ALBANY, N.Y. – Two hundred and fifty organizations ranging from hospitals to counties to advocates for the aging and many others, including the chairs of the state legislature’s aging committees, are urging a doubling of New York’s budget for aging services - $252.5 million more - including preventive and cost-saving investments for New York’s exploding older population next year.
In a letter to Governor Kathy Hochul (reprinted in full below), the organizations argue such an increase would more than pay for itself by keeping older New Yorkers off Medicaid and reducing the State’s huge outlay for the government health care program for the poor and disabled.
From 2011 to 2021, New York’s 65 and over population exploded by 31% while the number of residents under 65 shrank by 2.6%.
Yet less than one percent of the state budget supports community-based care for the elderly “and any investments have been minimal and have not kept pace with demand,” the letter says.
Tens of thousands of New Yorkers remain stuck on waiting lists for preventive and cost-saving in-home services for the elderly – services such as home delivered meals, assistance with grocery shopping, bathing and other daily activities, and respite for unpaid family caregivers. Those services help prevent unwanted moves to much costlier nursing homes and other institutional settings, which are funded mainly by taxpayers through Medicaid.
“When over 250 diverse organizations speak with one voice, the State should listen,” said AARP New York State Director Beth Finkel, whose association is among the letter’s signatories. “And when your 65-and-over population skyrockets by 31% over a decade while the under-65 population actually shrinks by 2.6%, the State should act to meet the needs of its fast-growing population of older residents – not to mention the 2.2 million family caregivers who provide them with over $39 billion a year in unpaid care.”
“New York chooses to spend billions they don’t have to in Medicaid, for services we can, and do provide at 1/10th the cost and without requiring someone to impoverish themselves to get that care” through Medicaid, the Association on Aging in New York State says in the letter – noting the State spends nearly $100 billion on Medicaid vs. only $200 million on aging services providers.
“Our average customer for some of our core services is an 83-year-old, low-income female, who lives alone, has 4 – 10 chronic conditions, and needs assistance with home care services for bathing, toileting, dressing, bill paying, shopping assistance, meal preparations, etc. We can serve them for 5-7 years for less than $10,000, all while preventing hospitalizations and skilled nursing facility placement.”
“The Association on Aging in New York is dedicated to ensuring older individuals and families have access to programs, services, and supports that allow individuals to age with dignity, autonomy, and respect,” said Becky Preve, Executive Director of the Association on Aging in New York. “Older New Yorkers are the backbone of the state, federal, and local economy and provide extensive contributions to communities. It is imperative that New York recognizes and values the older population, and provides adequate funding for the low cost, high yield services provided by the aging network. The Master Plan on Aging must address the ongoing inequity in funding for aging services, as tens of thousands of individuals are currently waiting to access services due to budgetary limitations.”
"I am honored to join the hundreds of organizations who dutifully serve our seniors in calling for an Aging Budget that is fair, equitable and most importantly, reflective of the needs of our older New Yorkers,” said Senate Aging Committee Chair Cordell Cleare. “The postulate could not be more simple: If the aging population is increasing and demand for services is increasing, the Aging Budget must also increase accordingly. I pledge to fight tirelessly until our service providers have the resources needed to serve our elders effectively."
“For many years, we have been sleep walking into an aging crisis,” said Assembly Aging Committee Chair Ron Kim. “Now we have better ideas on ways to get ahead of it. By investing in the State Office For Aging, and building out our institutional capacity, we help our communities flourish and increase revenue for our state. Plus, we save billions in Medicaid spending. It’s a win-win for everyone.”
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Association on Aging in New York
515 Broadway STE 402, Albany NY 12207
Phone: (518) 449-7080 | www.agingny.org
October 13, 2023
The Honorable Kathy C. Hochul
Governor of New York State
NYS Capitol Building
Albany, NY 12224
Dear Governor Hochul:
On behalf of the New York State Association of Counties (NYSAC) and our affiliate membership organization, the Association on Aging in New York (AANYS), a not-for-profit membership organization representing the 59 area Agencies on Aging and almost 1,200 community-based organizations serving older New Yorkers, I am reaching out regarding the dire situation facing older New Yorkers and their families.
