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.

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.

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.

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.

Age Discrimination in the Workplace

New York City Council
Joint Hearing
Committee on Aging, Chair, Council Member Chin
Committee on Civil and Human Rights, Chair, Council Member Eugene
September 17, 2018
Oversight: Age Discrimination in the Workplace

 LiveOn NY thanks Chairs Chin and Eugene for holding this important and historic Joint Hearing on age discrimination in the workplace.

Prior to illuminating the very real challenges that often exist for older adults in the workplace, we must step back and recognize the obvious but often underappreciated fact that aging is, in fact, a life process. By this we mean that we are all aging: that 50 is not the same as 85, nor are 75 or 45 monolithic experiences to be benchmarked by a standard set of life events. We all experience life, and aging, differently and deserve the opportunity to thrive in accordance with our own drive, desires, limitations, and values, no matter the age. For some, this may mean an early and long-awaited retirement; for others, a second act in an unexplored career path; for most, however, it means the continued economic pressures of an often unequal society.

This economic reality means that many older adults simply cannot afford the fiscal implications of a frequently age-biased and at times even discriminatory society and therefore workplace. Even beyond economic pressures, older adults should not be shunted the opportunity to fulfill the seemingly innate desire to have utility, be productive, and contribute.

Unfortunately, working in opposition to the economic and personal desires of many older adults, roughly 3 in 5 older workers have seen or experienced age discrimination in the workplace, as found by a recent AARP study. Though highly unreported, the most common age-discrimination reports involve an individual not being hired due to age, followed closely by being passed over for promotions. These occurrences’ have a clear fiscal impact on the individual and may be more common than has been enumerated given the aforementioned lack of reporting.

For already marginalized populations, such as women, immigrants, or minority communities, these age-related injustices only serve to exacerbate existing inequities. Inequities such as lost wages due to caregiving, persistent wage gap within communities of color, and lack of pension options for a multitude of workers, means that the financial margins for many older adults are so slim that the effects of age discrimination can be devastating.

It is critical that we, as a city, work to combat age discrimination in the workplace and to address the root causes of these injustices. It is time that older adults are recognized for their strengths, many of which are highly sought after in today’s workforce. Namely, it has been found that older workers demonstrate higher levels of professionalism, reliability, commitment, a stronger work ethic and lower turnover. Going beyond the workplace, it is imperative that we recognize the value of older adults in society at-large, as demonstrated through countless hours of volunteerism, local economic impact, caregiving responsibility, civic and community engagement, and more.

We at LiveOn NY are appreciative of this opportunity to change the narrative around the value of older adults and older workers. We support the Council’s call to better support older adults who experience age discrimination in the workplace and to ensure that employment opportunities exist for those seeking to work. Further, it is not enough that opportunities exist, but that older adults are aware of said opportunities. For example, it is imperative that older New Yorkers are aware of the federally funded Title V program, the Senior Community Service Employment Program (SCSEP) that is run through the Department for the Aging, as an opportunity for older adults to find gainful employment in their communities.

LiveOn NY is excited at the prospect of finding innovative solutions to the challenges facing this population, whether it be through increasing awareness of the Age Discrimination in Employment Act (ADEA) which gives adults over the age of 40 protections in the workplace or creating mechanisms to ensure a diversity of age representation in the workplace. We are confident that through private and public efforts improvements can be made. For example, a Starbucks in Mexico City will soon be run and staffed only by individuals 55 and over after seeing vast employment needs among the elderly in their community. While we recognize that there is no one size fits all solution, nor do we wish to segregate workplaces strictly by age, we would like to recognize the community responsiveness of this endeavor and the initiative that can be taken to address this inequity.

To close, LiveOn NY would like to stress the importance of recognizing the value and contributions of older adults in all aspects of the public and private spheres and to reframe the way we as a society view and treat the oldest among us. LiveOn NY looks forward to continued conversations on how to make New York a better place to work and age.

Thank you for your time and the opportunity to testify on this important issue.

LiveOn NY in the News!

At LiveOn NY, we work hard to make sure that the public hears about the issues affecting older New Yorkers, as well as the incredible momentum that exists as we grow old. To this aim, we are proud of each and every time we are able to share this narrative with the press and our local communities. Here are a few recent articles mentioning our work:

 

July 2, 2018 "Medicare Is Removing Social Security Numbers From New Cards" article by Juliette Fairley in the Financial Advisor

June 26, 2018 "Senior services nonprofits demand accountability from New York City" article by David Gentile in NY Nonprofit Media

June 25, 2018 "Human services nonprofits show how city drives them into the red" article by Zach Williams in NY Nonprofit Media

April 16, 2018 "Health Fraud Workshop" video interview by Bob Lee at BronxNet

March 28, 2018 "Three updates on how the 2019 New York City budget could affect nonprofits" article by Zach Williams in NY Nonprofit Media

