New York State Forum/Town Hall Roundtable on the Sage Commission'S Proposal to Merge the NYS Office for the Aging with the Department of Health

David McNally 17 AARP 18 Edie Mesick

UJA Federation of New York 19

Nancy Miller, LSMW 20 Executive Director/CEO

VISIONS/Services for the Blind 21 and Visually Impaired;

and president of the NY Vision 22 Rehab Association. 23 Christopher Nadeau

NYS Adult Day Services Association 24 25 1 2 ROUNDTABLE PARTICIPANTS, Continued: 3 Deb Ritano

Jewish Family Services for 4 the NORC project 5 Mike Romano

Director 6 Oneida County Office for

Aging and Continuing Care; 7 also, board of directors of the

NYS Association of Area Agencies 8 on Aging 9 Carin A. Tinney

Policy Analyst 10 United Neighborhood Houses 11 12 ALSO IN ATTENDANCE: 13 Brendon Bachelor 14 Jean Cerenos 15 Brenda Marino 16 Ed Wardenstein 17 Frank Stevio 18 19 20 21 22 23 24 25 1 SENATOR VALESKY: I want to welcome everyone 2 to -- this is called "a meeting of public interest." 3 It's intended to be more of a roundtable discussion 4 than what a public hearing would be. And I thought 5 that might serve our purposes better for the topic 6 that we're discussing. 7 For those of you who don't know, my name is 8 Senator David Valesky. I'm the chair of the 9 Senate Aging Committee. 10 And, I have an interest in gathering all of 11 you together, and many of you have actually reached 12 out to me in my office, to have a discussion about 13 the SAGE Commission's work, and the work that 14 they're doing right now, and what may or may not be 15 included as part of their report as it relates to 16 the state Office for the Aging. 17 Just before we start, the reason for the 18 microphones, we in the senate have -- as, hopefully, 19 many of you know, are placing a high priority on 20 transparency and openness in government. So, this 21 meeting is being webcast. And that's why the 22 technology, here. 23 And, in fact, anyone who has any comments, 24 who might be watching this, we certainly ask you to 25 submit them to my office. 1 So, again, this intended -- we may have other 2 members of the Aging Committee join us. There are a 3 number of things going on here in the Capitol this 4 morning. So, hopefully, we'll have some of my 5 colleagues join us as well. 6 I thought what we could do: We have about an 7 hour, give or take, and this is intended, again, to 8 be a rather informal conversation. 9 My goal in conducting this roundtable 10 discussion, is to listen to all of you, to take your 11 comments, to take your suggestions. And my intent 12 is to catalog the comments that I receive here 13 today, and get them to the SAGE Commission, and 14 Paul Francis, who is heading up that effort, just as 15 soon as possible. 16 The intent is, therefore, that all of you 17 will have a voice in the commission's deliberations, 18 which may be taking a while. I think that, you 19 know, from a process perspective, I think it may be 20 taking a little longer than they had originally 21 anticipated; but, that's fine with us. It gives us 22 more time to make our case. 23 So, I think with that, I would just like to 24 go around the room, and have everyone, at this 25 point, introduce themselves; tell us where you are 1 from, and then we'll open up the conversation. 2 So, if we could, we'll start on my left. 3 MS. MILLER: Hi. I'm Nancy Miller. I'm the 4 executive director/CEO of VISIONS/Services for the 5 Blind and Visually Impaired; and president of the 6 New York Vision Rehab Association. 7 And we serve people who are blind and 8 visually impaired in the New York City metropolitan 9 area. 10 And, NYVRA, the association, represents all 11 of the vision rehab agencies, consumer groups, and 12 people who are blind, around New York State. 13 MS. KRAKOWSKI: Hi. My name is 14 Molly Krakowski. I'm the director of legislative 15 affairs in JPAC at the Jewish Association of 16 Services for the Aged in New York City. 17 MS. ALVAREZ: Hi. My name is Maria Alvarez. 18 I'm the executive director of the New York Statewide 19 Senior Action Council. 20 MR. BURGESS: Mike Burgess. I'm doing public 21 policy work for the Statewide Senior Action Council, 22 now. 23 MS. MESICK: Edie Mesick. I'm with 24 UJA Federation of New York. 25 MR. JELLINEK: Igal Jellinek. I'm the 1 executive director of the Council of Senior Centers 2 and Services of New York City. 3 MS. COOK: AnnMarie Cook, president & CEO of 4 Lifespan of Greater Rochester. 