As you are aware, New York ranks fourth in the nation for the over 60 population with 4.84 million individuals. Their economic, social, and intellectual contributions to our state are vast and regularly unrecognized, and discounted. However, the need for life sustaining services for older residents has and continues to far exceed the resources available to meet their needs and we are calling on the Governor to increase funding for NYSOFA to $252.5 million in the SFY 2025 budget.
New York’s budget to support community-based care is only eight tenths of one percent despite the fact that the population has been growing for decades, and any investments have been minimal and have not kept pace with demand.
According to AARPs Longevity Economy research for New York, older New Yorkers contribute:
• over 43 percent of the state GDP, or $719 billion,
• support almost seven million jobs through their spending,
• provide $462 billion in wages and income,
• represent 38 percent of the state tax base and 42 percent of the county tax base,
• provide uncompensated care to someone else worth $39 billion annually, and
• their volunteerism provides $13.8 billion in service if paid at fair market value.
Volunteers are critical to direct and indirect services in a variety of not-for profits around the state such as polling places, veterans’ services, transportation, meal preparation and delivery, youth sports, tax preparation assistance, historical societies, health information counseling, quality of care in residential facilities, and much more.
Older New Yorkers are the backbone of our local, state, and federal economies, supporting schools and Medicaid with their local tax contributions due to high home ownership rates, supporting local businesses, they are the largest contributors to charity and philanthropy, the largest entrepreneur group in the country, and are a huge tourism block. Despite this data, we continue to underfund the services that a segment of the older population depends on, and deserves, to help them remain independent, stay off of Medicaid for their long term care needs in the community, and reduce emergency department visits, hospitalizations, observation status, and nursing home placement, all which saves the state hundreds of millions of dollars annually, and improves the individual’s quality of life.
We were extraordinarily excited that you signed an Executive Order to create a Master Plan for Aging. Overwhelmingly, the provider community through committees, subcommittees, town halls, listening sessions, and discussions with leadership, has identified the decades long issue of severe and consistent underfunding for non-medical, home and community-based aging services. Our services have proven to be comprehensive, person-centered, and incredibly cost effective in delaying/preventing spend down to Medicaid and supporting the State’s longstanding goals of aging in place, with dignity.
The New York State Office for the Aging provides services and supports for non-Medicaid eligible individuals, with a focus on home and community-based services. The majority of the State’s older adults are not on Medicaid, and do not need to be on Medicaid if community supports are strengthened and expanded. The infrastructure to provide these services and supports has been in existence for more than 50 years, but simply are not resourced.
Clients served through the Area Agencies on Aging include home delivered and congregate meals, transportation, personal care attendant services, health insurance information and counseling, registered dietician services, senior recreation and health, social adult day programs, information and assistance, case management, legal services, home modifications and repair, evidence-based programs, benefits and entitlement assistance, caregiver services, advocacy, and ongoing support for the millions of older residents of the state. As our network is community based and part of local governments, connections to other critical systems can happen in real time, such as local mental health, substance abuse, adult protective services, public health, housing, transportation, emergency management, etc.
Our network serves the 75-80 percent of older adults who consider themselves healthy and active and our programs work to sustain this status. Additionally, we serve the 15-20 percent who are at risk of losing their independence and spending down to Medicaid by coordinating a comprehensive package of services and cross systems work to delay and avoid higher cost, preventable services that are Medicaid funded.
Our average customer for some of our core services is an 83-year-old, low-income female, who lives alone, has 4 – 10 chronic conditions, and needs assistance with home care services for bathing, toileting, dressing, bill paying, shopping assistance, meal preparations, etc. We can serve them for 5-7 years for less than $10,000, all while preventing hospitalizations and skilled nursing facility placement.
Our network has tracked clients that have been assessed for services but are unable to receive them due to underfunding or workforce challenges and found that 10 percent of those on waiting lists go directly to a skilled nursing facility, and another seven percent go to MLTC or community-Medicaid. Our analysis of the waiting lists, just for the 17 percent of individuals who went directly to Medicaid, required a state share match of $65 million. Our network has shown for over five decades that the least expensive, most person-centered services, are offered through the aging services infrastructure.
