Gotham Gazette https://www.gothamgazette.com/component/tags/tag/1508 Fri, 20 Sep 2019 03:53:45 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) Funding Issues, Waitlists Plague City’s Services for Seniors https://www.gothamgazette.com/city/6550-funding-issues-waitlists-plague-city-s-services-for-seniors https://www.gothamgazette.com/city/6550-funding-issues-waitlists-plague-city-s-services-for-seniors seniors city hall

Seniors at City Hall (photo: @nonprofittalk)


A June City Council report on the budget for the city Department for the Aging (DFTA) detailed that there are approximately 1,400 seniors on waiting lists for case management services. The average age of these seniors is “85+,” with an average income of “$12,000-$20,000,” according to LiveOn, a senior advocacy organization. The City Council report examined the adopted budget for the new fiscal year, which began July 1, and makes clear that DFTA is not being funded with a sense of urgency to quickly reduce waitlists and serve the city’s oldest, often neediest residents.

The Department for the Aging uses federal, state, and city funds to provide advocacy, education, and services that range from hot meals at senior centers to transportation and legal aid. DFTA provides case management services for those not covered by Medicaid; those waitlisted are without access to trained employees of city-contracted nonprofits that evaluate seniors’ needs and coordinate appropriate care.

Seniors are one of the city’s fastest growing demographics: in a July press release announcing an “‘Aging in Place’ guide to help older New Yorkers,” Department for the Aging Commissioner Donna Corrado reported that there were 1.4 million adults over the age of 60 living in New York City, with an expected 2 million by 2040. Ninety-six percent of this group chooses to stay in their apartments over relocation as they age and need more attention. "So many seniors are held captive in their homes because of a lack of accessibility," Corrado said. Often, this accessibility takes the form of physical frailty, disability, chronic illness and disease.

DFTA reaches homebound seniors through case management services. Part of the state-funded Expanded In-Home Services for the Elderly, case management provides seniors ineligible for Medicaid, with counseling, advocacy, referrals, and information. The service is made possible through referrals to local senior centers and community-based social service and healthcare agencies.

Case management is also an entry point to homecare services, which include medical assessments and referrals and information to ensure appropriate care. Seniors are unable to receive homecare services without access to a case manager. In its May report, the City Council reported a homecare waitlist of 500-550.

The case management problem stems in part from high turnover among case managers, fueled by low salaries. The same LiveOn report claims an average annual turnover rate of 32%, with seven nonprofit agencies reporting over 40%, and each with 100 to 300-plus waitlisted seniors, as of February.

While, this year, the City Council called for $12 million to raise case manager salaries to $55,000 and supervisor salaries to $65,000, $4.8 million was allocated in the fiscal year 2017 budget and $7.3 million in 2018 to raise salaries to $50,000 and $60,000, respectively. Currently, each case manager is responsible for up to 65 clients at a time. Although this number may seem high, as of a few years ago it was in the neighborhood of 90, according to experts.

The administration of Mayor Bill de Blasio has also declined to provide funding to address other causes of the waitlist, independent of salary woes. The June City Council report showed that $1.8 million was baselined to strengthen existing services, short of the $3 million allocated in fiscal year 2016. The $3 million would have, at a very minimum, allowed DFTA to maintain its then-level of service. Bobbie Sackman, director of public policy at LiveOn, told Gotham Gazette that the city’s Office of Management and Budget (OMB) told LiveOn that the $1.2 million difference has been added since. Sackman could not confirm this information and an inquiry from Gotham Gazette to a budget spokesperson in the mayor’s press office was not returned by publication.

"We still have a way to go to restore aging funding to pre-recessionary levels," City Council Member Margaret Chin, chair of the Council's Committee On Aging, said in the Council report.

Chin refers to the heavy budget cuts that took place under former Mayor Michael Bloomberg's tenure. Taking action to address the fallout of the Great Recession, Bloomberg oversaw a $30 million reduction in the DFTA budget, according to a 2010 WNYC report. DFTA was left with a $264 million budget, far short of the current $330 million adopted agency budget for the new fiscal year, and a sliver of the city's $82 billion in expenses.

