Full Episode: Aging Together in New York

Full transcript of Aging Together in New York

Dan Clark: This week, we're going to take a break from the news and explore issues that matter to aging New Yorkers, and let's start with what we mean by that.

When we say aging New Yorkers, we're talking about older adults who are either close to retirement age or beyond it. That is a huge chunk of New York's population. People over the age of 55, for example, make up about 31% of the state's population, according to the US Census Bureau, and people in those age groups are also really politically active. Just look at Long Island in last year's primary elections. In June, almost 90% of voters in Suffolk County and almost 80% in Nassau were age 50 and up, according to the AARP. So, these are people literally deciding some of our elections, but they also face a unique set of issues that are important as we all age.

That's why the state is now creating a long-term strategy for its aging residents. It's called a master plan for aging, and it's designed to be constantly evolving to meet the needs of aging New Yorkers well into the future. For more on that and how the state already serves its aging population, we spoke with Greg Olsen, director of New York's Office for the Aging. 

Greg, thank you so much for being here. I appreciate it.

Greg Olsen: Oh, my pleasure. It's an honor.

DC: I think a lot of New Yorkers don't know that we have an Office for the Aging. So, tell me a little bit about what you do over there.

GO: So, we're the designated state unit on aging, and we oversee a network with 59 county offices for the aging and almost 1200 community-based organizations that provide a variety of community-based services, both in the home and in the community, with the sole goal of trying to help older adults remain as independent as possible for as long as possible.

DC: Recently you surveyed 20,000 older adults on their concerns. What do they value? What do they expect in their communities? I would imagine a lot of the issues are the same that we see across New York state but tell me what you found out.

GO: Yeah, we're really excited to do the deeper dive. We just started going through 26,800 responses, and that is a huge sample size.

DC: That is a lot. When we talk about Siena polls on the show, it's 900 people.

GO: That's exactly right, and that's what we're excited about. The great thing is we got people from every single county, every income range, and every age range over the age of 60. So, what you're seeing is them evaluating their communities. Many of them think that the community that they that they live in is a really good community, but then when you start asking questions about access to transportation or health care, or do you do you belong to civic groups? Can you afford your housing? Can you afford your prescriptions? You see the numbers start to change, and it's a really, really important data set both for our four-year plan that we're developing now for the feds and for the master plan on aging.

DC: When you talk about transportation, I would assume that that might be a bigger issue in rural areas, but you tell me. I'm thinking of like where I'm from in Shenango County, for example, the public transportation system is not like what you would see in New York City or Albany. It's kind of just a lot of it's just busses, maybe some vans picking people up across the county, and a county like Shenango is quite a big area.

GO: It is, and I know that county very well. It’s an issue everywhere, to be honest with you. Public transportation assumes you can physically use it, you can afford it, and you know how to use it. There are fixed routes around New York state, but as you said, 95% of the state's geography doesn't have any public transportation.
We provide over 20 million rides a year using paid staff, volunteers, cars, we have a new partnership with GoGoGrandparent, which is a specialized rideshare service that we are testing now in three counties, but there is an interagency task force that just launched last Friday that, we're a part of with the Department of Transportation and many others to look at and address rural transportation.

DC: Now on health care is it kind of the same issue of lack of access in these rural areas? You know, you see hospitals closing, you see healthcare kind of few and far between, especially specialists, which a lot of older adults require.

GO: Yeah, and a lot of people of all ages actually do, you're absolutely right. There are food deserts, there are prescription deserts, there are health care access deserts, so, in less dense places like where you said you're from, Shenango County and many of the others, we have 42 statutorily defined rural counties in New York state, where that lack of density does impact service provisions for sure.

DC: Let’s talk about how you are addressing issues facing these older New Yorkers over a number of years. So, Governor Hochul signed an executive order last year that will create a master plan for aging in New York. I believe that your officers are responsible for developing or it's a council of people?