Given that most health care costs, 70-75 percent are directly attributable to personal behaviors (eating well, exercising, not smoking, etc.), community-services are the only solution to preventing future Medicaid and improving the health and wellness of older New Yorkers, and allows the state to retain their substantial economic contributions. Unfortunately, even with this data available, each day individuals seeking services are placed on waiting lists or turned away. We have collected wait list data from all our counties and their partners and currently, there is an active waiting list of 18,857 in need of services. This is a very conservative count as some counties do not keep wait lists at all and attempt to work with other agencies locally to meet needs and some counties keep wait lists, but not for all services. For example, if someone needs transportation to a dialysis appointment, they are not going to go on a waiting list because the need is immediate.
Our members reported in September 2023 waiting lists for:
• Personal Care I and II – 3,548 individuals
• Consumer Directed Personal Care – 208
• Home Delivered Meals – 1,264
• Social Adult Day Services – 198
• Comprehensive Case Management – 7,691
• Comprehensive Case Management Only – 2,681
• Congregate Meals – 80
• Nutrition Counseling – 148
• Transportation – 599
• Legal Services – 323
• In-Home Contact and Support – 127
• Personal Emergency Response Systems (PERS) – 828
• Caregiver Support – 608
• Health Promotion – 255, and
• Minor Home Modifications – 241
These waitlists have grown by more than 5,000 since our last survey. Using data from our last analysis as a baseline – 3,205 individuals would either go to a nursing home or community Medicaid which would cost Medicaid, just on the 10 percent that went to a nursing home $177 million total, ($88.6 million state share). This does not include community Medicaid/MLTC which would cost about $60 million ($30 million state share), or increases in hospitalizations, rehabilitation stays, etc. This would place more out of pocket costs for individuals and families for co-pays and deductibles as well as increases in prescription costs
It has been suggested that you cannot predict future Medicaid savings, however, the data overwhelmingly shows that individuals can be supported in homes and communities at a fraction of the cost of institutional settings. If an individual who is low income, with many chronic conditions and needs help with bathing, dressing, toileting, ambulating, eating, shopping, preparing meals, paying their bills, personal care, and house cleaning, without our in-home and community services, they would not be able to remain home. Nursing home placement for most individuals is preventable if the infrastructure we oversee was resourced.
Finally, for many of the core services that target those at imminent risk of Medicaid spend-down and nursing home placement, we are unable to advertise to them because we currently cannot meet the demand. There are many individuals and families unaware of the services our network provides because they have been managing things on their own or they are simply unaware. Our inability to advertise preventive services and supports because there is no capacity, means individuals fail, go to higher levels of care that are preventable and then become financed by Medicaid place extraordinary financial and emotional burdens on family, friends and neighbors who provide day to day care due to the absence of services.
In looking at the New York State budget it is abundantly clear that older New Yorkers are not appropriately valued, nor is the vast community-network that serves them. Historically, NYSOFA is consistently flat funded while the population is getting older and New York chooses to spend billions they don’t have to in Medicaid, for services we can, and do provide at 1/10th the cost and without requiring someone to impoverish themselves to get that care. The current Medicaid budget is close to $100 billion, and yet aging services providers only receive about $200 million in state funding despite us being responsible for 30-35% of the state’s population.
Both the MPA and the updated Prevention Agenda provide the opportunity to address this imbalance. The recent directive from Division of Budget required state agencies to submit flat budgets, directly defies ensuring a robust Master Plan on Aging. The Aging services network cannot and should not create a plan for the next ten years when we have thousands of older New Yorkers and their families that did not receive services over the past decade, are not receiving services now, and cannot wait years for a plan to catch up with this realty.
The state spends billions on the most expensive and preventable services under Medicaid that are NOT comprehensive in nature. We are asking for your support in increasing the state’s investment in NYSOFA to $252.5 million to expand and strengthen existing services, eliminate waiting lists, address unique local challenges, address the workforce crisis, reorganize local AAA’s to have specialists and staff to serve individuals in a comprehensive way. We believe this investment will ultimately save the state far more money by preventing unnecessary placements in more expensive settings. Furthermore, older residents and their families have the right to age in place, with dignity, autonomy, and respect.
