Changes in the delivery of health care services

New York City Council
Committee on Hospitals
Chair, Council Member Rivera
Oversight - Changes in the Delivery of Health Care Services
Moving towards a Community-Based Outpatient Model

LiveOn NY thanks Committee on Hospitals Chair Rivera and the committee for the opportunity to testify today.  With a membership of more than 100 community-based organizations that serve over 300,000 older New Yorkers annually, LiveOn NY’s members provide core services that allow older adults to thrive in their communities, including senior centers, congregate and home‐delivered meals, affordable senior housing, elder abuse prevention services, caregiver supports, transportation, NORCs and case management. Through our work, and the work of our members, LiveOn NY strives to make New York a better place to age.

The work of community based service providers also has significant health impacts from lowering rates of depression, to preventing isolation, to even reducing hospitalization rates for older adults

LiveOn NY also administers a citywide outreach program that targets older adults in the communities where benefits are most underutilized.  This program educates thousands of older adults, including those who are homebound, about food assistance options, and screen and enroll those who are eligible for SNAP, SCRIE and other benefits. LiveOn NY also staffs a call hotline (212) 398-5045, staffed by a professional client services team that assists older adults and caregivers with benefits screenings and applications, serving approximately 1,000 clients per quarter.

The topic of this hearing is important to us because we know a strong vibrant New York City is built upon a foundation of strong, resilient communities. Central to these communities are older adults, who are often the bedrock of their families and their neighborhoods, whether it be caregiving for their grandchildren or being a key source of information and communication within their family networks.

We also know that the community based organizations, many of those funded by the Department for the Aging (DFTA), provide critical senior services, and represent a network of cost-effective programs in every community that work to holistically improve a senior’s quality of life and their overall health.

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With the aforementioned in mind, when looking at the healthcare system in New York, it is important to ensure that one’s view takes on the full landscape of health-impacting services and providers. For older adults, while services such as senior centers, home-delivered meals or affordable senior housing with services are non-medical by definition, their impact has a uniquely positive effect on the overall health of a senior and a reduction in costs that would otherwise be imposed to our healthcare system. For example, data has shown that the majority of the seniors that go to a senior center receive more than half of their daily nutritional intake from meals they eat at the center.

The work of community based service providers also has significant health impacts from lowering rates of depression, to preventing isolation, to even reducing hospitalization rates for older adults, and more. For example, given that studies now show that loneliness surpasses obesity as an early predictor of morbidity, the ability for senior centers to provide socialization opportunities is key to combating this risk-factor.

We come here today not with one “solution,” but to be part of this ongoing important conversation about the linkages between healthcare and community and how we all play a role.  We would like to highlight a few key examples, through the lens of our members, that show the breadth of the challenges and potential solutions related to delivery of health care, particularly to older adults, and how the city must support community based service organizations who are a key player in those solutions. One common linkage through these examples is that community based nonprofits serve as a critical part of an innovative solution.

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First, a great example of the value of community based services is the housing with services model, as can be found in the recently released study by LiveOn NY’s member Selfhelp Community Services of the residents in their independent senior affordable housing with services program. The study compared Medicaid data for residents in SelfHelp 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 access to a service coordinator led to:

  • 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

This research, and future research linking community based research to health outcomes is critical to showing the return on investment by city, state and federal funding in community based services collocated in senior housing. Selhelp will also be releasing additional research imminently to this study.

Second, an example of another recent challenge relating to information dissemination is the announcement by the State Department of Health of the closure of certain Managed Long Term Care (MLTC) plans.  The state will send letters to patients with information about choosing a new plan, but we know that navigating the complex system of health plans is not simple and many require assistance.  It should be recognized that several community based organizations such as NYLAG has provided streamlined critical information and updates on these complicated changes. Also, the senior service network, particularly the DFTA funded case management agencies which served over 33,000 clients last year, are a re instrumental assisting their clients navigate these changes.

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Third, in addition to building a system of aging services through ongoing increased city funding, given their intrinsic health benefits, the community-based service sector must be also seen as a viable partner and compliment to the overall healthcare system in New York. It is imperative that community-based organizations are able 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 funding and data limitations. It is LiveOn NY’s desire to work in collaboration with DFTA, the state, the medical community and all interested parties to improve data coordination and collection capabilities for nonprofits so that they can continue to improve the quality of life of seniors throughout the city, and to demonstrate through data these crucial improvements in a senior’s overall well-being.  We urge the city to look to these nonprofits as key stakeholders and support them to expand this work.

LiveOn NY looks forward to working with City Council, the Department for the Aging, all city agencies and the Administration to make New York a better place to age through a strong network of community based services.