As Older Population Explodes, 250+ Organizations Urge Doubling of State Aging Budget

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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AARP is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering people 50 and older to choose how they live as they age. With a nationwide presence and nearly 38 million members, AARP strengthens communities and advocates for what matters most to families: health security, financial stability and personal fulfillment. AARP also produces the nation's largest circulation publications: AARP The Magazine and AARP Bulletin. To learn more, visit www.aarp.org, www.aarp.org/espanol or follow @AARP, @AARPenEspanol and @AARPadvocates, @AliadosAdelante on social media.

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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.

Sincerely,

Stephen J. Acquario
Executive Director
NYSAC

Becky Preve
Executive Director
AANYS

CC: Blake Washington
Kathryn Garcia

Senator Cordell Cleare

Assemblyman Ron Kim

50 Forward Mohawk Valley

AARP New York

Action for Older Persons

Adirondack Health

Adirondack Health Institute

Adirondacks ACO, LLC

AHI

AIM Independent Living Center

Allegany County Office for the Aging

Alzheimer's Association

Andrew Mandelker

Angela Baker

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

Citizens, Inc

Benson Ridge Senior Services (Catholic Charities)

Best Life Older Adult Center

Beth McKinney RD

Blooming Health

Broome County Office for Aging

Canaan Senior Service Center

Caregiver Support

CaringKind

Carter Burden Network

CATHERINE SHERIDAN OAS

Catholic Charites Brooklyn and Queens

Catholic Charities

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

Services A.Rugen

Catholic Charities CCNS/ South West Queens

Senior Services

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

Senior Center

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

CCBQ- Northside Senior Center

CCBQ Woodhaven Richmond Hill Older Adult

Center

CCBQ Woodhaven-Richmond Hill Older Adult

Center

CCBQ-BRSS

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

CCNS/SWQSS

Chautauqua County Office for Aging Services

Chemung County Department of Aging and Long

Term Care

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

Clifton-Fine Hospital

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

legislature

Delaware County OFA

Dennis Yacobucci Montgomery County Office for

the Aging

DOROT

Dorthy Asbury, Director of Transportation, Schuyler

County Transit

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

Consulting

Family Services of Chemung County, Inc. Home

Care Department

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

Healthy Alliance

Heights and Hills

Henry Street Settlement

Herkimer County Office for the Aging/NY Connects

Home & Health Care Services, Inc.

Home Instead

Hospice and Palliative Care Association of New

York State

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

for Aging

Lewis County Office for the Aging

Lifespan of Greater Rochester

Lincoln Square Neighborhood Center

LiveOn NY

Livingston County Office for the Aging

Lourdes Palliative Medicine

Lucille Knowles

Margaret Haggard St. Lawrence County Legislator

Mary Hume, Program Director, Catholic Charities

Neighborhood Services/Benson Ridge Senior

Services

Meals on Wheels of Chemung County, Inc.

Medicare Rights Center

Montgomery County Clerk

Montgomery County Office for Aging

Montgomery County Office For Aging - Heather

Jablonski

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

Nima Roohi

North Country Healthy Heart Network, Inc.

North Country Home Services

OFA

Office of Mental Health

Office of the Essex County Manager

OldSmarts LLC

Ontario County Office for the Aging

Orleans County Office for the Aging

Oswego County Department of Social Services.

Oswego County Office for the Aging

Oswego YMCA

Otsego County Office for the Aging

Peta-Gaye Joseph

Polish&Slavic Center - JP2 Friendship Center

Potsdam Sandstone Senior Citizens Club

Project Guardianship

PSS (Presbyterian Senior Services)

Rae Hesseltine

RCOFA

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

OAC

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

Program Inc.

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

York

Town of Sodus

Town of Wheatland Senior Center

Tracy Hojohn

Ulster County Office for Aging

United Jewish Council of the East Side, Inc.

Village of Richville

VISIoNS/Services for the Blind and Visually

Impaired

Visiting Nurse Association of Albany Home Care

Corp.

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,

Inc.

Whitney Callaghan

Woodhaven-Richmond Hill Older Adult center

Young Men's and Young Women's Hebrew

Association of the Bronx, Inc. (dba Riverdale Y)

 

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