Stephen J. Acquario
CC: Blake Washington
Senator Cordell Cleare
Assemblyman Ron Kim
50 Forward Mohawk Valley
AARP New York
Action for Older Persons
Adirondack Health Institute
Adirondacks ACO, LLC
AIM Independent Living Center
Allegany County Office for the Aging
Arc of Chemung-Schuyler
Ardent Solutions, Inc.
Arkell Community Center
ASCEND Mental Wellness
Association on Aging in New York
At Home Care Partners, Inc.
Bay Ridge Center
Bedford Park Multi Service Center for Senior
Benson Ridge Senior Services (Catholic Charities)
Best Life Older Adult Center
Beth McKinney RD
Broome County Office for Aging
Canaan Senior Service Center
Carter Burden Network
CATHERINE SHERIDAN OAS
Catholic Charites Brooklyn and Queens
Catholic Charities - St. Louis OAC
Catholic Charities Bayside Older Adult Center
Catholic Charities Benson Ridge Senior Services
Catholic Charities- Benson Ridge Senior Services
Catholic Charities Brooklyn and Queens
Catholic Charities Brooklyn and Queens
Catholic Charities Brooklyn and Queens Southwest
Queens Senior Services
CATHOLIC CHARITIES BROOKLYN QUEENS
Catholic Charities Brooklyn- Queens
Catholic Charities Brooklyn Queens
Catholic Charities Brooklyn Queens Older Adult
Catholic Charities CCNS/ South West Queens
Catholic Charities Diocese of Brooklyn and Queens
Catholic Charities Neigborhood Services
Catholic Charities Neighborhood Services
Catholic Charities Neighborhood Services (Catholic
Charities Brooklyn and Queens)
Catholic Charities Neighborhood Services : Benson
Ridge Senior Services
Catholic Charities Neighborhood Services Bayside
Catholic Charities Neighborhood Services. Inc
Catholic Charities of Onondaga County
Catholic Charities of the Diocese of Ogdensburg
Cattaraugus County Department of the Aging
Cayuga County Office for the Aging
CCBQ- Northside Senior Center
CCBQ Woodhaven Richmond Hill Older Adult
CCBQ Woodhaven-Richmond Hill Older Adult
CCNS Benson Ridge Senior Services
CCNS Narrows OAS
CCNS NEQ HDMP
CCNS Pete McGuinness OAC
CCNS Peter J. DellaMonica Older Adult Center
CCNS SWQSS Case Management
CCNS THE BAY OAC
CCNS The Lodge OAC
Chautauqua County Office for Aging Services
Chemung County Department of Aging and Long
Chemung County Health Department
Chemung Schuyler Steuben Workforce NY
Chenango County Area Agency on Aging
Chenango County NY Connects
Chinese-American Planning Council (CPC)
Citizen Advocates, Inc.
City of Fulton
Citymeals on Wheels
Claxton-Hepburn Medical Center
Clinton County Office for the Aging
Columbia County Office for Aging
Community Health Center of the North Country
Consumer Directed Choices, Inc.
Cooperative Home Care Associates
Cornell Cooperative Extension- Clinton County
David W Forsythe Chairmans St. Lawrence County
Delaware County OFA
Dennis Yacobucci Montgomery County Office for
Dorthy Asbury, Director of Transportation, Schuyler
Doyle Security Systems
Dutchess County Office for the Aging
East Harlem Community Health Committee, Inc.
East Side House Settlement
eight two three Interior Planning/Design LLC
Encore Community Services
Essex County Health Department
Esther Greenhouse, CEO, Silver To Gold Strategic
Family Services of Chemung County, Inc. Home
First presbyterian church, Hector, New York
Forward-Thinking Home Solutions
Franklin County Public Health Services
Fulton Co Office for Aging and Youth
Glens Falls Hospital Community Care Coordination
HCR Home Care
Heights and Hills
Henry Street Settlement
Herkimer County Office for the Aging/NY Connects
Home & Health Care Services, Inc.
Hospice and Palliative Care Association of New
Hospice of St. Lawrence Valley, Inc.