March 9, 2018 "Rezonings Carry Opportunities and Risks for Low-Income Seniors" article by Abigail Savitch-Lew in City Limits

March 7, 2018 "Announce First Phase of Senior Affordable Housing Proposal" article in the Queens Gazette

We look forward to continuing to weigh in on aging issues throughout New York City, for upcoming press inquiries, please reach out to Katelyn Hosey at khosey@liveon-ny.org or 212-398-6565 x. 244

Press Release: LiveOn NY FY19 Budget Response

FOR IMMEDIATE RELEASE
JUNE 14, 2018 
Contact:
Andrea Cianfrani
(212) 398 6565 x.233, acianfrani@liveon-ny.org

Progress Made in FY19 Budget but More Must Be Done to Support Older New Yorkers

LiveOn NY thanks City Council for their commitment to older New Yorkers in this year’s budget. Seniors remain a clear priority of the Council, led by Speaker Corey Johnson, Finance Chair Daniel Dromm, Capital Budget Subcommittee Chair Vanessa Gibson and Aging Committee Chair Margaret Chin, who has remained steadfast in her work to prioritize aging services in the budget. 

LiveOn NY recognizes the strides towards equity made by Mayor de Blasio and City Council in this year’s budget, but we remain concerned as to if this fairness truly extends across the lifespan.

“Older New Yorkers have built this city, and continue to do so, through volunteering, civic engagement, caregiving, and community building,” states Allison Nickerson, Executive Director of LiveOn NY. “Despite their role in strengthening this City, we remain concerned that older New Yorkers and the community-based providers working tirelessly to serve this population are being left out of the gains made in this budget. While appreciative of the Administration’s investments in NORCs and Senior Center Enhancements, we are perplexed as to why nonprofit providers will continue to be tasked with serving meals for seniors funded at a rate that is 20% lower than the national average?”

While there is work to be done, we remain confident in the City’s ability to make New York a better place to age. LiveOn NY remains a willing partner of the City to find solutions to the challenges confronting older adults, and looks forward to continuing to work with Department for the Aging Commissioner Donna Corrado and her team. From economic insecurity, to the loneliness epidemic, to inadequate nutrition, New York City can rise to meet the needs of its growing senior population.

“LiveOn NY remains committed to amplifying the voice of older New Yorkers. This year alone seniors sent more than 2,500 letters to elected officials, held dozens of meetings with Council Members, and filled the steps of City Hall to call on the Administration to support these life-sustaining programs in their neighborhoods,” added Andrea Cianfrani, Director of Public Policy at LiveOn NY. “This activism represents only a few examples of how older adults work to move our City forward. As we all age, let us recommit to ensuring that the oldest among us have the tools needed to age with both dignity and respect.”

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Testimony: NYC Council Finance Committee Public Hearing

New York City Council
Committee on Finance, Chair, Council Member Dromm
May 24, 2018
Executive Budget Hearing – Public Hearing

LiveOn NY is a nonprofit membership organization representing 100 community-based organizations that serve over 300,000 older New Yorkers annually through senior centers, congregate and home‐delivered meals, affordable senior housing, elder abuse prevention services, caregiver supports, transportation, NORCs and case management.  Thank you Chair Dromm and members of the Committee for the opportunity to testify, and to Chair of the Aging Committee Margaret Chin for her leadership.

The city’s budget reflects its priorities.  For New York City to truly be the fairest big city, fairness must extend across the lifespan. The Department for the Aging (DFTA) budget accounts for less than ½ of 1% of the total city budget despite the fact that older adults are the fastest growing demographic. The proposed budget does not reflect fairness for New York’s older adults.

Our full list of priorities can be found here, and key areas are highlighted below.

Expedite “Model Senior Center Budget” Funding as Soon as Possible and Fully Fund Senior Center Contracts

$10 million was baselined in FY18 for “model senior center” budgets.  As of today, that funding is not yet registered into all contracts.  We do acknowledge that DFTA fiscal staff has been working very hard to process this funding. There a June 11 Aging Committee hearing on model budgets and we will discuss “model senior center budgets” in more detail at that time, but want to highlight a few key areas.

It is our understanding that:

• 249 senior centers were included the “model senior center budget” analysis.

• 26 of those 249 received no funding because they were deemed at or above the “model” amount.

• 38 additional programs were not evaluated in the “model senior center” budget process, and thus received no funding. Among those 34 were centers are former discretionary funded sites (11 centers), former NYCHA (4 centers), social clubs (17) and other social service programs (6).

Aside from the fact that some center received no funding, the small amount that was distributed among 223 centers can be used only in two areas: direct staffing and consultants. “Direct staffing” does not include food or meal staff, which has caused more salary disparity among programs.  This also means that the entire DFTA portfolio of senior centers received no funding for meals/meal preparation, meal staff, rent, transportation, OTPS, technology, facility costs or other costs that are required to run a senior center.

