New York State Assembly
Standing Committee on Aging
Chair, Assembly Member Ron Kim November 22, 2021
Thank you for the opportunity to testify on the impact of COVID-19 on programs and support services for older adults and their caregivers within the state.
LiveOn NY’s members include more than 100 community-based nonprofits that provide core services which allow all New Yorkers to thrive in our communities as we age, including senior centers, home‐delivered meals, affordable senior housing, elder abuse prevention, caregiver support, NORCs, and case management. With our members, we work to make New York a better place to age.
Background
It is evident that the pandemic itself exposed the limitations to our existing long-term care system — including our overreliance on institutionalization which proved deadly — that must be addressed to better support older adults into the future. Among other challenges, the ability to remain fed, access to community-based supports, and an insufficient technology infrastructure were some of the primary issues facing older adults during the pandemic. Further, efforts to mitigate risk of exposure to COVID-19 had the unintended consequence of exacerbating issues of isolation across our state.
Conversely, the pandemic highlighted the importance of the very community-based services that had long been ignored across our State. As programs such as Senior Centers, Social Adult Day programs, and NORCs were mandated to temporarily shutter in-person operations, dramatic increases in isolation and mental health concerns made clear the meaningful difference each makes in our communities when operating at full capacity.
Finally, data from the CDC found that Black and brown Americans represented 30% of COVID cases, despite accounting for only 13% of the population. Further, black workers made up a significant portion of the frontline workers deemed essential throughout COVID-19, placing these individuals and their families at greater risk throughout the pandemic. Consequently, hospitalizations and deaths due to COVID disproportionately affected people of color all over the country. This data makes clear the existing inequalities across our state that must be confronted in order to create a more equitable system of care.
Recommendations
Today, we have an opportunity to reflect how the pandemic has impacted programs and services geared toward older adults. Through the challenges, we have learned valuable lessons in how to address current problems. In order to tackle these challenges and overcome them in order to create long term solutions, LiveOn NY recommends the following:
Support the Workforce that Supports New Yorkers
Fund Just Pay for human services workers
The work that has been done by Senior Center directors, home-delivered meal cooks, home care workers, and so many other aging services positions unsaid, has been nothing short of heroic during the pandemic. And yet, their pay was rewarded with only a 1% cost-of-living adjustment (COLA) last year, the first adjustment in years. To date, the State has mostly deferred the statutory COLA for human services workers, costing workers almost $700 million in increased salaries over the last 12 years. This has resulted in increased staff turnover as underpaid staff leave nonprofits for better paying jobs in other sectors, depriving New Yorkers of services from the most experienced, well-trained staff and jeopardizing high-quality services.
In order to create a long-term system of care that is well staffed to grow to meet the demands of an increasing older adult population, better wages are among the first things that need to be addressed. Therefore, LiveOn NY recommends the State include the statutory COLA for human services providers in the FY23 budget. This COLA is a crucial investment, as human services nonprofits, including the aging services providers that proved so valuable during COVID-19, take on contracts with the State to deliver the most essential services to our communities, and yet these contracts last five or more years with no other mechanism to deal with increasing costs. There is a real opportunity here, by providing this COLA, to invest in a significant workforce made up of 66% women and 68% people of color, doing some of the most important work across our State.
Enact and fund Fair Pay for Home Care, S5374 (May) / A6329 (Gottfried)
This legislation would “establish a base wage for home care workers at 150% of the regional minimum wage,” thereby ensuring the role of home care workers remains competitive, at least in comparison to minimum wage positions. Without such a mandate and corresponding funding from the State government — whose role it is to set wages — wage compression will continue to diminish the viability of this occupation which would exacerbate the existing home care attendant shortage. In practice, this means that, by
State dictated wages continuing to devalue the wages of home care workers, an older adult who has been screened as eligible for home care may find it impossible to find coverage, making it likely that the individual will be forced to move into a nursing home in order to receive care. Only by the State appropriately funding, and thereby respecting, the role of home care workers can it begin to address the resulting home care attendant shortage and in-turn create the community system of care that is preferred by New Yorkers. It’s time for Fair Pay for Home Care.
Invest in the Home-Delivered Meals Program
Across the state, home-delivered meal programs, more commonly known as “Meals on Wheels,” are experiencing extreme challenges recruiting and retaining drivers to complete the State’s more than 2,000 meal routes. The program, which relies on a mixture of volunteers and professional drivers to meet the demand, is confronting both a difficult labor market and a shortage of volunteers. Volunteerism in New York is often executed by older adults, a population that is more reluctant to volunteer opportunities that take place outside of the home as a result of the high risks associated with COVID-19. Further, evidence of the driver shortage for the delivery of meals, the National Transportation Institute anticipates a 5-20% increase in wages for professional driver (referring to the truck drivers) wages through 2022. With these factors in mind, it is time to increase funding for existing Meals on Wheels programs to allow for wage increases.
