SUBJECT:

PURPOSE:

Assembly Hearing Room
Room 1923, 19th Floor
250 Broadway
New York, New York

Monday
September 17, 2007
10:00 AM

According to the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMSHA), substance abuse, particularly of alcohol and prescription drugs, among adults 60 and older is one of the fastest growing health problems facing the country. Ninety-seven percent of people aged 65 and older who need treatment for substance abuse don't get it. Currently 1.7 million Americans over the age of 50 are addicted to drugs and by the year 2020 that number will increase to 4.4 million. In New York State the number of people age 60 and older admitted to chemical dependence treatment programs are growing by 20% each year.

The needs of the addicted senior population are considerably different from that of youth or of middle aged groups. Life transitions such as retirement, death of friends and family, illness and loss of independence increase the risk factors for substance use and abuse by seniors. Similarly, seniors have unique needs and challenges during the recovery process. The implications of substance abuse by a population utilizing multiple prescription medications are yet to be fully understood. Often the symptoms of substance abuse and dementia mimic each other, leading to misdiagnosis and poor treatment outcomes. To compound this issue, there is little or no geriatric-specific training for chemical dependence counselors.

Project 2015, a statewide initiative launched in 2000 to broaden public awareness and to encourage discussion and input into planning for the future aging population in New York State, identified substance abuse services and other addictive behaviors of seniors as a growing concern which warranted a response of the applicable statewide agencies. In 2004, in response to Project 2015, New York State Office of Alcoholism and Substance Abuse Services (OASAS) held six community forums entitled "Substance Abuse Prevention and Treatment Senior Forums". A report was issued in May 2005 which highlighted key areas for development and included many recommendations for moving forward. The report included a comprehensive outline of suggestions including public education campaigns, need for additional and creative funding streams, cultural considerations, surveys to identify existing programs and resources, increased coordination among state and local governmental entities and service providers, education opportunities through the State University of New York system, workforce development and training, and modifying the delivery of services to decrease common barriers that seniors face when attempting to access services. At this time, it is unclear what progress has been made on any of these suggestions. A statewide need diagnosed in 2000 seems largely unmet years later despite public forums, reports and a plethora of recommended initiatives.

The Geriatric Chemical Dependency Act was first introduced in 2006 in an attempt to make grants available to providers to develop and implement innovative approaches to serve older New Yorkers with chemical dependence problems. Programs could include education, prevention and early intervention strategies, enhancement of treatment quality, integration of services, specialized programs, workforce development including recruitment, training and cultural considerations, innovative finance methods, legal services, an information clearinghouse and a training institute. While this bill passed overwhelmingly in both houses of the State Legislature, it was vetoed by the Executive. It was argued that OASAS was currently authorized to establish programs to meet the needs of seniors with substance abuse needs; hence statute was not necessary to accomplish the goals of the Act.

The 2007 session saw the Geriatric Chemical Dependency Act introduced again, and as in 2006, it passed both houses unanimously. The bill was however vetoed by Governor Spitzer as he reiterated the message of the past administration and declared that the OASAS Commissioner, Karen M. Carpenter-Palumbo, is aware that more attention needs to be paid to seniors with chemical dependency needs. In the absence of the enactment of the Geriatric Chemical Dependency Act, it is uncertain what progress will take place to decrease substance use, abuse and dependency among the senior population and how family members, who more and more incur the burden of caring for their elderly loved ones, will be supported.

The purpose of this hearing is to gather information about the status of the substance abuse needs of our aging population, to review innovative programs currently offered or are in the implementation process in local communities and to examine what efforts OASAS and SOFA have taken to address this important issue. It is our goal to gain a comprehensive view of our community needs, current available resources, future initiatives and to enact legislation to assist and enhance these initiatives ensuring that our graying population maintains the maximum quality of life as they age. It is well established and understood that a comprehensive, coordinated approach to recognizing and effectively treating chemical dependence among seniors is essential.

Please see the next page for a list of subjects to which witnesses may direct their testimony.

Persons wishing to present pertinent testimony to the Committees at the above hearing should complete and return the enclosed reply form as soon as possible. It is important that the reply form be fully completed and returned so that persons may be notified in the event of emergency postponement or cancellation.

Oral testimony will be limited to 5 minutes duration. In preparing the order of witnesses, the Committees will attempt to accommodate individual requests to speak at particular times in view of special circumstances. These requests should be made on the attached reply form or communicated to the Committee staff as early as possible. In the absence of a request, witnesses will be scheduled in the order in which reply forms are postmarked.

Ten copies of any prepared testimony should be submitted at the hearing registration desk. The Committees would appreciate advance receipt of prepared statements.

In order to further publicize these hearings, please inform interested parties and organizations of the Committees' interest in hearing testimony from all sources.

In order to meet the needs of those who may have a disability, the Assembly, in accordance with its policy of non-discrimination on the basis of disability, as well as the 1990 Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with disabilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities.

1. What are the needs of older New Yorkers with substance abuse behaviors? What trends are being identified? What are the projected needs over the next 5 to 10 years? What needs to be done in local communities and statewide to meet that need?

2. What unique needs do seniors have that are currently not met in existing programs? Please comment on prevention, screening, detox, AA/NA, outpatient, inpatient, housing, and any other service needs.

3. What programs currently exist? What services are provided? What are the treatment outcomes? How are they funded? What is being done in other states that could be replicated in New York State? What creative ways can we deliver services to enable homebound or medically frail seniors to engage in the recovery process? Are transportation and child care being provided?

4. What screening tools exist that could be used in hospitals, doctors' offices, social services and SOFA programs and by case management to identify potential substance abuse needs of seniors?

5. What should primary physicians look for when writing prescription medications? Are there medications commonly used by seniors that if taken with alcohol and drugs could lead to serious health problems? What mechanism do we have in place to monitor these interactions?

6. Do our current long term care providers, nursing home, adult homes, assisted living facilities, home care providers, etc… have adequate education, training and resources to provide appropriate care to seniors with substance abuse needs? What chemical dependency needs should be taken into consideration in the long term care reform process? Are the needs of aging methadone patents being taken into consideration? What role can POE play in screening and referring seniors to substance abuse services?

7. What additional funding streams can we tap into to enhance service delivery and access? What barriers and opportunities exist within the current health insurance construct, i.e. private insurance, Medicare and Medicaid?

8. What workforce initiatives can be undertaken to enhance education, training, recruitment, retention and cultural competencies? What education, training or support opportunities exist for family and other caregivers?

9. What is being done to decrease service fragmentation and enhance cross governmental/service communications, connections, referrals and case management?

10. What budget initiatives are currently being developed to enhance substance abuse services for seniors in New York State? What other statewide, multiple state agency initiatives are currently being developed?

11. What legislation could be developed and enacted to enhance current initiatives, to decrease barriers to services or to work in tandem with future proposals?

PUBLIC HEARING REPLY FORM

Persons wishing to present testimony at the public hearing on The Geriatric Chemical Dependency Act are requested to complete this reply form as soon as possible and mail it to:

Jennifer Best
Legislative Analyst
Assembly Committee on Aging
Room 522B - Capitol
Albany, New York 12248
Email: bestj@assembly.state.ny.us
Phone: (518) 455-4371
Fax: (518) 455-4693