5 MR. McNALLY: David McNally, with AARP. 6 MR. HALDEMAN: Richard Haldeman. I'm with 7 the Long-Term Care Ombudsman Program, representing 8 the Alliance. 9 MS. TINNEY: I'm Carin Tinney, policy analyst 10 for United Neighborhood Houses. 11 We have a federation of 37 settlement houses 12 and community centers around New York City. 13 MS. RITANO: I am Deb Ritano, for 14 Jewish Family Services for the NORC project, and our 15 mission is to help seniors age in place. 16 MR. ROMANO: I'm Mike Romano, director of 17 Oneida County Office for Aging and Continuing Care. 18 And, I also serve on the board of directors 19 of the New York State Association of Area Agencies 20 on Aging. 21 MS. CAMERON: I'm Laura Cameron, executive 22 director of the New York State Association of Area 23 Agencies on Aging. 24 MR. NADEAU: Christopher Nadeau, New York 25 State Adult Day Services Association. 1 MS. MARTEL: JoAnne Martel, public policy of 2 the New York State Association of Area Agencies on 3 Aging. 4 MS. AULDRIDGE: Allison Auldridge. I'm the 5 policy associate for Services and Advocacy for 6 GLBT Elders. 7 MS. DISARRO: I'm Ann Disarro, and I'm with 8 NYSCA (the New York State Coalition for the Aging). 9 SENATOR VALESKY: And in the back? 10 MR. BACHELOR: Brendon Bachelor (ph.) from 11 our town hall. 12 SENATOR VALESKY: Okay? 13 MS. CERENOS: Hi. Jean Cerenos (ph.), from 14 [inaudible]. 15 SENATOR VALESKY: Back there? 16 Go ahead. 17 MS. MARINO: Brenda Marino. 18 MR. WARDENSTEIN: Ed Wardenstein (ph.). 19 MR. STEVIO: Frank Stevio (ph.), [inaudible]. 20 SENATOR VALESKY: Very good. 21 Thank you all for being here. 22 I'm going to ask -- even though he doesn't 23 know this -- I'm going to actually ask Mike Burgess, 24 who, as all of you know, is a former director of the 25 state Office for the Aging, actually, speak first, 1 and offer us his thoughts, from his perspective. 2 And then, again, really, the intent is to 3 have a give-and-take. I would like everybody to 4 have an opportunity to, certainly, weigh-in. But, 5 certainly, feel free to have a back-and-forth, 6 because that's the intent of doing this in this 7 format. 8 So, Mike, if you wouldn't mind kicking us 9 off, that would be great. 10 MR. BURGESS: Thank you for having this 11 meeting, Senator, because we requested that you do 12 this, and appreciate it. 13 I would just say, to start, that, you know, 14 the state Office for the Aging, the history of it, 15 50 years, actually, this year, Governor Rockefeller 16 started it before there was an Older Americans Act, 17 and before there were state Offices for the Aging. 18 But, anyway, you know, for 45 years, there 19 has been a state Office for the Aging in New York 20 State. And it has been, the original charge of it, 21 was to be an agency to, advocate, and serve older 22 people, across the board, on a wide variety of 23 issues and concerns. 24 And, then, you know, here in New York State, 25 we have an elder law that was put into place also. 1 And I think, in the context of the discussion 2 today, I would like to keep pointing out, that the 3 mission has always been very broad. In fact, the 4 idea was, at the time, when older people were not 5 being fully represented in state government, and had 6 a lot of very serious problems, which many of us 7 have helped to address over the years, that older 8 people needed an advocate in all of state 9 government. Not just providing services, but that 10 there would be an agency that would sort of do an 11 aging-impact statement about everything going on in 12 government, whether it be in, health or housing, 13 discrimination, or whatever. 14 So, that's been the nature of the agency. 15 And, then, the network of county agencies, 16 over the years, of course, has been fully developed, 17 along with all of the program and services in 18 different areas that are represented at the table 19 here today. 20 And I think that many of us feel that, as we 21 go forward, looking at, certainly, the fact that 22 there can be some efficiencies, and some 23 administrative changes, that will be saving some 24 money, and maybe make services more coordinated, we 25 don't want to lose the things that have made this 1 network so unique and special. And that older 2 people look upon this as their gateway into state 3 government. 