GO: So, it's led by the Department of Health and we're a co-chair and we have over 20 state agencies. We have subcommittees of stakeholders throughout New York State, and we have an association committee. Really what that's designed to do is kind of take the next step. We became the first age friendly state in 2018, recognized by the World Health Organization, AARP, and this is the next iteration to make it stronger. What can the government do with our partners, both public and private, to change the built environment in the home and community that support people of all ages? 
We know that 60% of all health care costs are attributable to our own decisions. Do I smoke? Do I have access to good food? Do I exercise and the environment that we live in? So, what the Governor has been so successful with is pulling all of these things together so that we can build communities to help people grow up and grow old and thrive.

DC: It hasn't been too long since the executive order, so, I know you're in the early stages, but where are you in the process of developing that master plan?

GO: Yeah, so right now we've had four meetings of the state agencies, but a lot of the work is going to be done by the subcommittees. We've got about seven or eight subcommittees that are meeting as we speak. Then what we need to be doing is going out to the public and doing public forums to get input and feedback from them. That'll happen over the summer and we'll be able to start to piece together recommendations, gaps, how we deal with diversity, equity, inclusion, access, issues, hard to serve communities, etc.

DC: Do you have a deadline or due date? Do you have an expectation of when the plan would be?

GO: The state of the state and the executive order gave us 18 months in to conclude. So, it'll be sometime in early 2024.

DC: Is that enough time, do you think? I mean, this is such a big issue, you're looking at a lot of things but at the same time, people really can't wait.

GO: I really do, because like I said, this state has been working on livable communities, smart growth and age friendly since 2006. This is not new. We have a lot of resources and activity going on in all ages. So, you know, aging just does not impact my agency. Older adults hit DMV, Department of Transportation, Housing and Finance, Office of Children and Families, etc. 
So, there's a lot that we've already done. We need to pull that together, show the public that we're doing these things. We sit on over 31 interagency task forces and commissions that are dealing with individualized issues that have made recommendations such as the Alzheimer's Disease Coordinating Council, the most integrated setting coordinating council, which is our Olmstead plan. We have an emergency management council, we have a Geriatric Mental Health Council, Suicide Prevention Council, a hunger nutrition council.
So, you don't need to recreate the wheel, you just pull that stuff in.

DC: You're doing quite a bit of work with the master plan. Once you have it complete, how far ahead does it look? Are we talking about just a master plan in perpetuity or is this kind of like the federal plan that you're putting together where it has like a five-year, ten-year kind of thing?

GO: Yeah, so the goal is to have it always be an evolving and working document. Things are very different in aging today than it was ten years ago, 20 and 30 years ago. We've had a growth over the last ten years of 880,000 older adults and a loss of those under 60 at 400,000. Growing older isn't the problem, it's the way that we've structured our caring community. 
And that's really the focus on what can we do in the communities, whether you're younger, middle age or older to impact you, that's going to be positive for your public health, your well-being, your mental health, your behavioral health, so that as you get older, you're not declining. We're not waiting for people to get sick, we're not waiting for people to go to the hospital and spend down to Medicaid. So, there's a lot of things on the front end that we can and should be doing.

DC: On that note, Governor Hochul, the legislature just passed a state budget earlier this month. What is in there for aging New Yorkers, you think that would benefit your work?

GO: So, we can start with our agency. There was almost $10 million in additional money to provide personal care in the home. We received $2.5 million additional dollars for our long-term care Ombudsman program. These are people that go into nursing homes and make sure that the quality of care that residents are getting is appropriate. That’ll allow us to hire another 50 or so full-time employees, and that was in addition to the $2.5 million we got last year. 
So, you're talking about 100 more staff because we saw what happened during the pandemic in these facilities. There's also a lot of additional money in health, long term care on the workforce side, on the capital side, there's almost $1 billion in additional mental health. There are dollars in the housing arena to, you know, improve energy efficiency, to retrofit homes so that you can reduce the costs to assure people aren't being evicted.
So, there's a lot of things in various other agencies in addition to ours that have a positive impact on older adults.

