This opinion piece, by UNH Executive Director Nancy Wackstein and Policy Analyst Carin Tinney, was originally printed in the May 9, 2013 issue of the New York Nonprofit Press. Read the original piece here.
Until very recently, most New Yorkers hadn't heard of something called social adult day care. If they did, perhaps it conjured up images of frail seniors on small plastic chairs, drinking from ½ pint milk cartons while having a story read to them by a teacher. That is why the attention now being paid to this program - due to the recent scandal involving two Bronx Assembly Members and the resulting articles in the New York Times about alleged abuses by “pop up” social day care providers- is bittersweet.
The unfortunate impression is that this program is at best unnecessary and at worst riddled with fraud, political kickbacks and unscrupulous operators. But the attention, however negative, does give us a chance to highlight the benefits of this program, which when done the right way by credible and professional providers, has helped thousands of genuinely frail seniors remain independent in their communities and has given their family caregivers essential support and respite.
The social adult day care model has been around for decades. In many cases, there is a dual focus on providing supervised care and support to seniors while allowing family caregivers a few hours of relief. Social adult day care specifically supports seniors who would have a difficult time adapting to a bustling environment of a traditional senior center because of their frailty or dementia. These seniors are dependent on continuous care and need extra supervision, usually with eating, using the bathroom, or walking. The benefit of the social adult day care model is that it allows otherwise homebound older adults to get out and socialize with their peers through art, shared meals, exercise and music.
The challenge to the model, as it was designed, began about a year ago. Many senior center operators located primarily in immigrant communities began noticing a decrease in daily attendance. As a general rule, the number of seniors served varies on a daily basis, but this was not normal fluctuation. Seniors were being lured out of senior centers and into “adult day care programs” with cash and other incentives. This was alarming on many levels. First, the seniors leaving for adult day programs were not physically or cognitively frail, which is the main eligibility criterion of social adult day care. Second, this exodus jeopardized funding for traditional senior centers because reimbursement partially depends on the number of meals served daily. Third, it was clear that these new “social adult day care” programs were unregulated and were not using precious Medicaid dollars in the way it had been intended: to help frail seniors remain in their communities. The new centers called into question the integrity of the entire model and cast a shadow on the longstanding history of many quality-driven programs
United Neighborhood Houses, the federation of the city’s settlement houses and community centers, has within our membership some of the finest and most experienced providers of social adult day care. UNH members helped pioneer the concept and some of their adult day care programs have been operating for over a decade. It would be a horrible shame for these legitimate and important programs to be swept up in an enforcement reaction meant to shut down the Medicaid cheats.
Legitimate social adult day care programs are one of the components of a comprehensive continuum of care for older adults in their neighborhoods. They greatly benefit a population in need of specialized and supervised care, and contribute to a better quality of life for both seniors and their caregivers through constant emotional support. This program deserves not only to continue but to expand in order to accommodate the dramatic increase in the number of older adults who are projected to need this kind of care. Let’s not allow a vulnerable population to become the victims of a few dishonest program operators. Don’t throw the good out with the bad.
Nancy Wackstein in Executive Director of United Neighborhood Houses. Carin Tinney is a Policy Analyst with UNH.
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UNH Releases "PEG'd Away: The impact of NYC PEG plans on New York City, its people and its communities"
Twice a year, in order to close gaps in the City's budget, City agencies face the task of cutting spending; in City-speak, these budget reductions are known as Programs to Eliminate the Gap (PEGs). Over the last several decades in NYC, Peg'd has become the most unlikely of verbs, as in "this program just got Peg'd," meaning the City budget proposal includes a program that will be restructured or eliminated for cost savings.
PEG'd Away also explores the changing role of the City Council. Once, the Council was able to use its discretionary funding to support innovative initiatives and meet emerging community needs. Now, this one-year discretionary funding is used to keep core human services afloat. Learn more by downloading PEG'd Away or viewing it online.
UNH is pleased to release a brief on Medicaid managed long term care and its early implications for UNH member agencies (and potentially other community-based nonprofits) serving older adults. It was prepared by UNH policy analyst Carin Tinney for UNH members in order to provide context for the massive changes occurring in the funding environment for services for seniors.