"Seniors should not be on any waiting list,” Chin said in an interview. “Our senior population is growing tremendously, so as the numbers grow, the needs grow also…by 2030, one in five is going to be a senior, so we have to make sure the budget reflects that."

Chin was critical of the lack of salary parity between case managers and comparable government positions. "If other agencies are paying a higher salary for the same type of job, it's very hard for the agency that has these case managers to compete, so there's a lot of turnover, and we don't want that to happen," Chin said. "We have to make sure there are enough case managers.”

Sackman of LiveOn lamented that "There is no plan.” “The fastest-growing segment of the city's population, and there is no plan," she said. Sackman offered a potential explanation: "I think some of it is because you can't get any more invisible than being a homebound 85-year-old person."

"There's not enough money,” Sackman concluded after discussing the problems facing the city’s older population and the city government response. No one from DFTA was made available for comment for this story.

One key issue, Sackman noted, is that case management services are for seniors above the Medicaid level. "So, no one's running to the bank," she said. "If you're eligible for Medicaid, it's an entitlement, and you get a pretty broad array of services…if you're not eligible you're really out in the cold a lot."

The same is true for homecare services. "If you are on Medicaid, you can get 10 hours a day of homecare, and while it's more difficult, you could still get 24 hours care. On the EISEP (Expanded In-Home Services for the Elderly), it's not an entitlement, you might get one to 12 hours a week," said Sackman. "Remember, to get homecare you've got to be assessed by a case manager. They are the gatekeepers. So if you're sitting on a waiting list, you can't get home services. It's a vicious cycle."

Both and Sackman and Chin were quick to highlight that the waitlist issue also impacts family members and loved ones already acting as unpaid adult caregivers. "They are struggling day-to-day, figuring out how to juggle work and other responsibilities in life while taking care of their elderly parents," Sackman said. "They just don't have a system in place to help them."

Chin offered an example of what this looks like: "Imagine someone in their sixties taking care of someone in their eighties and nineties."

Sandy Myers, director of government and external relations at Selfhelp community services, a city contracted nonprofit, knows case management waitlists firsthand. Selfhelp’s two DFTA funded case management programs have a combined 170 waitlisted seniors.

"All seniors are needy, regardless of their needs," Myers said in an interview. She emphasized the relevance of senior issues. "We want to have good people in the field who will be caring for all of us when we age."

Selfhelp was founded in 1936 to serve those fleeing Nazi persecution. After World War II, the organization began serving survivors as well, providing them with job training, resettlement, and case management, among other services. As the refugees and survivors continued to age, Selfhelp evolved into a senior-focused organization to help vulnerable populations "age with independence and dignity."

Today, Selfhelp serves 20,000 seniors at 27 across four boroughs and Nassau County. This includes five senior centers and four Naturally Occurring Retirement Communities (NORCS). A number of sites are located in Queens, many of which serve the Chinese community, as well as Korean, Latino, and other immigrant populations. Selfhelp emphasizes hiring culturally sensitive staff, including employees fluent in Russian for the 25% of clients who are WWII survivors. These professionals are well-versed in relevant topics of interest, like Soviet Union reparations, for one.

Myers views the case management dilemma through a humanitarian lens. "For some of our clients, their interaction with the case manager is really one of their only interactions, if not the only interaction,” she said. "When you have people who are constantly leaving, the quality of service suffers, as well as the client-worker relationship…there is obviously a lag between the time that someone leaves and when we are able to bring in someone new to train them." Myers noted that this turnover time is often two to four months, or more.

Above all, Myers classified case managers as an invaluable safety net. She told a story of a 102-year-old client who one day didn't answer the door for her meal delivery. The service provider contacted Selfhelp, who proceeded to call her house, to no avail. Selfhelp alerted case management staff, who went to her apartment, opened up her door with another key, and found the woman lying on the floor, unable to move. "It's probably not an exaggeration to say that we saved her life," Myers remarked.