DC: I want to circle back to the Ombudsman program for just a moment. A report from the AARP in New York found that over a three-month period last year, about half of the state's nursing homes didn't get a visit from someone from the program. You and I were talking about this before we started taping. Is the new money that you're getting that you mentioned? How much of a dent can we put into that gap?

GO: It's going to have a significant dent, and you're right. So, the long-term care Ombudsman program is a federally mandated program, and they provide the state of New York hardly any resources. It's very difficult to have a program like that when you're not actually paid to do it. 
The state has stepped up over the years, but we've always been heavily reliant on volunteers. We love our volunteers, they do a great job, but you need paid staff to do this, and so we've known this has been an issue for a while. We've seen the number of volunteers before the pandemic going down. We had 700 at one point, we're down to 240 and then during the pandemic, that was difficult. 
People couldn't enter the nursing homes for obvious reasons. So, what this additional $5 million is going to do is allow for many, many more full-time and part-time staff that are trained and certified by us to go visit.
Now, we will always respond to a call. So that doesn't matter which facility it may come from. What we're trying to gear up to is to make sure that every facility gets a visit at least once a week.

DC: Before I let you go, I want to talk to you about an issue that we don't really talk about too much, and that's social isolation for aging New Yorkers. This is an issue that is important to me because mental health is very important to me as an issue, and when we talk about aging New Yorkers and their isolation it's a snowballing thing where it can affect your mental health and your physical health. As a state, as communities, what can we do to fight against that?

GO: There's a lot we are doing. You're absolutely right, the pandemic really shined a light on. This is something our network has been doing for over 40 years, but we saw a huge impact actually on younger people. But to your point, for older adults, I mean, a lot of the folks that we serve live alone. Our average person is an 83-year-old low-income female that lives alone.
And you talked about transportation. When you give up your ability to drive or you can't get somewhere, you're more isolated. So, we have launched a variety of low, medium and high-tech innovations to combat isolation, like our animatronic pet project, which has shown to reduce isolation, depression and loneliness by 75%. That's now been replicated in 35 states.
We launched a platform called Get Set Up, and within 18 months we had 200,000 people over the age of 50 taking over 2000 classes. They took a million classes. So, we've done things like that. We've developed tutorials with our association with DOROT on how to develop a friendly visiting program. But the simple solution is if there's any older adult or younger person in your life, reach out You know, sometimes it's just old school sitting down and talking to somebody.

DC: Yeah, exactly. You know, sometimes issues don't have to be complicated. 
Greg Olsen, director of New York's Office for the Aging, thank you so much.

GO: My pleasure. Thank you for your interest in the topic and for having us.

DC: Whether we're talking about isolation or health care, the state's Office for the Aging can connect you with help. Their website is aging.ny.gov.

Dan Clark: When it comes to aging, it's more complicated than just state services and other supports. Sometimes help with aging comes from your next-door neighbor or your kid or your community. In this piece from WMHT’s Will Pedigo, we look at how one person can make a big difference.

Carolyn Grosvernor: Now that I'm going on 69 and I'm thinking about aging, who's going to look after me? Who's going to notice that I didn't bring out my trash cans, or I didn't pick up my mail? That my car has not moved? Does anybody care?

I'm a physician volunteering here at the capital City Rescue Mission. My focus as a primary care provider is identifying the problem.

I remember a veteran that I saw when I was working at the VA and he actually said, I'm starved for conversation. He wasn't having an issue. He just wanted to be able to share some joy with someone.

We live in a country where we all have our own independent lives, and I'm not so certain that that has helped us. We are created to live in a community.

If each of us looked at the older people in our community, in other words, we could adopt our neighbors. I am going to be going over to see my neighbor after work today. I'm only there about 15-20 minutes, but she's lonely and she needs someone to talk to.

I think it begins with asking questions. How are you feeling? Are you eating? Are you sleeping? What are you doing for social activities? It's going to be up to our whole society to value the lives of older people who raised us, supported us, helped us along the way.