4 It's really kind of a constitu- -- one of the 5 few agencies that really, as opposed to being 6 regulatory, or just a bureaucracy, is the 7 constituent service agency, that provides some 8 direct services, like the ombuds program, is 9 actually run by the state Office for the Aging. The 10 only program that the state actually runs. 11 And, then, having a senior citizens' help 12 line, having a governor's advisory council, I think 13 that all of these issues, as we have heard some of 14 the debate about the SAGE Commission, are these 15 kinds of things, this kind of entry, this kind of 16 outreach to the public, is this going to be 17 maintained? 18 Or, you know, if there are other 19 alternatives, let's separate out some of the 20 functions that we've seen, and make sure that, that 21 just for the sake of efficiencies, that we don't 22 lose the advocacy part of it. 23 So, that would be kind of my overview of 24 this, but everybody else has a lot more they can 25 give. 1 SENATOR VALESKY: Who would like to -- 2 MS. MESICK: Laura, do you want to speak 3 first, and then I will? 4 MS. CAMERON: Sure. 5 MS. MESICK: Okay. 6 MS. CAMERON: Well, Senator, thank you again 7 for convening this meeting. It's very important, as 8 we're looking at the future of aging. 9 In preparation for this meeting, the group 10 that is seated today has been working together in an 11 informal coalition. We've been having a lot of 12 conference calls and in-person meetings. 13 And our goal was, really, after we saw the 14 SAGE Commission's goal of efficiency in government, 15 et cetera, and there were a few recommendations 16 that, you know, have bubbled to the surface from, 17 apparently, their steering committees, and, we, as 18 various groups representing senior programming, got 19 together and said: 20 Let's collectively put our minds together, 21 and what can we dream that the state Office for 22 Aging could be? And, what would the possibilities 23 be? 24 And, how could we best serve the seniors of 25 this state? -- which, pretty soon, will be us, 1 sitting in the room. I think we're all realizing, 2 that's kind around the corner for us as well. 3 So, how can we put our minds together, and 4 make a recommendation to the SAGE Commission, and to 5 you, as chair of the Aging Committee? 6 And, what would it look like? What would we 7 call it? 8 All of those kinds of questions we've been 9 talking about. 10 So, we do -- we do -- we did put together, 11 actually, a written proposal. And we'd be happy to 12 share it with you. 13 To be honest, we finalized it in the late 14 hours last night, so -- 15 [Laughter.] 16 MS. CAMERON: -- sort of "hot off the press," 17 if you will. 18 But, what we would like to do is, I'll 19 introduce the concept. And, then, there are some 20 others that will really talk about the underpinnings 21 and the guiding principles that got us to the 22 proposal we're going to give to you today. 23 SENATOR VALESKY: Great. 24 MS. CAMERON: Essentially, what we have 25 proposed, is something that we call "The Office for 1 Aging and Community Supports," with added 2 responsibilities; because, we believe that NYSOFA 3 has always been the picture of efficiency, and has 4 delivered services exceptionally well. 5 Mike Burgess is a previous NYSOFA director; 6 has highlighted a lot of the really good things that 7 NYSOFA has done. 8 What we envision is, an enhanced-and-improved 9 NYSOFA; because, you know, as our state has fiscal 10 issues, we believe that NYSOFA is well positioned to 11 provide the cost-effective services to keep seniors 12 in their homes, which is where they want to be. 13 And, they only can do that, however, if they 14 do have additional resources and additional programs 15 that helps seniors. 16 You're well aware of all of the demographics 17 of seniors. And we really believe that this would 18 position the state office very well, for the future, 19 and for our seniors. 20 And as we examine this, what really led us to 21 this, was a long list of guiding principles, that 22 Edie will talk about, which will help you to 23 understand how we came to that conclusion. 24 MS. MESICK: Right. 25 So, we wanted to approach the question, 1 because we both understood that there was a 2 proposal, perhaps, that the SAGE Commission was 3 considering. 4 But, we also understood that the real 5 question is: What is best for the aging of the 6 population in New York State? 7 And, also: What is best, from a public 8 policy perspective? 9 And, so, we looked at, really: What are our 10 guiding principles? 11 What do we think are the issues that need to 12 be considered in any configuration of service 13 delivery in New York State? 