Good Morning. My name is Greg Olsen, and I am the Deputy Director of the Division of Policy, Management and Public Information. I oversee policy development, coordinate legislative and intergovernmental affairs, oversee the development and implementation of our point of entry initiative and oversee our communications bureau. First, let me thank you, Assemblyman Rivera and Assemblyman Dinowitz for asking the New York State Office for the Aging to testify at this important hearing to ascertain the outcomes of the Geriatric Mental Health Act of 2005 and our thoughts on including chemical dependence to the Geriatric Mental Health Council. Michael Burgess, the Director of the Office could not be present today, but he asked that I share his personal appreciation to you for your recognition of the importance of identifying and serving older adults with mental illness and chemical addictions and for the leadership that you have shown in proposing and passing this landmark statute.
Previous to joining NYSOFA, I served as chief staff and legislative and policy director for Assemblyman Englebright and was intricately involved in the development of, and passage of the Geriatric Mental Health Act of 2005. I have also worked directly with Assemblyman Dinowitz to draft legislation that would address Geriatric Chemical Abuse issues. Last fall, Assemblyman Dinowitz held a hearing on the Geriatric Chemical Abuse Act and I have submitted the testimony that NYSOFA delivered at that hearing along with our testimony submitted today that demonstrates the agency's strong support for serving older adults with addictions, but also our support for adding chemical dependence to the Geriatric Mental Health Council.
The New York State Office for the Aging (NYSOFA), established in 1965 by Article 19-J of the Executive Law (now, New York State Elder Law, Article II, Title 1), is designated as New York's lead agency in stimulating, promoting, coordinating, and administering Federal, State and local programs and services for older New Yorkers. NYSOFA plays a central role in advocating on behalf of the 3.4 million older adults and their families living in our State, collaborating with public and private organizations and agencies in order to achieve common goals in better serving older New Yorkers, facilitating and guiding policy development to improve the quality of life of older New Yorkers, and assuring the delivery of high-quality services in communities across the State to help older adults remain as independent as possible for as long as possible . and engaging older adults, their families, and other stakeholders in the process.
NYSOFA collaborates with state and county agencies, thousands of non-profit and for-profit organizations, academic institutions, and our 59 area agencies on aging throughout the state. NYSOFA relies upon the network of area agencies on aging to be the front line for older adults and their caregivers, to provide critical information pertaining to local needs, barriers to services, sharing best practices and so on. We are currently working with the area agencies and local department of social services through our New York Connects point of entry initiative to develop a more formal mechanism to identify issues that prevent, or make it difficult for, older adults to remain in their homes and communities. The network of service providers strong working relationships enable us to provide training, develop policies and programs, respond to issues of concern, provide technical assistance, and advocate on behalf of the individuals and families that we serve. Collaboration and cooperation among the various partners are important, and have laid the groundwork for vital initiatives that are being developed, tested, and implemented.
New York is home to 3.2 million people over the age of 60, representing 17% of the state's population. By year 2015, this number is expected to grow to 3.7 million, representing over 18% of the state's total population and by year 2025, those 60 and over will number 4.4 million.
New York's older population is very diverse - diverse ethnically, culturally, in geography, living arrangements and so on. Generalizations about the needs and interests of this population usually lack accuracy because of the difference in the age groups and age span, and from the wide diversity.
Chapter 568 of the Laws of 2005 established the landmark legislation creating the Geriatric Mental Health Act. The Geriatric Mental Health Act created a very important vehicle to begin to raise awareness of, and address the mental health needs of the older population in New York State. The geriatric population has traditionally been underserved, the mental health support and service system was not designed to meet the unique needs of older adults, and the Geriatric Mental Health Act was critical in setting the framework to develop better ways to serve those older adults and their families who have long suffered from mental disorders.
NYSOFA and the Office of Mental Health (OMH) co-chair the Interagency Geriatric Mental Health Council and, along with sister agencies and other critically important council members, have engaged in groundbreaking program and policy initiatives designed to improve the well-being of the segment of the older population that suffer from some form of mental illnesses. The goals of the Geriatric Mental Health Act are to:
I understand that testimony from the Office of Mental Health will focus on providing additional detail regarding the Request for Proposals (RFPs) that funded two separate community-based program models for older adults with mental illness as well as the evaluation of the grant projects currently being conducted. The grantees providing testimony can talk in more detail about their programs and the unique ways in which they are providing access to critical mental health services to older New Yorkers. NYSOFA was intimately involved in the development of the RFPs and played a significant role in the comprehensive review process used to select grantees. We look forward to continued progress by the grantees and more importantly to the testing of successful models that will hopefully be applied in other communities across the state
The Geriatric Mental Health Act has now set the foundation and the mechanism to determine how we, as a State, can work collaboratively to identify new and emerging issues as well as address critical issues that have already been identified to serve older adults with mental health issues. The 2006 annual report describes the work of the Council to date and recommendations, as required by law, to improve mental health services for older adults. Recommendations in the 2006 annual report include:
These recommendations are confirmed by many advocates and mental health providers, some of which serve on the Council. The complexity of mental illness and its relationship to one's health and the health care system and aging service systems must be a central part of planning for care and service delivery in the future. The different care systems must not continue to operate in isolation, integration is a crucial component in order to ensure the best outcomes and to reduce costs. Care must include the mental and physical health and aging service supports.
