| A Graying NYC Threatened by Cuts and Consolidations |
 |
 |
 |
| Tuesday, 28 April 2009 18:32 |
|
All this adds up to an irreversible growth in the need for community-based services to support these older New Yorkers, services which allow them to remain living at home, connected to friends and family rather than in high cost, institutional care. Fortunately, there is no need to create an entirely new system of senior service programs from scratch. New York City already contracts with hundreds of community-based service providers which offer senior centers, case management, home delivered meals, transportation, home care, social adult day care, elder abuse prevention, etc. to an estimated 300,000 seniors annually. Clearly, however, this is the time to begin expanding and strengthening this service system to meet the challenges ahead. Over the past several years, the Bloomberg Administration has undertaken a massive “modernization” program at its Department for the Aging (DFTA) with the stated goal of streamlining its system of senior services to bring down costs and expand the numbers of individuals it can serve in the future. Taken at face value, this would seem to be the right move at the right moment in time. Unfortunately, these seemingly well intended initiatives now appear to be having precisely the opposite effect. The combination of service system consolidations and repeated cycles of across-the-board budget cuts brought on by the economic crisis now threatens to destabilize – rather than strengthen and expand – the City’s senior services infrastructure. Let’s begin by looking at the budget cuts. Since the middle of last fiscal year, DFTA and its nonprofit service provider partners have been subject to a total of $16.6 million in funding reductions. These include a 3% across-the-board cut on all contracts except case management and home delivered meals, plus the loss of almost $2 million for space, equipment, rental and transportation costs; $467,000 for non-core social services; $600,000 for information and referral, $547,000 for Safe Streets/Safe City; $888,000 for caregiver support services and $311,000 for senior employment. Complete service systems have been eliminated including the Social Adult Day Program, which allowed seniors with Alzheimer’s to live in the community, and Intergenerational Programs, which bring youth and seniors together for mutual support. Looking ahead, Mayor Bloomberg’s Preliminary Budget for FY2010 which begins on July 1st would more than double these cuts – reducing DFTA’s budget by another $21 million. It would reduce funding for senior centers by another $5 million, Case Management by $1.1 million and Home Delivered Meals by $1.4 million. Elder Abuse Prevention services would be eliminated entirely. $5.1 million of these cuts, just announced last month, has yet to be identified. Finally, the Mayor’s Preliminary Budget does not include budgetary allocations for programs originally funded by the City Council. This could mean another $22.4 million in program cuts, including $4.5 million and $3 million to address the rising costs of food and transportation services, $2.4 million for the Geriatric Mental Health program, $1.5 million for Healthy Aging, $1 million for Naturally Occurring Retirement Communities (NORCs) and other funding. In total, these $60 million in cumulative budget reductions represent more than one-third of DFTA’s total City Tax Levy funding. Since more than 90% of DFTA’s budget goes directly into contracts for senior centers, case management, meals and other programs offered by community-based agencies, these cuts have an immediate and devastating impact on services provided to seniors. They also undercut the Mayor’s own initiatives to reshape the senior services system. The recent redesign of DFTA’s case management system is a case in point. In April of 2008 – a little over one year ago – DFTA issued contracts with nonprofit providers for a new model of Case Management services. Officially known as EISEP (Expanded In-home Services for the Elderly Program), social workers go out to do in-home assessments and provide ongoing service coordination for the most vulnerable New Yorkers, homebound seniors typically in their 80s and 90s. Based on their assessments, case managers can “turn on” other vital services, including home delivered meals, home care services, etc. However, as with other recent DFTA service redesigns, the new Case Management contract model called for a smaller number of agencies providing services over a larger geographic area. This time, the City reduced the number of Case Management regions from 32 to 23 with contracts going to a total of 15 provider agencies. The new model also expanded the authority and responsibility of the Case Management agencies by eliminating the long standing ability of some individual senior centers to “turn on” home delivered meals for seniors in need. Problems with the new system surfaced quickly. First, it appeared that DFTA had significantly underestimated the total number of seniors which would be receiving case management services, both on a system-wide basis and from individual contractors under the new regional format. Providers quickly were swamped by the combination of transferring cases and new clients. Many found themselves with caseloads far in excess of the numbers originally forecast by the DFTA Request for Proposals. Today, a year later, we continue to see a system in crisis. Individual case managers are carrying caseloads ranging from 65 to as high as 145. As a result, they are unable to take on new cases or even provide services for existing case management clients. An estimated 900 seniors who had been receiving case management services prior to the transition have yet to be assigned to a new case manager. These “unassigned” clients are awaiting a potential crisis before they can receive services. Similarly, another 1,300 seniors who have never received case management services are currently on waiting lists. They, too, are unable to access home delivered meals, home care or other services while they wait for response from a system that is clearly overloaded. With current caseloads far in excess of any acceptable levels, it is an open question how long they must wait. Ironically, this gridlock in the Case Management intake process also has slowed up referrals to agencies which provide home delivered meals, effectively leaving undelivered meals which seniors on waiting lists desperately need. The additional budget cuts which Mayor Bloomberg is proposing for FY2010 will surely make matters even worse. We estimate that Case Management agencies will lose at least one social worker, further increasing caseloads and waiting lists. In our opinion, there are several important lessons to be learned from the current Case Management crisis. First, DFTA can no longer be expected to absorb wave after wave of budget cuts without seriously impacting its ability to provide critical services for vulnerable, homebound seniors. The $21 million in cuts proposed by the Mayor for FY2010 must be restored. So too must be the $22.4 million in City Council initiatives which have been dropped from the Mayor’s Preliminary Budget. Second, program redesign and budget reductions simply do not mix. We all want to find ways to create and strengthen effective and cost-efficient programs to meet the challenges of a rapidly growing senior population. The focus of these efforts, however, must be on building high quality, financially viable and sustainable services – not as a way of stripping away further resources from programs which are already over stretched and underfunded. Third, this combination of budget cuts and program consolidations has the unintended consequence of destabilizing even some of our strongest service providers and, in the process, weakening the City’s ability to meet the needs of its burgeoning elderly population. Finally, we must take immediate steps to address the crisis facing our Case Management system. One possibility would be to utilize a small portion of New York City’s federal stimulus funding to hire additional social workers to address both the backlog in “unassigned” cases and the growing waiting list of seniors currently waiting for assessments and services. It would address a service crisis while also create jobs immediately – a primary goal of the stimulus effort. New York City’s senior services providers look forward to working with Commissioner Lilliam Barrios-Paoli who has taken on the leadership of DFTA at an extremely difficult time. We appreciate her recognition of the challenges we all – DFTA and its nonprofit community-based partners – must face together if we are to meet the needs of New York’s most vulnerable residents. Bobbie Sackman is Director of Public Policy at the Council of Senior Centers and Services (www.cscs-ny.org.)
Add this page to your favorite Social Bookmarking websites           |
We’re all getting older. New York City is already home to more than 1.2 million seniors over the age of 60. Mayor Bloomberg’s Plan NYC2030 predicts that this number will grow by 45% over the next two decades. And, as we live longer, the number of older seniors – those above the age of 85 – continues to be the fastest growing segment of the City’s population. 
COMMENTS