SUBJECT:

PURPOSE:

As consumers in this state age and become seniors, it is more difficult for them to participate in community activities and maintain themselves in their homes without assistance. Seniors correctly expect quality and consistency from the services being provided to them as do any other consumers in this state. It is a priority for the New York State Assembly to ensure that these valuable members of our society who have contributed to the richness of our communities are able to age with dignity in their homes. To that end, we support our seniors by providing funds to the local Departments for the Aging to maintain activities that encourage continued social contact and services that aid with basic needs such as case management, nutrition assistance, and health.

The City of New York Department for the Aging has determined that a redesign of services provided to older adults would ensure a more coordinated and uniform system that recognizes the changing lifestyle, needs and wants of older New Yorkers. The three pieces of this modernization are case management services, home-delivered meals, and senior center services. While the case management piece is nearing completion, implementation of home-delivered meal and senior center services continues. A series of workgroups were organized and the ideas generated were developed in concept papers.

In 2004, a pilot program called Senior Options was launched in the Bronx to modernize the Meals-on-Wheels program, which provides nutritious meals to medically frail home-bound seniors who are unable to cook for themselves. This program often is the only source for a hot, nutritious meal, and the only life-line to the outside world. The Senior Options program consolidated sixteen Meals-on-Wheels contracts into three. There were two levels of service for seniors enrolled. Those seniors capable of reheating meals would be given the choice between daily meals or frozen meals delivered once or twice a week. Those seniors incapable of reheating meals for themselves, whether because of lack of equipment or capacity, would automatically receive daily meals. There have been mixed reviews of this program from community groups and the Department for the Aging.

In March 2007, KPMG LLP did an independent evaluation of the Senior Options program. They found that seniors were largely pleased with the food provided and that there was no increased risk of isolation. With the program deemed a success, the Department for the Aging developed a concept paper describing plans to expand the program citywide. Community groups have reacted strongly in opposition to this move, pointing to their ongoing concerns with the Senior Options program.

In October 2007, the new RFP for a reorganization of case management services was released citywide. Existing contracts are set to expire by June 30, 2008, and the new contracts will take effect on April 1, 2008. This reorganization was based on the same principle as the Meals-on-Wheels pilot program in the Bronx, consolidation of many providers to a few who would do the work more efficiently. These case management services provide individual help with coordinating benefits that seniors are eligible to receive. They are essential to the advanced elderly who have been able to remain in their homes thanks to the case managers ensuring they have all necessary supports. The goal for the modernization is to make the system for case management more effective, coherent, and integrated to better serve existing clients and set the stage to serve increasing numbers of seniors in the coming years.

Also in 2007, the Department for the Aging developed a concept paper to address modernization of the senior center system. Senior centers provide the main source of socialization with peers for many seniors who have very limited abilities to travel from their homes. Some seniors cannot travel more than a block or two from their homes. The services provided are also targeted to seniors and their special needs. The modernization would be designed along the same lines as Meals-on-Wheels and case management - consolidating many small senior centers into fewer large centers that will provide a wider range of services relating to health, nutrition, social, and cultural activities. There has been no pilot program for this initiative. This approach appears to be designed to attract more seniors to participate in programs and thereby increase the socialization the centers provide.

There are several concerns with both of these proposals as they relate to ensuring seniors are not being left out by the new systems. The first concern is isolation. While it is not the intent of the City Department for the Aging to increase the isolation of seniors, it has not been demonstrated adequately that this approach to modernization of senior services will not result in this outcome. The study done by KPMG LLP of the Senior Options program did not address isolation from the seniors' point of view, and it is unclear if it has been addressed at all in the senior congregate activities concept paper. Seniors who have to travel farther to reach a center may choose not to attend if the journey is a difficult one. For some, it may not be a choice because they simply cannot make the trip without increased transportation support.

