Joint Meeting Governor's Advisory Committee on Aging
Aging Services Advisory Committee
Wednesday, May 7, 2008 (9:00am to 3:00pm) Holiday Inn Express, Albany, New York
I. Call to order and attendance
In attendance:
| Governor's Advisory Committee | Aging Services Advisory Committee |
|---|---|
| Irv Appel | William Au |
| Joan Byrne | Priscilla Bassett |
| Suleika Cabrera-Drinane | Elizabeth Bird |
| James Chang | Sharon Boyd |
| Michael Conners | Peg Corbett |
| Loretta Donlon | William Dionne |
| Roxanne Given | Barbara Intrieri |
| Lore Koppell | Linda Leest |
| Cheryl Loria-Dinolfo | Charles Pederson |
| Dottie MacVean | Terry Russ |
| Richard Menapace | Clifford Whitman |
| Tom Nagowski | |
| Lani Sanjek | |
| Cecilia Sanz | |
| Nelsa Selover | |
| Doris Welch |
Linda Leest, Chair of the Aging Services Committee and Lani Sanjek, Chair of the Governor's Advisory Committee jointly co-chaired the meeting. Dr. Leest called the meeting to order at 9 AM and welcomed the members, staff and guests. Ms. Sanjek noted that members had several briefings by conference call on the state budget between meetings. The Chairs identified the desire to have members dialog during the meeting and noted that there was a question form in packets in case time did not permit discussion of all items of interest.
II. Minutes
The minutes of the October 31, 2007 meeting were approved as drafted.
III. Director's Comments
Director Mike Burgess introduced new staff who had joined the agency: Long Term Care Ombudsman Mark Miller; Director of Affirmative Action Programs, Willie Ross; Assistant Director for Intergovernmental Relations and Strategic Planning, John Cochran; and Assistant Director in the Division of Finance and Administration, Sheela Rowland.
Director Burgess reviewed the state budget process. Members discussed their desire to see the aging services considered as entitlement programs that have open ended funding, based upon recipient qualifying income. EISEP and other aging services are not currently considered entitlement services and are limited based on appropriation rather than driven by actual need.
Director Burgess noted that there is a $5 billion deficit in the state budget predicted for the next fiscal year (SFY 2009-2010.) Members articulated the need to find a revenue stream that will support aging services so that the area agencies on aging can respond to the growing need for services, in spite of the decline in state revenue. Members suggested that NYSOFA explore the possibility of multi-year budgeting and an income tax check-off for aging services. Additionally, it was noted that the STAR program does not target those most in need of financial relief. Members also encouraged NYSOFA to explore fee for service payment systems on a sliding scale. It was noted that a sliding scale often protects the impoverished and allows those with higher income to pay based on what they can truly afford, but on occasion results in those that are in the middle incomes of the scale getting disproportionally impacted.
Director Burgess introduced the NY@Home theme. NY@Home is NYSOFA's slogan to package some of our proven initiatives that support "aging in place." Talking about those NYSOFA initiatives as part of NY@Home will make our mission to support aging in the least restrictive setting more understandable to consumers and policymakers alike.
NY@Home represents a comprehensive consumer program to assist persons to continue living independently through the provision of non-medical home and community based services, support for caregivers, economic security - (including tax relief and heating and weatherization programs), individualized information for long-term care decision making (including HIICAP, LTCIEOP and NYConnects), and promotion of livable communities and community empowerment.
Older New Yorkers want to remain in their homes and communities of choice but often cannot because their housing is no longer appropriate or their communities do not provide the supports necessary to do so. While there are many efforts to support housing, transportation, community-based health care services and a movement toward Livable Communities, the programs have not before been identified as part of an overarching theme of services to support "aging in place."
Director Burgess shared with members changes planned by the NYC Department for the Aging that were mentioned in the NYC Modernization Plan. There is the possibility that some senior centers may close as a result of the City's modernization proposals. It was noted that NYSOFA does not micromanage the area agencies on aging and provides flexibility to ensure that local offices are defining the services that need to be provided. Upstate counties are also seeking flexibility as they redesign services, and are faced with workforce shortages and burdgeoning populations of older New Yorkers. NYSOFA has numerous transition questions and will be monitoring the situation closely. Members raised concerns with modernization plans that would eliminate the delivery of fresh meals, noting that the delivery of the meal helps to ward off isolation and also allows the deliverer to report on the situation in the home.
IV. Review of Home & Community-based Services
Marcus Harazin and Greg Gardiner described the core services that NYSOFA funds and distributed information on the volume or units of service delivered. A significant amount of services are additionally funded, outside of allocation formulae, by direct allocations by the legislature (member item funding.) There is no impact analysis on those services funded through member items. Undertaking an analysis of the services funded through member items would require additional administrative funding for NYSOFA to assign budget examiners to this activity.
V. Council Member Reports on Local Issues and Innovations
Mr. Nagowski reported on the need for medical recruitment. He also emphasized the need to get older New Yorkers physically fit and identified the RSVP program as a vehicle to do so.
Mr. Menapace identified concern for budget cuts to EISEP.
Ms. Selover requested the status of proposed regulatory changes to advance Consumer Directed EISEP. Director Burgess responded that staff were continuing to work on the issue to examine how to ensure accountability.
Ms. Bassett asked to be kept informed on state and federal proposals that would advance universal health care coverage.
Ms. Welch reported that most seniors and their families do not know about aging services and that both outreach and community organizing were essential. She urged other members to talk within their communities about the services available.
Ms. Welch and Ms. Cabrera-Drinane both reflected on their disappointment that awardees at the Senior Citizen Day recognition ceremony do not reflect the minority populations in the state. The discussion included the need for more equitable representation on advisory committees.
