CSCS: Council of Senior Centers and Services of NYC, Inc.

Testimony

PUBLIC HEARING: S. 3340
SENATE COMMITTEE ON AGING
CHAIR, SENATOR RUBEN DIAZ, SR.
MAY 14, 2009

Council of Senior Centers and Services (CSCS) is the central organization in NYC representing the 329 multi-service senior centers and meals-on-wheels providers who comprise the major nutrition program for the elderly in the five boroughs. CSCS members service 300,000 older New Yorkers through a broad array of community-based services including transportation, case management, home care, NORCs, adult day care, housing, mental health, elder abuse, intergenerational programs, ESL and services for immigrants, health and wellness programs, cultural and educational programs, voluntarism, and other services.

Who is growing old in NYC?

• The 85+ population is the fastest growing segment of the city’s population.
• Over 50% of the 65+ age group is comprised of minority elderly.
• Mayor Michael Bloomerg’s 2030 plan projects a 44% growth in the 65+ population by 2030.
• Poverty among NYC elders is growing. Based on federal poverty criteria, one out of five seniors live in poverty. Mayor Bloomberg’s recalculation of poverty based on criteria from the National Academy of Sciences reported a 32%, one out of three, poverty rate among NYC elders. Much of this poverty is centered in minority communities.
• It is projected that due to the deep recession the country is in, there will be no COLA increases in Social Security for a number of years. This will significantly impact the income of senior citizens. Additionally, the state almost cut funds to SSI recipients which was, fortunately, restored by the state legislature.
• CSCS’ 2007 hunger study reported one out of three seniors interviewed as reporting “food insecurity” – fear of not having enough money for food, actually not having enough nutritional food, and being hungry.

An idea whose time has come - preventing waiting lists for meals-on-wheels recipients as a integral piece of a community-based long term care system –

On behalf of its 200+ members providing 13 million meals annually to older New Yorkers, CSCS commends Senator Ruben Diaz, Sr., Chair, Senate Committee on Aging, for introducing S.3340. This forward thinking legislation addresses the first recommendation in the 2007 CSCS hunger study: “Community agency capacity and funding must be made available so that older New Yorkers have access to congregate and home-delivered meals throughout the neighborhoods of the five boroughs…” (emphasis added)

It is time that NY State and NYC end waiting lists for meals-on-wheels. A simple, straightforward idea. Yet, a compelling one which begs the questions:

• Why hasn’t New York done this sooner?
• Who would be opposed to the state ensuring eligible homebound elderly New Yorkers receive meals-on-wheels?
• What would the opposition be based upon? If it is cost, then the health care benefits of proper nutrition and preventing social isolation will far outweigh the cost of providing meals-on-wheels per year. Based on the current reimbursement rate in NYC, it costs about $1750 per year for a meals-on-wheels recipient (food and delivery costs). This is a drop in the bucket compared to hospital stays and unnecessary re-admissions.

As older New Yorkers grow in number, diversity, longevity, increasing poverty, and more likely to live their old age in the community, community-based social service supports will become increasingly important. Central to that, is meals-on-wheels which addresses both the nutritional needs and social isolation of homebound elderly individuals.

Research of relationship between elderly nutrition, hunger and chronic diseases clearly establishes the value of “food as medicine” –

In the forward of the CSCS 2007 study, “Hunger Hurts: A Study of Hunger Among NYC’s Elderly”, the following studies are quoted clearly showing the importance of adequate nutrition among the elderly:

“Developing programs that provide opportunities for “healthy aging” is a public policy shift that is discussed by service providers, advocates and government officials. According to the April 2007 report - “Older Americans Act Nutrition Program, Choices for Independence” - “Research has shown that a healthy diet and physical activity are more important than heredity in avoiding declines associated with aging…Nutrition is central to disease treatment and management. All top nine chronic diseases…have dietary and nutritional implications. These in turn influence the ability to remain independent in the community.” (emphasis added)

Hunger does not support health. Hunger has ramifications for the individual and for the city. The OAA Nutrition Program report compared the impact of
older adults receiving three or more meals a week with those receiving fewer and found that both congregate meal and meals-on-wheels recipients receiving more meals had significantly fewer inpatient hospital admissions.

The May, 2007 UCLA Health Policy Research Brief, - “Falls, Disability and Food Insecurity Present Challenges to Healthy Aging” - states, “food insecurity – struggling to afford enough nutritious food – can imperil healthy aging…food insecurity has serious health consequences for older adults. Three of the most common chronic diseases – hypertension, diabetes and coronary heart disease – can be prevented, and in some cases treated by a healthful diet.” (emphasis added)

The CSCS Hunger Study recommends: (full report – www.cscs-ny.org -
http://cscs-ny.org/advocacy/files/2007CSCSHUNGERSTUDYFinalReport.pdf)

“Addressing hunger among the elderly has many implications. All can agree that no elderly person should be hungry. CSCS is challenging itself, community service providers, advocates, government officials and private philanthropy to commit to ensuring that we all work together to facilitate access to three nutritional meals daily for older New Yorkers. As policy decisions are made on the types of city services and level of funding made available such as the cost of housing, transportation and health care, the impact on those struggling with hunger and food insecurity must be taken into account.”