14 And, so, we started to understand, to make 15 clear to ourselves -- and we thank you again, 16 Senator, for this opportunity to make it clear 17 through your efforts as well -- that the aging 18 process is multi-faceted. That it is not -- most 19 seniors, as they age, do not need medical services. 20 What they need is social supports. 21 And, as Mike said, as Laura said, it's so 22 important that this ---therefore, that the state's 23 Office for Aging services be, really, an independent 24 office; an office that reports directly to the 25 Governor, so that it really reflects the voice of 1 the people. 2 We looked at the fact that, obviously, aging 3 in place, in homes, and with community-based 4 services, is the least expensive, and the most 5 appropriate, way of delivering services. 6 So, that has to be a part of whatever this 7 new entity looks like. 8 We recognize that the ombudsman program is a 9 very successful program. And, it needs to be 10 protected from conflict of interest with an agency 11 that otherwise regulates services. 12 So, we put that down as one of our guiding 13 principles. 14 We also recognized that there is an important 15 opportunity in this question for many other services 16 that are provided in different agencies in 17 New York State. 18 And, therefore, our recommendation is, that 19 we have, truly, a strengthened Office for the Aging, 20 and an Office for Aging and Community Supports, that 21 takes in some other of the services. 22 So, those are our guiding principles. That's 23 how we came to this recommendation. 24 And I'm sure there are others who want to 25 jump in, from their particular perspectives. 1 MS. COOK: Senator, AnnMarie Cook again, from 2 Rochester. 3 We also talked about strengthening, really, 4 the Office for Aging, for two reasons, as others 5 have said: 6 One: We recognize the difficult financial 7 times that there are. There is no question about 8 that, and that services have to be delivered in a 9 cost-effective manner. 10 Second thing: With this proposal, that we're 11 saying, preserves the desire of older adults to 12 remain independent. 13 And I think the philosophy of NYSOFA has 14 always been to support and empower older adults; 15 and, therefore, has always led to that 16 cost-effective way. 17 We're also suggesting, in addition to 18 state Office for Aging programs, because they are 19 disbursed throughout the state, I'm just going to 20 name a few: 21 First of all: The Kinship Care Program 22 currently resides in the Office of Children and 23 Family Services, in which, of course, is 24 Grandparents Raising Grandchildren. 25 And those individuals can benefit greatly, I 1 think, from other support services that Office for 2 Aging could bring, and melding that into the office. 3 Second one: HEAP, the heating assistance 4 program for older adults over the age of 60, 5 currently, an OTDA, and, as we all know here, that 6 provide direct services. There are so many older 7 adults who need that assistance. And, need many 8 other programs, that they need HEAP services. 9 Third one we'd like to talk about is: 10 False Prevention Program. 11 Currently, in the department of health, falls 12 are the leading cause of accidental death in older 13 adults. 14 Also, is a great way, very cost-effective 15 way, in which we can provide evidence-based services 16 to older adults, to prevent falls, in our senior 17 centers, and other areas where older adults gather. 18 And, then, the residential emergency 19 services, home repair, to the elderly; once, again, 20 helping them remain independent in their own 21 community. 22 There are other services in other areas of 23 state government. We have highlighted these, but we 24 would like to bring these services that help older 25 adults under the umbrella of the Office for Aging 1 and Community Support Services. 2 MS. ALVAREZ: Maria Alvarez, from New York 3 Statewide Senior Action Council. 4 The other thing is, that we also recognize 5 that the population of New York State is 6 increasingly aging, so the infrastructure has to be 7 adapted to what the population realistically is 8 becoming in New York State. And, so, all of these 9 services would be more efficient. 10 In order to provide them a more efficient 11 service to the -- this population, it would be 12 better to do, you know, to consider it, this 13 proposal. 14 The other thing is, that, all of these -- all 15 of these programs represent economic stability for 16 seniors. People who are living on fixed incomes 17 need these supports in order to stay in the 18 community. 