Invest in the Long Term Care Ombudsman Program (LTCOP)
The LTCOP is an advocate and resource for older adults and persons with disabilities who live in nursing homes, assisted living and other licensed residential facilities. Today ombudspeople help residents understand and exercise their rights to good care in an environment that promotes and protects their dignity and quality of life. The program advocates for residents at both the individual and systems levels to address issues that have the potential to impact their health and wellness. Ombudspeople investigate and resolve complaints; promote the development of resident and family councils; and inform government agencies, providers and the public about issues and concerns that impact facility residents. Ombudsmen’s activities also greatly enhance the footprint of DOH facility surveillance activities by sharing resident concerns and quality of care issues observed during regular interactions with residents.
The importance of this program was seen during the COVID-19 crisis. Throughout this pandemic, the LTCOP staff and volunteers worked to remain engaged with residents,
families, and facilities to provide information and support to ensure that resident rights are protected but, without access, it was hard. Further, unfortunately, continuity of the program amidst COVID-19 has been strained given the significant reliance on volunteers, which, as with the home-delivered meal and other programs, were less available to execute the aims of the program. No longer can we rely on volunteers to execute what should be core, well-paid functions of our community care system. In this vein, it is critical to invest an additional $4.81 million dollars to modernize and further professionalize this program.
Expand Service Capacity to Meet Demand
Fund NYSOFA to address waiting lists for services.
Waiting lists for home care and case management remain a chronic issue in New York City. The existence of waiting lists increases the likelihood of an older adult being institutionalized since waiting lists for services can exist for years. To delay a single older adult from getting such support—particularly during a global pandemic that has left older New Yorkers most vulnerable—is to deny them the opportunity to age with dignity and respect. Given the exorbitant strain COVID-19 has placed on the older adult population, the prospect of adding further stress to the lives of older New Yorkers by forcing them to wait for critical services is untenable and must be addressed through significant and immediate investments.
Additionally, increased investments in addressing waiting lists will inevitably help balance the State’s budget by reducing Medicaid expenditures. Findings indicate that for every 1% increase in home-delivered meal service to the older adult population, there is a significant savings to Medicaid through the reduction of higher-cost care. In particular, findings indicate that in New York, savings from just a 1% increase in meal service would lead to $11,427,143 Medicaid savings—proving that waiting lists for such services are more costly than the cost of the meal service itself. To date, the State has included two funding allocations to address waiting lists ($15 million and $8 million respectively), both allocations should be renewed in the coming fiscal year to continue these critical services. Additional funding to address new waiting lists must also be allocated.
Invest in the Technology Infrastructure of the Aging Services System
COVID-19 has shown the vast digital divide in the older population. The most vulnerable older residents have been without interaction for months, and having the ability to create and implement a robust virtual platform for our clients is paramount. There needs to be a
substantial investment to purchase and implement technology to bridge the gap in social isolation and loneliness. The network of Area Agencies on Aging and subcontracting non-profit providers stand prepared to implement a variety of programs, including expanding virtual senior centers across the state, with a pilot investment of $5 million.
Legislate to Improve Systems
Sign S598B and A3922 into law
S598/A3922 laudably seeks to create a task force to reimagine long term care in New York State. LiveOn NY has long advocated for the emergence of a Task Force to seize the opportunity to emphasize the cost-effective, community-based long term care models that already exist and could be further expanded. For example, one of LiveOn NY’s members, Selfhelp Community Services, have designed the Selfhelp Active Services for Aging Model (SHASAM) which provides a culturally competent social worker in affordable senior housing to serve their diverse residents. This model also provides other supportive services such as benefits and entitlement assistance and health programming. Additionally, Naturally Occurring Retirement Communities (NORCs) offer the NORC model which employs social workers, nurses, and in programming to encourage physical activity and combat social isolation. By mobilizing a dedicated Task Force to oversee the growth and expansion of these models and others alike, New York will contribute to the larger cause of enabling older adults to age in place with their care needs addressed. It is critical this legislation be signed into law and operationalized.
Sign S4652 and A6590 into law
S4652/A6590 is an act directing “the commissioner of economic development, in consultation with the commissioner of health, labor and OCFS to study, develop, and implement a long-term strategy to support the growth of the caregiving industry in New York state.” This legislation recognizes long-term care as an area not only of great social need, but one of incredible economic opportunity that has yet to be fully appreciated. To begin to view care work within the context our our State’s larger economic and labor strategy would constitute a significant step forward that could prove to shape better outcomes amidst a future crisis. It is critical this legislation be signed into law and operationalized.
In conclusion, LiveOn NY stands ready to work with the State to continue to learn from the COVID-19 pandemic and further determine mechanisms to improve our system of care into the future.
Thank you for the opportunity to testify.
Testimony Delivered By: Katelyn Andrews Director of Public Policy
For questions, Contact: kandrews@liveon-ny.org