Government at all levels is moving towards fulfilling the desire of older New Yorkers and their family caregivers to restructure long term care service delivery and funding to allow senior citizens to age in place in their communities. This desire along with a variety of dynamics has created the timeliness of government and aging services providers to come together to take a fresh look at the broad array of community-based services for the elderly throughout NYC:

• Demographics of aging in NYC make a compelling case for the city to plan to address needs of current elderly and the future older population as boomers age. Population trends include increases in: number of old-old, 85+, poverty, diversity, immigrants and minority elderly, and those living alone.
• Olmstead Supreme Court case deciding older adults and disabled people have the right to remain in the community.
• Constraining growth of Medicaid budget.
• Disability status increases with age and is more concentrated among low income elderly. As of 2000, 39% the 65+ population had at least one disability; 75+ population, 56% reported at least one disability. There are 200 NYC census tracts where 88% of those ages 75+ have one or more disabilities.
• Four out of five seniors are not eligible for Medicaid and so depend upon DFTA funded services.
• Caregivers provide 80% of all caregiving for older adults worth $20 billion annually in NY state. Caregiver support services are critical to assisting families to continue in their role.

CSCS is committed to advocating for policies and funding that systemically enhance senior center capacity to serve seniors across New York City. Given the environment described above, it is important for the city to increase its investment in social service, non-medical support services that are delivered on the neighborhood-specific level. These services are integral to assisting seniors to age in place for many years with chronic illnesses, frequently for the rest of their lives. Additionally, sponsoring organizations of community-based services must be competent and able to work within the economics, diverse cultures, and human service needs of older residents of the particular community they have agreed to serve. Seniors depend upon non-medical social services to remain in their homes and communities. The experience to be learned from and expanded upon is the value of neighborhood-specific services senior centers have provided for over three decades. Public and private funding should move long term care services to the local community-based level rather than regionalizing contracts for “cost efficiencies”.

There are a variety of definitions of “home and community-based care” and “community-based”. The role of senior centers in long term chronic care drills down to another level beyond only home care – a place for seniors to maintain their independence and prevent unnecessary physical and mental deterioration caused by isolation. Senior centers are one piece of the array of services that fulfill the “community-based” part of “home and community-based care” Community-based, as discussed previously, is bringing services that are appropriate on a neighborhood-specific level.

The 329 senior centers have been at the center of neighborhood-based services for elderly residents for over 30 years. Maximizing their potential to provide meals and services is key to allowing seniors to age in place, remaining engaged with others, eating nutritionally and not becoming isolated. Allowing for the flexibility and resources to develop senior centers without walls in communities, i.e., meals and services at sites around the community, would extend the reach of senior centers and would benefit more seniors. This includes the acknowledgement of all services offered by a senior center, not just meal counts, when assessing utilization rates of centers. Older adults go to centers out of their own choice. They want to be there because they belong and are among peers.

It is important to keep in mind that senior centers also work with homebound elderly individuals through meals-on-wheels, case assistance, adult day services, transportation, and in some cases, programs for the homebound such as classes by telephone conference calls.

It is evident that preventive services provided by senior centers have an integral role in maintaining the health and ability of older adults to remain in their communities. “For example, the results of a 2000 study done in Sweden indicate that the lack of human contact may play a role in the development of Alzheimer’s disease. The Lancet medical journal has published results of research done by Dr. Laura Fratiglioni of the Stockholm Gerontology Research Center. In this study, researchers worked with 1,200 Stockholm residents, who were all over 75 years old and free of Alzheimer’s at the initiation of the study. After three years, 176 had developed Alzheimer’s, and researchers analyzed the information they had collected about the health and social networks of the study participants. These results showed that a poor social network increased the risk of dementia by 60%. Dr. Fratiglioni said that the study results indicate how important it is that older people are not left isolated in their homes as they age, and to ensure that they are given opportunities for contact and interaction.”