Mayor de Blasio often talks about budgets as indicators of values and about the need for government to treat its most vulnerable citizens well. It is especially difficult to advocate for senior services funding and reform, Sackman said, because "it's not the sexiest issue." Told she was the second person to use those exact words, Sackman laughed and said, "Well, it's true. Except, if you're in my world, it's very sexy."

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by Benjamin Jurney for Gotham Gazette
     

Read more by this writer.

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Funding Issues, Waitlists Plague City’s Services for Seniors Mon, 26 Sep 2016 04:00:00 +0000
Under-reported Abuse Given Higher Priority in New City Budget https://www.gothamgazette.com/government/5812-under-reported-abuse-given-higher-priority-in-new-city-budget https://www.gothamgazette.com/government/5812-under-reported-abuse-given-higher-priority-in-new-city-budget seniors rally

Rally for senior funding (photo via Council Member Chin)


After more than a decade of abuse, she finally called for help. Dialing 311, the 80-year-old widow - who had remained silent for years as the granddaughter she had raised yelled and cursed at her, slapped her, and stole from her - reached out for help after the younger woman threatened to seriously injure her.

She was referred by 311 to JASA, a non-profit serving seniors that contracts with the city. JASA staff helped her obtain an Order of Protection to stop the abuse, put her in a support group, and ensured the police would check on her. But even now, she refuses to have her granddaughter removed from her home and continues to live with her abuser.

This grandmother is among the more than 120,000 New Yorkers believed to be suffering from elder abuse. Both her situation and her unwillingness to report it are typical of the vast majority of elder abuse cases. Except in the most horrific instances, these are not headline-grabbing incidents, and the victims are among society's most vulnerable, often unable to fight for themselves.

Elder abuse includes physical, sexual, and emotional abuse, as well as neglect. Its most common form is financial exploitation. "Elder abuse victims are 300 percent more likely to die prematurely than non-abused elderly," says Risa Breckman, executive director of NYC Elder Abuse Center, citing a medical study. This problem is increasing in scale with New York City's aging population. And with nine percent of the city's seniors estimated to be victims of abuse, it is also a problem that has been remarkably underfunded according to advocates and providers of elder abuse services.

This year, New York City's budget includes $2.8 million in funding for elder abuse services, more than three times the amount devoted to this issue in previous years. "They have it exactly right," says Breckman. "There needed to be more resources for this."

The city's Department for the Aging contracts its elder abuse services to community-based organizations. There are only a handful of organizations—some with surprisingly small staffs—carrying out this work in all of New York City.

These providers execute wide-ranging services such as counseling, support groups, legal advice and counsel, safe haven, and lock changing to keep an abuser out of the house. They also perform outreach to senior centers to make seniors aware of their options and to other groups such as neighbors, doormen, meal delivery personnel, librarians, and even barbers who may be able to recognize and report the signs of abuse.

Since the administration of Mayor Michael Bloomberg, around $800,000 was allocated annually for elder abuse services. This funding often became part of the "budget dance" with the mayor cutting it down and City Council fighting to restore it. Advocates for seniors argued that this was too small an amount for the protection of the over 1.4 million New Yorkers over the age of 60.

Last year, Bill de Blasio's first as mayor, the funding in the budget for elder abuse services did not increase, though the City Council allocated $1 million of its discretionary funds for such services. Seniors and their allies then launched a concerted effort to bring about an increase and it was widely expected that funding by the mayor would jump to over $2 million for fiscal year 2016. But when de Blasio announced his preliminary and executive budgets earlier this year, the funding remained the same as it had been. Advocates then intensified their lobbying, and advocacy groups like LiveOn NY turned out more than a thousand seniors at City Hall between March and June on Advocacy Day, Elder Abuse Awareness Day, and for budget hearings.

