to pass legislation and for the state to fund a new senior housing resident coordinator program.  A new dedicated funding stream for service funding for affordable existing and new senior housing buildings that includes an array of services would assist residents remain healthy and independent and age in place in their homes.  This new program could be a strong pillar of the Governor Cuomo’s Health Across All Policies Initiative. 

Elder Abuse Prevention and Services

The hidden crisis of elder abuse is under-recognized, under-reported and under-prosecuted. According to one New York State study, approximately 260,000 cases of elder abuse go unreported each year. That means that for every one case of elder abuse reported, 23 cases are unreported. Financial exploitation is the most common form of elder abuse with only one out of 44 cases reported. Financial exploitation is costing New York state an estimated $1.5 billion annually, according to the 2016 New York State Office of Children and Family Services study. Community-based programs are on the front lines for connecting with elder abuse victims and preventing elder abuse. They educate older adults about elder abuse prevention; provide social and legal services; link victims to resources, such as law enforcement and APS; work with families; help victims access public benefits; and run victim support groups. The Rochester-based Enhanced Multi-Disciplinary Team (EMDT) model program has recovered more than $1 million in court ordered restitution for financial elder abuse victims - more than the previous ten years combined. Funding to expand and sustain EMDTs throughout the State is crucial.

A Dedicated Commitment to Supporting New York State’s Nonprofit Human Services

As a member of the Human Services Council (HSC), LiveOn NY also supports the Strong Nonprofits for a Better New York campaign, which is a Statewide coalition of more than 350 nonprofit human services providers, calling for increased State investment in the sector’s workforce and infrastructure. Working under contract with the State, human services agencies provide crucial services to uplift New Yorkers from all walks of life. The State must ensure these organizations can continue their vital work. 

LiveOn NY thanks Assemblywoman Lupardo, the Standing Committee on Aging for holding today’s hearing and we look forward to working with the state legislature, Governor Cuomo, SOFA and the administration to make New York a better place to age.