Medicaid managed long term care plans (MLTCs) are approaching social service agencies to contract for services and gain access to participants. There are both opportunities and challenges in this “new frontier” of collaboration. On the upside, it is a new source of funding for under-resourced programs, but at the same time it requires a different and new level of oversight. It is, in fact, a new way of doing business. UNH first learned about this trend over a year ago and has been closely monitoring its impact on our communities and agencies. The attached paper, “The New Frontier: Social Programs for Older Adults and Managed Long Term Care Plans.”, is meant to be a primer, explaining the history and background of the trend.
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United Neighborhood Houses Responds to Release of the Neighborhood Senior Center Award List
by the NYC Department for the Aging
Statement by Nancy Wackstein, Executive Director
July 18, 2012
“UNH applauds the NYC Department for the Aging for efficiently re-procuring its entire senior center portfolio after a decade, without disruption to this essential system and the thousands of older adults who rely on it. A total of 235 senior centers will be awarded “Neighborhood Center” contracts. These contracts will provide a fresh start, with more stable and predictable funding, for a system that has been plagued by steady budget cuts and piecemeal restorations over the last decade. Budgetary pressures in the past made budgeting and program planning difficult for nonprofit service providers and created great anxiety for many older adults who feared losing their centers. The list released today affirms the value of providing services to older adults at the neighborhood-based level.
UNH is also pleased by the City's use of the term 'Neighborhood Center,' replacing the use of 'Senior Center' as it echoes the notion that local programs are most effective and that neighborhood residents want to have a sense of partnership with their centers.
Of the 235 Neighborhood Centers designated, thirty-three – or 14% of the centers-- will be operated by UNH member agencies. UNH is pleased that two of our members have acquired new contracts, Lincoln Square Neighborhood Center and The Educational Alliance. For decades, Lincoln Square Neighborhood Center was serving over one hundred seniors a day on the upper west side but doing so without formal designation or funding as a center.”
United Neighborhood Houses (UNH) is the membership organization of New York City settlement houses and community centers. Rooted in the history and values of the settlement house movement, UNH promotes and strengthens the neighborhood-based, multi-service approach to improving the lives of New Yorkers in need and the communities in which they live. UNH's membership comprises one of the largest human service systems in New York City, with 38 agencies working at more than 400 sites to provide high quality services and activities to a half million New Yorkers each year. UNH supports its members through policy development, advocacy, and capacity building activities.
On Wednesday, October 5th, volunteers from HSBC Bank served lunch to almost 300 seniors at UNH member Hamilton-Madison House’s City Hall Senior Center.
After a full morning of tai chi and ping pong, the seniors settled into the main dining room for lunch. UNH Board member Mark Hershey (Senior Executive Vice President and Chief Credit Officer of HSBC Bank USA) led his volunteer team of 15, serving hearty lunches of curry chicken and rice to the lively seniors.
The seniors who utilize the center only pay about $1.25 for a nutritious lunch, keeping them healthy and allowing them an opportunity to socialize with friends. On a busy day, City Hall Senior Center can serve up to 325 meals. Attendance can vary with holidays on the Chinese Lunar calendar –they serve a largely Asian population – and sometimes the attendance at lunch can “depend what’s on the menu,” joked Isabel Ching, Assistant Executive Director for Senior Services for Hamilton-Madison House. And lunch wasn’t the only game in town. Seniors played ping pong, read Chinese language newspapers in the reading room, and played Mahjong in other parts of the center while lunch went on. After lunch cleared out of the cafeteria, karaoke moved in.
As the volunteers filed out, the seniors expressed their gratitude for lunch service with a loud round of applause. Thank you to all the HSBC volunteers for spending time with the Hamilton-Madison House seniors, and to the staff at the City Hall Senior Center for coordinating with UNH to put on this volunteer event.
To see more photos, view our Facebook album.
The stooped woman hustling through the Sunnyside senior center’s main hall at lunchtime is Gertrude McDonald, age 95. She’s spent most of her adult life in politics, as an aide to former state Sen. George Onorato, and as the first woman from Queens to run for the state Assembly in a Democratic primary, back in 1968.
“That was a time when women were still just licking the backs of stamps,” she said.
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New York Nonprofit Press Highlights Seniors' Rally Against Budget Cuts featuring Nancy Wackstein, Executive Director of UNH
Over the past three years the Department for the Aging (DFTA) has lost over $50 million in funding for programs that support the older adult population. DFTA is only supported with $140 million in city funds in the current fiscal year. This relatively small City agency has a major responsibility of assisting one in every eight older New Yorkers live independently in the community.