In this effort to increase funding, the biggest ally of seniors and senior advocates was Council Member Margaret Chin, chair of the City Council Committee on Aging. "She's a great chair," says Bobbie Sackman, director of public policy at LiveOn NY. Hundreds of seniors came for the committee's executive budget hearing, many having to watch the proceedings from an overflow room. "What we need is a budget that really makes seniors a top priority. And this budget right now is not it," Chin said in her opening remarks at the hearing.

"She wouldn't let it go and she kept pushing back...to the administration saying 'you've got to fund this $2 million,'" says Sackman. Fighting alongside Chin was Council Member Paul Vallone, chair of the Subcommittee on Senior Centers. His opening remarks were equally firm. "The senior population will increase by 50 percent [in the next 10 years] and this budget didn't go up by a dollar," he said. "To me, if that's not a cut, I don't know what is."

Eventually the administration conceded and the adopted budget more than tripled the funding to $2.8 million.

Advocates say the toughest challenge in getting funding for elder abuse is the lack of reporting of such cases. "We have a hidden crisis and we're asking them to fund something that you're seeing the tip of the iceberg of," says Sackman. A 2011 study of elder abuse in New York State showed that only four percent of the cases of elder abuse are reported. "That's why it's important to really do education to let people know that there are services available to help them, that it's nothing to be ashamed about and that they would be able to get help," Council Member Chin told Gotham Gazette.

A close relationship with the abuser is one of the main reasons for low reporting rates. In the vast majority of cases—many studies cite the number at 80 percent—the abuser is a family member. "That's one of the reasons it's so hidden, because people are either afraid or ashamed," says Sackman. "Who's going to report on their son or daughter?"

Some also blame ageism for the lack of attention to this problem. "People assume that someone who is over the age of 60 or 70 or 80 will have some form of dementia and won't be able to report reliably or give information that is pertinent," says Martha Pollack, director of elder abuse services for JASA. "And this is not the case at all." People are often less likely to believe seniors when they complain of abuse.

With a few dozen people and $800,000 from the city budget to deal with all the cases of elder abuse in the city, elder abuse fighting organizations' resources have been stretched thin. "Prior to the city providing this [new increase] we were at a point where we would have to tell individuals we may have to shut the program and we would go around scrambling for money," says Donna Dougherty, an attorney at JASA.

Advocates say that the increased funding will ensure that more elderly people are served. Organizations will be able to hire more staff, do more outreach, and collaborate more effectively with the NYPD and offices of the district attorneys. Dougherty says this funding "has made a tremendous, tremendous difference in our ability to provide this service and our ability to provide it ongoing, to expand, and to be able to tell our clients: 'We'll be there tomorrow, we're not going anywhere.'"

The Carter Burden Center for Aging is another organization that will benefit from the increase in funds in the budget. Michelle Galligan, director of their Community Elder Mistreatment & Abuse Prevention Program, says they will use the money to double their staff, which currently consists of only two social workers.

The organizations contracted by the city are also planning to use the additional $2 million to reach out to more diverse and immigrant communities where victims of elder abuse speak out at even lower rates, either because of cultural norms or language barriers.

The City Council also took this into consideration in the distribution of the $335,000 of discretionary spending allocated to non-profits to carry out elder abuse services. They have allocated $135,000 to New York Asian Women's Center, $50,000 to Sakhi for South Asian Women, and $50,000 for Turning Point for Women and Families, a nonprofit helping Muslim women. "We want to make sure that seniors who don't speak English and who are linguistically and culturally isolated, that they are also able to get information about what elder abuse is, how they can access service and what organizations are available to help them," explained Chin.

But Galligan cautions that even this tripling of the funding is not as much as it seems when divided across the city and translates into $480,000 for Manhattan, where her organization operates. "As much as we're grateful for the increase in funding," she says, "we can always use more."

"We just want to make sure that money stays in the budget, that it's not money we have to keep fighting for, because we want to grow it," says Sackman. "It's a good thing, we just need more."

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by Zehra Rehman, Gotham Gazette
@GothamGazette

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Under-reported Abuse Given Higher Priority in New City Budget Fri, 17 Jul 2015 03:22:37 +0000