In addition to the FY18 baselined $10 million, the city promised an additional $10 million “by 2021.” That money should be allocated immediately in FY19.  Senior centers have been grossly underfunded for decades and the city must fully fund nonprofits to cover the costs of the contracted services to meet current demand. Allocating these funds is extremely important with the projected next RFP for senior centers to be released in calendar year 2020.   Further, while this initial funding is an important first step, the city must make a serious commitment going forward to add funds reflecting the full scope of what it takes to run a robust senior center today and in the future.

Add $12.1 Million in Baselined New Funding for Congregate and Home Delivered Meals

Thank you to the Council for including a funding request to address senior hunger in the Council Response to the Executive Budget. Meals also offer socialization and improve lives, as isolation has been found to be a greater predictor of morbidity than obesity and provide critical nutrition services for seniors of all backgrounds, language capacities, religions, and socioeconomic status. Lunch at a center or a home delivered meal is truly more than a meal. 

This $12.1 million in new funding request is incredibly important because as noted, the city failed to include  funding for meals, meal preparation or meal staff in the “model senior center budgets” nor in its FY19 Executive Budget, despite the fact that meals are a core component of senior centers.

If the city wants to address senior hunger, the logical, not to mention incredible, resource is the network of senior service agencies that already exists through senior centers and home delivered meals providers. Senior centers provided 7.6 million senior center meals last year and more than half of seniors report that meals eaten at the center equate to 50% or more of their daily food intake and nutrients for the day from these meals. This year, providers will distribute 4.5 million home delivered meals. The majority of seniors utilizing the program tend to be women, living alone, receiving meals that on average account for ½ or more of their total food for the day.

However, the city must fully fund the nonprofits it contracts with who are providing these crucial services.  Nonprofits should not be routinely operating at a loss to provide for the current need.  New York City spends 20% below the national average on senior meals – that means they are only paying for 4 out of every 5 needed meals.

Further, almost 50% of older New Yorkers are foreign born, reflecting a significant need for meals that are culturally appropriate to an array of background, according to a recent Center for an Urban Future study. Providers are required, not to mention eager, to offer menus that culturally appropriate and nutritious. This requirement brings a fiscal implication: for example, in 2015, DFTA stated that, “in DFTA’s HDML network, each catered Kosher [meal] is on average $1.38 more than non-Kosher catered meals.” Similar to Kosher meals, Halaal, gluten free, vegetarian, vegan, or other cultural or nutritional needs have an associated cost-increase. 

We urge the Administration address this vital shortfall and to help address senior hunger adding $12.1 million in new funding be baselined to increase the reimbursement rate for congregate and home-delivered meals.

Council Restorations and Investments in Senior Services Through Schedule C

City Council has long been a staunch supporter of systemic city and district wide senior services programs through allocations in Schedule C.  In fact, the Council added $31.6 million to DFTA’s budget in FY18, which is more than 9% of DFTA’s total budget for the current fiscal year.  We thank you for your investments and advocate for full restoration for all Senior Service Programs funded in Schedule C.  These include NORCs, Support our Seniors, SuCasa, Senior Centers for Immigrant Populations, Health Aging Initiative, Social Adult Day, and others.  Council funding is critical to sustain the existence of these programs.

For example, in FY18, Sunnyside Community Services' Senior Center was partnered with Dance Entropy through the SU-CASA program.  Through this partnership, they provided a dance movement class to 20 seniors for 15 weeks where seniors learned about modern dance and dance history as well as had the opportunity to attend performances at Green Space that would not have otherwise been possible.  These older adults have enjoyed each other's company and are looking forward to the grand finale performance in June.  Overall, this experience enhances physical and social well-being.  Elimination of this funding would be detrimental to this program, as well as the over 200 SuCasa programs like this throughout the city and just one of the many Council supports through systemic Schedule C funding.

Continued Investments in Human Services Sector

Finally, LiveOn NY strongly supports the agency-wide investments in FY19 in the human services sector.  Last year saw an important investment in human services provider organizations that hold City contracts. With your help, we secured $300m of our $500m ask to help nonprofit provider organizations cover the cost of delivering essential services to New Yorkers. 

In the upcoming year, there are several areas of human service nonprofit operations that need special attention:

• Include trend factor/cost escalation formulas in all new procurements for the duration of the contract;

• Provide $200 million in additional baseline funding to:

  • Address implementation of the following allowable rates on all HHS contracts and all new procurements

  • 15% for indirect costs

  • 37% for fringe benefits

• Fund key operating expense increases in all HHS contracts and new procurements by the following rates:

  • 10% increase to occupancy costs

  • 10% increase to casualty and liability insurance

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.