Additionally, the recently released CSCS long term care policy paper, “No Time to Wait: The Case for Long Term Care Reform”, recommends, “optimizing older adult nutrition programming through the expansion of congregate and home-delivered meal programs as well as nutrition education targeted at those living with chronic illness.” (full report – www.cscs-ny.org – http://www.cscs-ny.org/advocacy/reports/long-term-care-paper.pdf )

A study supported by the National Institute on Aging “A Multidimensional Approach to Understanding Under-Eating in Homebound Older Adults: The Importance of Social Factors”, Julie L. Locher, PhD, Christine S. Ritchie, MD, Caroline O. Robinson, MA3, David L. Roth, PhD7, Delia Smith West, PhD and Kathryn L. Burgio, PhD, published in the Gerontologist in 2008 reported:

“Homebound older adults, including those who are homebound because of health-related reasons, are a heterogeneous group, and experts must take these differences into account when developing programs. Specifically, where appropriate, experts should take gender and ethnic differences into account in designing and implementing programs found that homebound men and women with poor nutrient intake, regardless of BMI, have the lowest level of lower extremity physical performance. Recent reports from the University of Alabama at Birmingham Longitudinal Study of Aging have found that unintentional weight loss, but not intentional weight loss, predicts declines in function and life space mobility and mortality across all BMI groups. These findings by Sharkey and investigators from the University of Alabama at Birmingham suggest that prevention of unintentional weight loss, including for those who are overweight or obese, may be beneficial in the prevention or restoration of function disability. Future studies, including our own ongoing longitudinal follow-up of this sample, might investigate further the effects of under-eating across all BMI categories on weight loss, health outcomes, and health service utilization.”

It is clear that ending waiting lists for meals-on-wheels is not only the right thing to do, it is the healthy, cost-effective path for the state to take.

CSCS supports S.3340 with the following recommendations –

S. 3340 would establish a new section in the NY state elder law, that under the Supplemental Nutrition Assistance Program (SNAP), persons age 60+ meeting certain criteria would be eligible to receive meals-on-wheels (MOW). CSCS wholeheartedly supports this concept. In order to strengthen this legislation, we make the following recommendations:

• Calculating cost of enacting this legislation could be based upon –
  • CSCS recommends that existing criteria for MOW eligibility be continued. Using existing criteria for meals-on-wheels eligibility, the cost calculation can be based upon projected annual waiting lists. Waiting list numbers should be used because existing MOW are already being paid for. Therefore, we need to base the cost calculation on future growth, ie- waiting lists, and not public funding that already exists. Provision for regional costs and service delivery models need to be made.
  • As we know, the AAA’s are not required to maintain waiting list numbers. However, there are some known numbers around the state as stated in the public hearing notice. In NYC, historically there has been about 500 people on waiting lists over the course of a year. It is reasonable to project an annual waiting list statewide of 1200-1500 homebound elderly individuals a year.
• Maintenance of effort provision – Historically, the provision of MOW has been a federal/state/local responsibility. The Older Americans, III-C-2, does require a local match. The primary state funding source is SNAP administered through the State Office for the Aging. There is no required match for localities to receive SNAP funds. Localities have sometimes added on their own funds in order to address the need for MOW. In order to retain the funding base that exists for MOW, CSCS strongly recommends a “maintenance of effort” provision. Upon enactment of this legislation, the state would become responsible for the full costs of providing MOW going forward. Localities would:
  • Experience budget relief for future growth MOW program. Their responsibility would be to maintain the current local dollars in MOW – both food and delivery costs. This should not be an unfunded mandate for local governments, but rather a cost containment initiative.
  • This would be a win-win situation for localities and the state as the loss of existing funds would destabilize agencies currently providing MOW, disrupt meal provision for thousands of frail, older New Yorkers, and unnecessarily burden the state with additional costs which could become an obstacle to the passage of this legislation.
  • An exploration of how much localities currently fund MOW beyond the required OAA match would be helpful.
  • This bill is an opportunity to set the state on the right path going forward through a partnership with local governments and community-based providers.
• Evaluation of MOW program –
  • Within a given amount of time once this legislation is enacted, there should be an evaluation of the operation of the MOW program and the impact on the health and well-being of older New Yorkers.
  • A study exploring the state and local health care cost savings vs. MOW provision should be done.

Thank you for the opportunity to testify today. CSCS looks forward to working with Senator Diaz and all stakeholders to ensure the passage of this important legislation. It will be a proud day for New Yorkers when this legislation becomes a reality – showing common sense and caring. Please feel free to call upon us should you require any further information.