Dan Clark: When we talk about aging, there's more to it than just what the state's doing and how people experience it in their daily lives. There's also the legislative perspective. In the past few years in particular, issues around aging have been at the forefront in the state legislature, from conditions at nursing homes to access to home care. 
But as you know by now, aging New Yorkers deal with a lot more than just those two issues. So, to learn more about the legislative approach, we spoke with Assembly Member Ron Kim, the chair of the Assembly Committee on Aging. 
Assembly Member Ron Kim, thank you so much for being here.

Ron Kim: Thank you so much for having me on.

DC: So, you are chair of the Aging Committee. Let's start there. What does the aging committee handle in terms of issues, topics that people who aren't familiar?

RK: It's the Standing Committee on Aging in the Assembly. This is my second term chairing this very important committee. Our primary task is to take care of older adults, as they did New York. Making sure they don't fall through the cracks. It’s a very complex, huge system that involves Medicaid, Medicare, but they’re a population that are always falling through the cracks.
My main task is to work with the State Office for Aging to make sure that we fully fund those programs. So, they don't they don't fall through those cracks.

DC: It's an interesting issue, because for aging New Yorkers every issue for everybody else in New York is also their issue, but they also have specific issues to them, like transportation, health care, things like that, but what do you see as the top issues for aging New Yorkers right now?

RK: Well, we don't have any planning for the elderly population, and we have a crisis in our hand, and by the time we wake up and realize, oh my god, there's no insurance, there's no nursing home, there's no homecare worker for my grandfather, father, my loved ones, it's too late. 
We all kind of went through this and people don't understand it does have an economic toll when working families have sacrificed so much to take care of our older adults. When the government should be stepping in and taking care of our most vulnerable.

DC: Oh, absolutely. I mean, when you have to spend money on caring for somebody else, you don't have money to put food on the table and pay your bills, everything like that. 
Something that I wanted to talk to you about in particular is nursing homes. During the pandemic, you were very outspoken about the conditions in nursing homes. You and I both know the former administration, the Cuomo administration gave out misleading and false information to the public on nursing home deaths and later tried to correct that in some way, shape or form. We've also passed laws to make nursing homes safer. So safer staffing allows care, nursing homes have to provide at least three and a half hours of care per resident per day now. Do you think we need to go further?

RK: Yeah. I mean, we met when many states a long time ago decided to try to administer the type of care in nursing homes. That's a guaranteed state-backed government. New York chose to outsource and contract everything, and this is many decades later. We only have 14 municipal-run nursing homes in the entire state, and they're failing.

In the last ten years we have to shut down like a dozen under the former administration, and that's part of the problem. The moment the public money goes out of our hands, we have insurance companies and nursing homes and predatory operators and bad operators that are just preying on those dollars and not delivering the care that we are putting their money for.
So, I think at the core of this problem is that the government lacks the administrative capacity to actually deliver the guaranteed care that our people deserve, but it's not too late. Other states have done a better job at this, and we can look at how they've done it. We can set up care infrastructure. We talk about treating care like infrastructure, but we don't have any mechanisms to actually do it.

I believe post-budget we should focus on creating like a Port Authority, Power Authority, like an MTA type of agency, a long-term care authority that’s dedicated to supporting the long-term care sector, including those facilities that are failing.

DC: Now, you look at nursing homes. There's also the issue of home care. People who are at home either for a long period of time, maybe in hospice, things like that, or, you know, just need help around the house. Everybody wants to get home care, and home care is very difficult to find in New York.

What homecare workers will tell you is that's because there's such high turnover, because the wages are so low for home care workers. I know in this year's state budget, we're keeping their wage a little bit above the minimum wage, I believe. Do you think that goes far enough or is there a better solution for this industry.