Ms. Selover noted that regulation in meal programs do not address ethnic preferences in meals.
Director Burgess raised problems encountered in rural communities that have limited services and little opportunity to develop innovative aging in place programs because there are few providers and a lack of not-for-profit infrastructure.
Ms. Cabrera-Drinane identified that SSI has not been increased and there is a coalition formed upon principles to do so.
Mr. Dionne suggested that the Advisory Committees establish work groups to tackle some of these issues. Counsel Seehase reviewed the charge of the Advisory Committees. They serve to make recommendations to the Office for the Aging. Members expressed interest in forming work groups to advise the Office on policy and outreach issues. Chairs Sanjek and Leest agreed to develop a process for work group coordination. The Committees decided to form several work groups to focus on the issues of budget & flexibility for local governments, outreach & diversity, and public policy. Members volunteered for workgroups as follows: Budget & Flexibility - Mr. Menapace, Mr. Whitman, Ms. Selover; Outreach - Ms. Bird, Ms. Cabrera-Drinane, Ms. Welch; Policy - Mr. Dionne, Mr. Conners, Ms. Bassett, Mr. Appel. Advisory Committee members who were absent will be informed of the plan to create work groups and invited to identify their interest in serving.
VI. Regulatory Review Process
General Counsel, Jennifer Seehase, discussed the need for updates to the Office's Freedom of Information Law (FOIL) regulations to ensure consistency across state agencies. A draft document had been shared with members prior to the meeting and consensus was achieved to recommend to the Director to move forward with the draft.
Counsel Seehase provided an update for the Advisory Committees on the ongoing regulatory review process. The next issue to be reviewed will be the EISEP regulations, including the development of language to authorize consumer directed care. The process will include review of concerns with the area agency directors as well as the convening of a stakeholder committee to provide comments. When developed, the draft regulations will be brought to the Advisory Committees for review, comment and recommendations.
VII. Long Term Care Ombudsman Program Update
State Ombudsman Miller reported that there are 43 local programs with paid coordinators working either part time or full time in each program. There are more than 1000 certified ombudsman in the state, but that is not sufficient to meet the need to provide advocacy in the 160,000 residential long term care beds in the state. NYS has the 5th largest number of beds in the country; the state ranks 31st in the degree to which the program provides a presence in residential facilities. Currently, there is a 75% presence in nursing homes and a 33% presence in adult homes and assisted living facilities. Where there was a presence during 2007, the program handled 18,418 complaints; 88% of these were resolved which is greater than the national average.
Director Burgess stressed the importance of the program to identify community, resident and family member concerns and find resolution. Ms. Bassett described an unsafe and unsanitary facility in Sullivan County that did not have an assigned ombudsman. When reported to NYSOFA, the LTCOP requested the state Department of Health investigate, resulting in the closure of the home and the transfer of residents to other facilities.
Mr. Miller identified the program's priority goal is to increase volunteer recruitment in order to improve consumer education and outreach. New York's desired standard is 1 volunteer for every 100 beds. Advisory Committee members are urged to assist with volunteer recruitment in their communities. Mr. Miller identified that the main complaint fielded by ombudsmen relates to workforce issues. There is large turnover of residential care staff combined with lack of appropriate and consistent training. Mr. Miller noted that nationally, Ombudsmen are advocating for federal bill S2641, the Nursing Home Transparency Act.
VIII. State and Federal Legislation
Greg Olsen distributed a chart of the state Legislature's bills tracked by the Office that relate to aging services, noting that not every bill on the topic is tracked. The Office will be asked to provide comment to the Governor on bills that pass both Houses of the Legislature prior to Executive Action. The Office's review will include the ensuring that the bill language has been appropriately drafted, the ability of the state to afford any costs to implement and concern that the Office's administrative costs to implement the proposal are included. Advisory Committee members were encouraged to provide comments on bills listed on the chart by mid July so that their recommendations could be considered at the time of final bill review. A final list of bills signed into law, vetoed, or pending action will be shared with the Advisory Committees later in the year.
Sandy Longworth reported on federal budget process and deliberations as a supplement to the comprehensive federal updates that she shares frequently via email. She also distributed information on Project 2020, a white paper describing how to implement Choices for Independence, drafted by the NAAA (the National Association of Area Agencies on Aging) and NASUA (the National Association of State Units on Aging.)
Ms. Bassett asked Ms. Longworth to track S2219/HR3932 regarding Medicare Part D reform.
IX. Advisory Input to NYSOFA Initiatives
- John Cochran reported on plans for a NYSOFA co-sponsored Housing and Community Empowerment Conference, scheduled for November 12-13 in Saratoga Springs. Dr. Leest sought members' interest in participating in the Conference and members determined that they would plan to have their next Advisory Committee meeting held in conjunction with the Conference.
- Gail Koser provided an update on NYConnects, noting that there was a continuing increase in the number of counties providing information and assistance and the number of counties with functioning long term care councils. Ms. Koser also reviewed the types of callers accessing services, noting that the most calls received have come from professionals on behalf of patients, followed by family caregivers. Staff have been coordinating the work of the NYConnects program and the Family Caregiver Council, including work on satisfaction surveys and service gap analysis.
- Gary Malys presented information on the Senior Health Check-Up projected wellness and prevention activities. Mr. Malys also requested volunteers to help staff the Office's table at the Senior Games.
- Advisory Committee members provided positive feedback on Senior Citizen's Day activities.
X. Future Meetings
The Advisory Committees will continue to meet in joint session. The next meeting will be on the evening of November 12 in Saratoga Springs. The Spring meeting will be in Albany in concert with Senior Citizens Day, May 5 - 6.