Housing Assistance Program of Essex County
Independent Living Center of the Hudson Valley
InterFaith Works of Central New York
JCC OAC Stapleton Senior Center
Jeanne R So. Board of Trustees. Montgomery
County Office for Aging
Jefferson County Office for the Aging
Joint Council for Economic Opportunity of Clinton
and Franklin Counties
Joshua Held, Administrator for Wilkinson
Residential Healthcare Facility
Katy Dunlap Yoga
Kim Benjamin, LCSW Community Social Worker-
Finger Lakes VA
Kim V Leonard, Town of Macedon Supervisor
Kirsten E. Dunn, Esq. Montgomery County Office
Lewis County Office for the Aging
Lifespan of Greater Rochester
Lincoln Square Neighborhood Center
Livingston County Office for the Aging
Lourdes Palliative Medicine
Margaret Haggard St. Lawrence County Legislator
Mary Hume, Program Director, Catholic Charities
Neighborhood Services/Benson Ridge Senior
Meals on Wheels of Chemung County, Inc.
Medicare Rights Center
Montgomery County Clerk
Montgomery County Office for Aging
Montgomery County Office For Aging - Heather
Montgomery County Office for Aging, Inc.
Montgomery County Office for the Aging, Board
Member, Kathleen Rose
Montgomery County Sheriff's Office
Mountain Valley Hospice & Palliative Care
Narrows Older Adult Center
North Country Healthy Heart Network, Inc.
North Country Home Services
Office of Mental Health
Office of the Essex County Manager
Ontario County Office for the Aging
Orleans County Office for the Aging
Oswego County Department of Social Services.
Oswego County Office for the Aging
Otsego County Office for the Aging
Polish&Slavic Center - JP2 Friendship Center
Potsdam Sandstone Senior Citizens Club
PSS (Presbyterian Senior Services)
Rev. Robert C. Dievendorf
Rick Perkins St Lawrence County Vice Chairman
Ridgewood Bushwick Older Adult Center.
Riseboro- Brevoort Older Adult Club
Riseboro Community Parntership- Palmetto Gardens
Social Adult Club
Riseboro Community Partnership
Riseboro Community Partnership/Diana H Jones
Riseboros Hope Gardens OAC
Rita Curran FNP St Lawrence County Legislator
Rochdale Village Social Services Inc
Rochdale Village Social Services Inc.
Rockland County Office for the Aging
Schoharie County Office for the Aging
Schuyler County APS
Schuyler County Office for the Aging
Seneca County Office for the Aging
Seneca Nation AOA
Senior Citizens Council of Clinton County, Inc.
Senior Nutrition Program
Seniors Helping Seniors®
Southern Adirondack Independent Living Center
Special Services For Senior Citizens
ST Lawrence County
St Lawrence County Legislature
St Lawrence County Office for the Aging (Board
Member Joan Howlett)
St. Lawrence County
St. Lawrence County Board of Legislators, District 6
St. Lawrence County Community Development
St. Lawrence County Health Initiative, Inc.
St. Lawrence County Legislators
St. Lawrence County Office for the Aging
St. Lawrence County Sheriff's Office
St. Louis Older Adults Center
Steuben County Office for the Aging
Steuben Senior Services Fund, Inc.
Substance Abuse Prevention Team of Essex County
Suffolk County Office for the Aging
Sullivan County Office for the Aging
TextBook Consulting Corp.
The Arc Chemung-Schuyler
The Institute For Human Services INC.
The St Lawrence County Health Initiative
The Wellness Chord
Tioga Opportunities, Inc.
Tompkins County Office for the Aging
Town of Russell Town Clerk Office: Russell, New
Town of Sodus
Town of Wheatland Senior Center
Ulster County Office for Aging
United Jewish Council of the East Side, Inc.
Village of Richville
VISIoNS/Services for the Blind and Visually
Visiting Nurse Association of Albany Home Care
Volunteer Transportation Center, Inc.
Warren/Hamilton Counties Office for the Aging
Washington County Office for Aging and
Disabilities Resource Center
Watkins-Montour Lions Club
Wayne County Department of Aging and Youth
Wayne County Emergency Management
Wayne County Public Health
Wayside Outreach Development
Western New York Integrated Care Collaborative,
Woodhaven-Richmond Hill Older Adult center
Young Men's and Young Women's Hebrew
Association of the Bronx, Inc. (dba Riverdale Y)