CSCS and its member agencies are enthusiastic about developing programs and meals that are appropriate to meet the needs and interests of the changing elderly population. One of the challenges in this service sector is serving people age 60-100+ - at least two generations – whose needs and desires sometimes differ. Senior center staff will welcome the chance to develop “senior centers without walls” to reach out across the community.

Recommendations:

• “Senior Centers Without Walls” – Flexibility and funding that allows senior centers to provide meals and services to additional sites around the community such as senior housing, churches, synagogues, and NYCHA senior clubs. Development of an inclusive, community-wide congregate meal program. Value of senior centers is in its preventive work in identifying and addressing emerging needs of the neighborhood elderly population. Build capacity of senior centers to be in a position to respond to emerging needs such as HIV/AIDS in older adults, mental health services and other services.
• Capacity building of senior centers – Invest public dollars to strengthen programmatic, physical, human infrastructure of senior centers. Baseline funding for core operational costs such as food, vans and rent. Negotiate indexing cost of meals to annual inflation rate. Need to bring in Medicaid and Medicare dollars into the aging services network to expand capacity for services.
• Senior Center role in long term care – neighborhood-specific senior center services – The definition of “Home and community-based” must move beyond just home care and include more locally based services through senior centers - The health value of providing older New Yorkers with an array of services in senior centers that allow seniors to age in place in their communities over many years including services such as: nutritional meals, socialization to avoid isolation, transportation to medical care, senior centers, food shopping and other important places, case assistance, health education, exercise and chronic care management classes, counseling, arts and other classes to stimulate creativity and maintain cognitive ability, and bilingual staff to work with elderly immigrants. Develop programs with hospitals around discharge planning where senior centers work with the older adult when they are discharged to ensure they have supports at home. Many elderly people are re-admitted to hospitals soon after discharge and hospitals are not reimbursed for re-admissions within 30 days.
• Workforce – Support the senior center workforce through salary increases, scholarships for MSW degree, funding to bring MSW trained professional social workers into senior centers through the city. Provide ongoing staff training and agency technical assistance.
• Mental health services – Providing mental health services for the elderly in senior centers would allow more seniors to access necessary services.
• Caregiver supportive services – Provision of supportive services for caregivers including counseling, respite, groups, and I&R for benefits and services. Also working with grandparents raising grandchildren. Build capacity to provide community wide information on long term care services and retirement planning.
• Voluntarism – Strengthen capacity of senior centers to develop volunteer programs.
• Senior center impact study – Senior centers have assisted thousands of older New Yorkers over the past three decades to age in place in their communities. They continue to be on the frontlines of identifying emerging needs as the elderly population grows. Funding for a study on the impact of senior centers on older New Yorkers would be valuable to gauge their role in the long term care system and where to strengthen their capacity to serve seniors and family caregivers. The gamut of services provided at senior centers across the city is frequently not known or recognized as a valuable part of long term care. As the central organization in NYC representing the 329 senior centers, CSCS is uniquely positioned to do such a study and would appreciate the opportunity to do so.

Based on this vision of the role of senior centers, CSCS makes the following recommendations that we believe will impact the utilization of meals as well as other services:

1. Allow for plans for systemic efficiencies and strengthening the capacity of senior centers to take effect: In recognition of the responsibility of the aging services network to incorporate efficiencies into its delivery of services, CSCS has embarked on several fronts:
   1. CSCS has begun its web-based Marketplace program, which is a group purchase program for food and other products. Other products include office supplies, vehicles, capital equipment and project support, and back office services such as payroll. Because the Marketplace aggregates the purchasing power of the $54 million for food purchased by the congregate and home-delivered meal programs, savings will be achieved which can be re-invested back into the meals.
   2. CSCS is currently exploring a group vehicle insurance program to see if lower premiums could be achieved.
   3. CSCS is developing a program with Cornell University School of Hotel Administration to provide training for senior center staff in the latest customer service techniques
   4. Maximizing Public/Private Partnerships – CSCS’s program, Building Bridges to Business, offers a way to bring resources into senior centers from a variety of businesses. Having the endorsement of Mayor Bloomberg would provide the leverage needed to make this venture successful.
2. Build capacity for outreach:
   1. Citywide marketing and public relations campaign to raise awareness of senior centers - While most senior centers routinely partner and health care providers and other local organizations, they do not have the capacity to do outreach to seniors in the community on a sustained basis. Frequently, there is insufficient capacity at senior centers for funding for staff, outreach activities, and technology. A broad based marketing campaign initiated by the city would reach seniors and their adult children across the city who are not aware of the meals and services provided at their neighborhood senior center.
   2. Formalizing a systemic referral system between senior centers and emergency food pantries and soup kitchens could increase meal utilization and benefit vulnerable seniors. For example, CSCS is working with City Harvest to provide nutrition education at senior centers and bridge the senior center congregate and home-delivered meal program with emergency food pantries and soup kitchens.
   3. Creating a universal logo for senior centers that could be displayed around neighborhoods so local residents know where senior centers are located coupled with a public campaign to advertise the logo. Local art school students could be asked to submit logos through a contest.
   4. Allowing for flexibility of funding and regulations for a senior center without walls program to bring congregate meals and services to sites throughout the community, not just at the senior center – an inclusive congregate meal program. OAA allows for nutrition sites throughout the community. CSCS and its members are anxious to move in this direction.
3. Investing additional funds in senior centers – CSCS would welcome the opportunity to work with the city to develop a plan for aging services to address the challenges ahead of us as seen by the demographics of aging. While the community is working on efficiencies, public dollars to support senior centers are also needed.
   1. Senior center infrastructure - Funding for fixed costs, maintaining the agency’s infrastructure and funding core services has not kept pace with inflation. This includes items such as rent, utilities, staff salaries, operating cost of vans and funds to replace vans, programmatic funds for initiatives such as health education, exercise and arts. Many senior centers do not have adequate computers or internet capacity making their administrative responsibilities less efficient than it could be. Need to bring Medicaid funds into senior centers for meals, transportation, adult day services, chronic care management and other services.
   2. Physical infrastructure – Many senior centers are located in basements of churches, synagogues and NYCHA buildings. A significant number do not even have windows. An MOU between City Council and OMB requires a minimum of $500,000 cost for a capital project in non-city owned property. This leaves out many senior centers and needs to be modified. After 30+ years of operation, senior centers need to be made more attractive, handicapped accessible, and renovated where needed. For example, there are senior center kitchens that need repair and equipment updating. Sometimes, bathrooms don’t work properly. There is leakage after storms. Working with organizations such as Public Color to paint senior centers across the city would greatly improve the attractiveness of centers. Experience has proven that renovated and attractive senior centers bring in more seniors. Seniors deserve an attractive, safe haven to go to each day.
   3. Human infrastructure – Developing a Leadership in Aging Institute -CSCS currently provides staff, board and advisory council training (senior centers are required to have senior advisory councils) and technical assistance for senior centers and other senior services. One of our premier trainings is the annual four-part New Director series. As the central organization representing senior centers and other aging services in every neighborhood in NYC, CSCS is interested in developing a Leadership Institute for current staff and to build future leadership in community-based aging services. Provide ongoing staff training and agency technical assistance. Providing scholarships for MSW’s or other advanced degrees, as is done in HRA, would strengthen the capacity of the senior center workforce to address the needs of senior participants. To this end, CSCS is seeking $4.2 million for the MSW/INFOA HUB initiative bringing one new MSW per City Council district to a local senior center. Additionally, we are working to establish AGE Scholarships (Aging Graduate Education) to provide financial assistance for MSW students planning to work in the community-based aging services sector.
