Health
Snow was falling on a cold morning, and the usually busy streets outside the Jefferson Senior Center in East Harlem in New York City were almost deserted and silent.
Inside the building, however, it was a hive of activity as kitchen staff worked frantically to prepare hundreds of hot meals to be delivered to New York’s homebound elderly. Though some staffers worried that the snow might prevent employees from making it in, every meal was still set to be delivered to people who needed it — no matter how hard the center staff had to work.
“If we don’t go out, the folks won’t eat,” said 66-year-old Richard Johnson, a center employee who has been delivering meals on wheels for the past 15 years and has shown up for work during blizzards and in the aftermath of hurricanes. “For a lot of our homebound, this is the only food they get.”
Hot meals and homebound care are a small component of the range of services that the center — one of 250 in operation around New York — offers to the city’s growing elderly population. Every day, thousands of seniors flock to the centers to partake in yoga-for-arthritis classes, fitness training, computer training and arts-and-crafts lessons or just to have some company and a nutritious lunch.
The demand for such services is increasing as the city experiences an aging boom, but years of stagnant funding and now the federal sequester cuts are making providers nervous. Some fear that if the squeeze on funding continues, disaster could lie ahead.
“Every year, agencies have more people to serve with the same money or less,” said Bobbie Sackman, director of public policy for the Council of Senior Centers and Services of New York City. “Without adequate funding, we just can’t keep pace with demand.”
It is not only New York. Across the country, many service providers are feeling the same anxiety. A survey (PDF) in November from the National Association of Area Agencies on Aging (N4A) to assess the impact of reduced federal spending on the elderly population in nine states found that 96.7 percent of respondents were concerned about the ability of seniors to continue living independently if current funding levels do not rise.
Although 60 percent of service providers managed to come up with some funds to reduce the impact of the first round of sequester cuts in 2013, the majority say those alternative funds will not be available after 2014 and critical services are already being cut. The result: 36.7 percent of respondents said they are reducing caregiver programs, 50 percent are reducing transportation services, and a whopping 73.3 percent are reducing nutrition services, including meals on wheels.
Service providers and advocates for the aging are doubly frustrated because they say these cuts are counterproductive. A series of state studies (PDF) has consistently found much lower per-person costs for home- and community-based services compared with institutional care. Poorer health leads directly to higher Medicare costs and, indirectly, to higher Medicaid costs. According to the N4A, most people exhaust their savings within six months of entering a nursing home, so they end up qualifying for Medicaid to cover the costs. There are practical reasons as well as humane ones, then, for investing in services that maintain the health and well-being of seniors. Put simply: The healthier the senior, the less of a drain he or she is on taxpayers.
“Here at Jefferson we are very much into health,” said Maria Alejandro, director of senior services, as she detailed the array of exercise and wellness programs the center offers. “Exercise and proper nutrition are very important to us.” Because of this focus, she said, many of the seniors spend a lot more time at the gym than they do in a doctor’s office.
Indeed, some of the elderly gymgoers sound like fitness fanatics less than half their age.
“My favorite is the rowboat machine. It works out every part of your body,” said Mary La Petina, a wiry and energetic 87-year-old who exercises almost daily with the advanced group. She may be thinking less about the effect her exercise regimen has on government budgets than on her need to stay fit enough to manage the three-story walk up to her Manhattan apartment. But taxpayers benefit from her dedication nonetheless.
These home- and community-based services that are available, for now, to elderly New Yorkers are funded mostly by the city’s Department for the Aging (DFTA), which, like similar agencies across the country, lost some funding because of sequester cuts and has had to come up with alternative funding sources to keep its programs intact.
“While there was a sequester cut of $6.6 million, we self-funded our programs with the thought that the federal budget negotiations would lead to a restoration of funds and therefore did not have to cut programs and services,” said Jon Minners, director of public affairs for the DFTA.
So far, however, there has been no restoration of federal money, and the DFTA’s budget for 2014 is 2 percent less (PDF) than last year’s, leaving many seniors in New York anxious.
“What am I gonna do — lie in bed and watch TV all day?” said Ramonita Rivera, 70, who is recovering from a brain operation and relies on a home-care worker to take her out of the house every day and help her with routine tasks like shopping.
If she lost her home aide, the bejeweled Rivera — who likes her day trips to the casinos and is clearly not ready to be homebound — would have little choice but to go to a nursing facility or risk premature decline. For now, there has been no reduction in the home-care program, but it’s difficult to see how the city and other communities around the country are going to cope with reduced budgets and increasing demand.
This is hardly a problem that is going to go away. One in three seniors is living in poverty, and by 2030, New York’s 60-and-older population is expected to increase (PDF) to 1.84 million, or 20 percent of the city’s population. Nationally, the aging boom is even larger: By 2020, 22.5 percent of the U.S. population will be over 60. With these figures in mind, cutting back on basic services like nutrition and mobile meals can only mean bleak times are ahead for the nation’s elderly.
In New York the meals-on-wheels program has reached 94 percent capacity, and demand continues to rise. At the Jefferson Center, program coordinator Wesley Correa said that in the past two years, the number of homebound elderly who have enrolled in the center’s meal service has doubled.
Despite the snow, for one day more, at least, everyone on the center’s list got a hot dinner and the extra sandwich it began providing recently, in spite of budget constraints, when Jefferson staffers realized that some of their homebound clients had no other food.
But no one knows how long that will continue.
“At some point, people are going to end up on waiting lists, and that would not be good,” Correa said. “If they’re asking for the service, it means they need it.”
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