RK: Just like nursing homes, I think we need a fully integrated government solution here. We also outsourced home care. In the 1980s. California created these type of long-term care authorities in each county of California administers home care to the county governments. So those homecare workers are viewed as public servants and public employees. They belong to public employee unions. But here (in New York) we made a choice to contract everything out. 
So, a lot of the money gets lost. We lose about $1 billion in back wages every year in the home care sector, and there's no accountability because what's the alternative here? Our people need care, and if we break up the entire industry without offering a solution, no one gets care.

DC: You know, both home care and nursing homes, I have to imagine, will be part of the state's master plan on aging. It's a thing that has been created under an executive order from Governor Hochul in 2022. It's kind of just getting started now.
Do you have confidence in that process to be the thing that you're looking for to create that plan that you said that we're lacking, or do you think that we need to go farther?

RK: I'm always hopeful with any governor, with any party, if they're willing to build a capacity to care for people, I want to be there every step of the way. If this plan is taking us in that direction, I want to be there. I want to support it. I don't know. I think they've had a couple of meetings, a few meetings. I'm not that confident at this point whether we're going in the right direction based on what they push for in the budget. 
Older adults can't wait another two years for us to issue a master plan. We know what the problems are, we should have been funding it from this budget on, but that's not what happened. 
So, regardless if there's a golden opportunity, I think, for Governor Hochul and her administration to say we need to build capacity, we need to build the public sector that has been severely undercut for last 20 years, and it's something that she didn't create, right? That she inherited, but it gives her a platform to be a national champion on how to get this right.

DC: So speaking of Governor Hochul, her and the legislature just passed this year's state budget. You mentioned it a few times. Is there anything in there that could go towards these problems that that we're talking about?

RK: Yeah, one of the things that we were proud of was to fund the state Office for Aging. So, the area that office and my committee focuses on is the above poverty home care sector. So, people who don't qualify for Medicaid, but if we don't take care of them, they will spend down, impoverish themselves to get Medicaid.
So if we fully invest in that sector, we will save up to hundreds of millions of dollars the next couple of years. In fact, for every dollar we invest in that middle sector, we save up to $8 in Medicare savings in the back end. Wow. That's a that's a tremendous economic return for the state. So, we’re able to secure close to a total $15 million the last two years to fund that need and also to get rid of the waiting lists.
There's thousands of people, up to 15,000 people on a waiting list to get home care who don't qualify for Medicaid. So, if we can take care of those people, we will start solving a lot of problems in the state.

DC: All of these issues that we talk about when we talk about aging New Yorkers, it just feels like we need a whole lot more money invested in it.

GO: Yeah, and that's why my original idea going forward, which I've been talking to AARP and other organizations, is let's truly treat this like infrastructure. That means that we need an authority to dedicate every resource to leverage every dollar that comes in just like MTA leverages in future fees to finance bridges, lets also financed the long term care sector, the way that we treat bridges and tunnels.

DC: And do you see that as a separate kind of authority, or do you want to just beef up the Office for the Aging?

RK: That would have to be a separate public benefit corporation. General government agencies are unable to float bonds, borrow in the market. It's the authorities that have the power to do that. But such an authority would work in conjunction with the Department of Health and the State Office for Aging. So all these things that we fall short on, they'll be there to step in and finance those things and build the public sector to deliver care.
Right now, we're doing through one, borrow legislation at a time like we would try to activate a dormitory authority to borrow money for the nursing homes. It doesn't work. We need a dedicated agency to build infrastructure for care.

DC: There is just a lot in the aging space, and we'll have to have you back to talk about where everything is going. But Assembly member Ron Kim, thank you so much for talking about all this. I appreciate it.

RK: I appreciate your time. Thank you.

Catch this week's show on your local PBS member station, or watch on YouTube, Facebook, or using the free PBS app anytime after Friday.

On This Week's Edition of New York NOW:

• We explore how New York serves its aging residents, the unique challenges those individuals face, and where gaps in service exist.
• Greg Olsen, director of New York's Office for Aging, joins us to discuss their work and resources available to aging New Yorkers.
• Assembly Aging Chair Ron T. Kim chats about how the state can better serve aging residents from a legislative presepctive.