4. Health value of senior centers and services –
   1. Discharge planning - Developing a formal program between discharge planners and community-based services could save the city health care dollars by preventing unnecessary re-hospitalization. CSCS would welcome the opportunity to develop such a program. The discharge planner in a hospital can determine how millions of dollars of Medicaid, Medicare and other health care dollars are spent. An inappropriate plan upon discharge, and in too many cases no plan, often sends an elderly person home to no food, no services, no assistance with medication management, no contact with other people, no assistance in the home at all. Medicare does not cover hospital costs if the person is re-admitted within 30 days. Hospitals then have to look to Medicaid and other funding to meet costs. Hospitals have substantially cut their social work staff in general. Discharge planners need training that would equip them with the skills to meet the demands of their jobs, a move that could offset the high turnover rate. Unfortunately, many discharge planners are unaware of community-based aging organizations that could assist seniors upon discharge. They could play a pivotal role in connecting the senior with their local senior center at this time, a move that can be integral to the senior’s health and not becoming isolated which leads to physical and mental health problems. Senior centers should be reimbursed for these services through Medicaid or other funding sources.
   2. Patient self-care management for chronic illness – http://patienteducation.stanford.edu/ As we discussed, Stanford University has developed a program to train professionals and retirees in leading programs at senior centers on self-care management for chronic illnesses such as diabetes, heart disease, Parkinson’s, etc. The program has been implemented nationally in senior centers. An investment of funding to develop these programs in NYC would reap benefits as evaluations have proven that health care dollars are saved and quality of life for seniors is improved. Self-care management fits well into the boomer culture of prevention. An investment of funds towards bringing this program to senior centers throughout the city would save the city health care funds. The self care management program would mesh well with Commissioner Thomas Frieden’s view of addressing diabetes among adults as discussed in the January 31st NY Times article - http://www.nytimes.com/2007/01/31/nyregion/31diabetes.html?_r=1&ref=nyregion&oref=slogin
5. Mental health services –
   1. With the growth of the aging population in numbers, diversity and longevity, the need for accessible and affordable mental health services will grow in importance. CSCS is working towards bringing mental health services into senior centers and other community-based senior service organizations.
   2. It is important to work with city and state mental health agencies to allow community-based agencies such as senior centers and case management agencies to apply for geriatric mental health funding without having to be a licensed mental health agency.
6. Caregiver supports –
   1. Caregivers provide 80% of all caregiving for older adults worth $20 billion annually in NY state. Caregiver support services are critical to assisting families to continue in their role.
   2. CSCS has taken a leadership role in forming the recently founded NYC Family Caregiver Coalition. The mission of the coalition is to create strength out of diversity and build a united forum that will lead to targeted action including advocacy, education, information and public awareness. A “family caregiver” is a person who provides unpaid care for relatives and loved ones. Caregivers served by NYCFCC include grandparents raising grandchildren, adults caring for older parents, spousal caregivers, gay and lesbian caregivers, and caregivers from multi-cultural backgrounds. The member agencies of the coalition serve over 400,000 people annually.
   3. Through Older American Act funding, senior centers currently provide supportive services to caregivers including respite care, counseling, information and referral, and support groups. These funds also assist grandparents raising grandchildren. NYC should supplement this federal funding to expand and enhance caregiver support services around the city.
   4. Senior centers could develop community forums on long term care and retirement planning.
7. Voluntarism –
   1. Voluntarism has always been the backbone of senior centers. Seniors who are members of senior centers have been the most loyal of volunteers. As times change, many younger seniors prefer working on specific projects rather than helping out at the center every day. Investing in volunteer coordinators at senior centers would help maximize neighborhood residents to assist the local senior center.
   2. “Civic engagement” is a much discussed issue in the aging field nationally. It is expected that boomers will volunteer if they feel their skills are engaged and they gain personal satisfaction from helping.

CSCS has been the leading organization in NYC since 1979 working to strengthen and broaden the work and vision of senior centers. As we move forward towards re-thinking long term care and how to assist seniors to remain in their communities for years, it is time for the potential of senior centers to be maximized. Strengthening senior centers and community-based aging services is key to creating communities that allow seniors to age in place with affordable, accessible services.

For further information, please contact Bobbie Sackman, Director of Public Policy, (212) 398-6565 x226 or bsackman@cscs-ny.org