With this complexity in mind, the mental health, health and the aging networks need to plan for individuals with:
While the overall demographics of the state show that the population will age, it must be understood that increases in mental health problems and chemical abuse will also rise. This growth will challenge health, mental health and the aging services networks to provide adequate access to services that respond to the unique needs of older adults in a coordinated way.
The majority of older adults live in their communities (94%) and most consider themselves healthy and active, which is counter to public perception about aging in which the general public view aging as a time of loss - both physically and mentally. Combating stereotypes and ageism in the general public but also among health and mental health professionals themselves is critically important if this state and country are to be able to effectively serve older adults. The current cohort of Baby Boomers has shown a relatively high rate of depression, anxiety and substance abuse. We can anticipate that these trends will accompany them into old age, and therefore, evidence-based models for screening and intervention along with demonstration programs that have been evaluated and proven effective must become mainstream in service delivery. In other words, best practices must become standard practice.
Cognitive functioning is a primary determinant of mental health in old age. Cognitive impairments related to organic mental disorders such as Alzheimer's disease and multi-infarct dementia are a critical mental health concern. It is estimated that 10 percent of the population over age sixty-five may have some degree of cognitive impairment and this rate increases with age. In New York, there are 330,000 individuals diagnosed with Alzheimer's disease, the most common form of dementia, however, the numbers related to overall dementia are higher. We know that living longer increases the likelihood of dementia and need for long term care.
Chronic illness and conditions are prevalent among older persons and they can have a major impact on their emotional well being. The most common medical problems affecting older adults are arthritis, hypertension, heart disease, diabetes, and sensory loss. In fact, health factors often lead to depression and depressive symptoms which are considered the most common mental health concerns among older adults. The presence of a chronic ailment is closely tied to functional capacity. Age and the presence and duration of chronic disease significantly decrease the ability to perform activities of daily living. Dependence on others in regard to shopping, bathing, and dressing has a negative impact on one's self-esteem and self-worth, which contribute to depression and other mental health problems.
We are all aware of the financial crisis the state is facing with a projected deficit over the next three years in excess of $20 billion. What this means is that we must continue to work smarter. The Geriatric Mental Health Council, the Most-Integrated Setting Coordinating Council, the Family Caregiver Council, the Alzheimer's Disease Coordinating Council and other Councils have brought together the correct agencies that need to communicate and collaborate to address barriers to living in the community. Through these collaborations, identifying regulatory and statutory changes that need to be made can be advanced to help reduce the silos that have been built over the decades that prevent better cooperation and integrated care.
One area that we believe can be of great assistance in helping to screen, identify and provide services to older adults is the existing community-based infrastructure such as senior centers and congregate programs, NORCs, adult day services, etc. The network of senior service providers is a trusted source for information and they are focal points in the community to coordinate care, provide screenings, implement evidence-based programs including prevention and health and wellness programs. We do not need to build a new infrastructure - it already exists, we need to work together to coordinate and co-locate, so individuals' holistic needs can be met and people do not fall through the cracks. Staff training is also critically important so as senior service providers and other human service staff interact with individuals and families each day, they are sensitive to what to look for that may help connect someone to the help they may need.
Another critically important initiative that NYSOFA is leading and working with the Department of Health at the state level but with county stakeholders such as the department of social services, disability providers and advocates, mental health providers and advocates and other aging and health community stakeholder is the NY Connects - Choices for Long Term Care point of entry initiative. Fifty-seven out of fifty-nine area agencies on aging are now implementing information and referral, and screening to provide unbiased information about long term care services in the community. NY Connects is positioned to help ensure that older individuals in need of some type of mental health service are not left to fall between the cracks. Many of the NY Connects programs have engaged mental health providers locally through their long-term care councils. The long term care councils are required of every NY Connects program and they are designed to bring together community stakeholders to work together to understand each other, get a listing of the variety of services that are provided so the program can provide accurate and comprehensive information, perform a gap analysis to determine what services are needed but are not provided and problem solve locally to meet local needs. One important vision the councils have is to help facilitate interagency collaboration and training of staff across agencies so as to better identify and ensure people receive the appropriate referral and care they need. One other critical function of the local long term care councils is to build a mechanism where they can feed information to NYSOFA addressing barriers, gaps and other important information that can be used to develop and implement policies that will help delay more costly care in institutions.
There is still much to do and these issues cannot be solved in one year, but will require years of working toward a common goal - a more integrated health, mental health and aging services system. We need to develop strategies over time that will address:
In closing, I want to acknowledge the continuing work of our partners in helping to move the vision outlined in the enabling legislation that established the Geriatric Mental Health Council to a point where we will soon have tangible preliminary outcomes from both the policy directions set forth in annual report documents and the demonstration programs currently receiving funding. I want to express our interest in continuing to work with the Office of Mental Health in co-chairing the Geriatric Mental Health Council and look forward to continued efforts to advance services and programs that address the mental health needs of older residents of our state.
Thank you once again for inviting the State Office for the Aging to testify today at this hearing and thank you for your leadership and dedication to this underserved yet critically important population who deserve to have access to help. I assure you that your findings will be most helpful to the future deliberations of the Geriatric Mental Health Council and we look forward to any report that results from your work here today.
I would be glad to answer any questions you may have.
Deputy Director Olsen's Testimony with cover [PDF] [Word]