Another concern is the quality and type of services being offered by these modernized systems. The quality of the frozen meals is in dispute by many community residents, though the report done on the Senior Options program does indicate that medically frail home-bound seniors with dementia think the meals are nutritious. There does not appear to be any mechanism to ensure nutrition nor any mechanism to ensure sensitivity to seniors' cultural and special dietary needs. There are similar questions regarding the senior center consolidation. The new services envisioned may appeal to younger seniors who are more willing and able to travel to the center, but what about older seniors? We need to ensure there will be activities that are attractive to them as well. An integral part to centralizing these centers must be to improve support for transportation to the facilities for seniors. The services offered are of no help to seniors if they cannot reach the center.

The purpose of this hearing is to ensure that all due care and caution has been taken to ensure that these modernization efforts proposed by the New York City Department for the Aging will not result in a reduction in benefits for the seniors who rely on these services.

Oral testimony will be limited to five minute durations. Ten copies of any prepared testimony should be submitted at the hearing registration desk. The Committees would appreciate advance receipt of prepared statements. Written testimony will also be accepted and may be sent to the contact persons listed on the reply form. In order to publicize the hearing further, please inform interested parties of the Committees' interest in receiving written testimony from all sources.

In order to meet the needs of those who may have a disability, the Senate and Assembly, in accordance with their 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 Senate and Assembly facilities and activities.

SELECTED ISSUES TO WHICH WITNESSES MAY DIRECT THEIR TESTIMONY:

1. What steps has the New York City Department for the Aging taken to evaluate the implementation process of the senior options program in the Bronx and the most recent case management consolidation program? What challenges have been identified? What has the Department done to overcome these challenges going forward?

2. Have senior services providers, citizens, and other stakeholders throughout New York City been provided sufficient time to respond to DFTA's requests for proposals for the new case management contracts, Meals-on-Wheels services contracts, and senior center consolidation projects?

3. Have comments from providers, citizens, and stakeholders been thoroughly reviewed and appropriately incorporated in the final plan?

4. How will the consolidation of contracts impact utilization of case management? Will there be an increase in caseload due to restructuring? Is the case management proposed as part of the Meals-on-Wheels restructuring an extension of the existing case management service or a new program?

5. How will the consolidation of contracts impact Meals-on-Wheels? Will the use of frozen meals enable the program to accommodate more seniors and eliminate waiting lists? Will the proposed model sustain the growing demand over the next five to ten years?

6. How will the proposed senior centers maximize utilization? What programming will be required to meet the needs of the current participants in senior centers, and of those who will be utilizing them in three years?

7. Over a period of five to ten years, what would be the repercussions of not continuing with this proposed reorganization on the schedule proposed by the New York City Department for the Aging?

8. What are the community and financial benefits of this proposed reorganization of services?

9. What does the New York City Department for the Aging envision as the senior center of the future? What services would they provide? How much would they cost?

10. What planning process has the New York City Department for the Aging undertaken in assisting community-based organizations in the construction and development of new senior centers throughout New York City?

11. How does the State Office for the Aging work in tandem with the Department to ensure that changes to services to seniors are in the best interest of the senior community?

12. What is the role of the State Office for the Aging in the local planning process?

13. What types of barriers prevent older consumers from obtaining the services they need to maintain a high quality of life? How would the Aging Services Modernization initiative address these barriers?

14. How do older consumers who are homebound obtain information about the food delivery programs and services that are available to them? How does the Department for the Aging ensure that seniors are adequately informed of their options?

15. Older consumers living in certain areas of the City with limited public transportation options often rely on private services to transport them to and from senior centers. Has the Department for the Aging considered the possibility of increased costs to seniors traveling to new or consolidated centers located farther from their homes?

PUBLIC HEARING REPLY FORM

Persons interested in presenting testimony at the public hearing on Aging Services Modernization in New York City to be held on April 18, 2008, or who wish to submit written testimony only, are requested to complete and return this reply form to:

Erin Cunningham
Assembly Committee on Aging
Alfred E. Smith Office Building
80 South Swan St., Floor 22
Albany, New York 12248
Phone: (518) 455-4355
Fax: (518) 455-7250

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