19 We have -- through our study, we have found 20 that, on the average, in New York State, it takes 21 about $26,000 for a healthy senior to live in the 22 community, independently. You know, that's without 23 any type of home care or home attendants or 24 long-term care in the community. 25 We also know that only a quarter of the 1 seniors live socially on social security, which is 2 about, you know, $14,000, this year. 3 So, in order to bridge that gap, we need 4 these services in order to keep seniors in the 5 community, which are becoming the largest part of 6 the population. 7 MS. MILLER: Nancy Miller, from VISIONS. 8 I wanted to add to what Maria was saying, but 9 from a slightly different perspective. 10 People think of NYSOFA as an umbrella, but I 11 think of it as an upside-down funnel. 12 NYSOFA has a brand. It is well known. It is 13 where people focus when they have a question, of all 14 economic backgrounds. 15 And, although NYSOFA has been a strong voice 16 for people of low income and limited income, what 17 they have been able to do is, mobilize people of all 18 economic backgrounds to build the supports that 19 older people need. 20 They may be well-off today, but 30 years from 21 now, when they outlive their savings, they may not 22 be so well-off. 23 So, think of NYSOFA as the funnel. 24 It's like a laser. Everybody knows where 25 that point is. 1 That entry point is NYSOFA. 2 And, then, the funnel opens to all of the 3 other services and supports that exist, both, in the 4 Aging Network, but also in the other agencies around 5 New York State. 6 The role that NYSOFA has played, as an 7 advocate, to amplify the voice of older people, is, 8 actually, to work collaboratively with other state 9 agencies. 10 So, for example: The New York State 11 Commission for the Blind and Visually Handicapped, 12 which is housed in the Office of Children and 13 Family Services, for the 200,000 older severely 14 visually impaired and blind people, CBVH, the 15 commission, works collaboratively with NYSOFA so 16 that they can get the information out to the 17 population that is most in need. 18 I understand the purposes behind SAGE. And 19 there are some state agencies that, if they were to 20 disappear, nobody would notice. 21 NYSOFA is not one of them. 22 NYSOFA is so well known, and is such a focal 23 point, that its loss would be like creating a black 24 hole. 25 I think it also represents the extreme 1 diversity of New York State. And some of the recent 2 census analysis, is that, as New York State ages, 3 it's not just the 60-and-over population, but we 4 have fewer younger people. And the average age 5 upstate now, has gone up several years; which sounds 6 like not much, going from, maybe, 30 to 33, average. 7 But, when you look at what makes that happen, it's 8 that dramatic increase of the 85-plus population. 9 It's people who are the most frail, the most 10 vulnerable, that's where you find most severe vision 11 loss and blindness. You're talking about other 12 disabilities that people have to manage with. 13 But, if you talk to older blind people, and 14 if you ask them, "Are you sick?" they say: 15 Absolutely not. With rehabilitation, with support 16 services, with transportation, with respite, I'm not 17 sick. I just need access. And with that access, I 18 can be as independent as any person, with or without 19 sight. 20 That's what NYSOFA is able to do; is to take 21 that resource, that is the strength of New York, and 22 provide it to individuals, so that, not only can 23 they age in place, but they can age in place as 24 healthy as possible, which is less stress on all of 25 the other resources of New York State. 1 So, it's nursing-home diversion, it's 2 Medicaid delay. 3 We're not going to say that our services 4 prevent people from needing long-term care. But, if 5 we can delay it six months, eight months, 6 nine months, that's billions of dollars of savings 7 for New York State. 8 So, why fix something that isn't broken? 9 NYSOFA works. 10 And it works as a collaborator, and it works 11 as a focal point. Everybody knows it's there, uses 12 it. And, NYSOFA has been agile enough to really 13 meet the needs of seniors who ask for it, and need 14 very different things. 15 SENATOR VALESKY: Uh-huh. 16 I want to follow up on one of the points that 17 you made. But, before I do that, I want to 18 introduce Marty Golden, who, as all of you know, is 19 former chair of the Aging Committee, and a 20 tremendous advocate for seniors around the state. 21 We just began about, 10, 15 minutes ago. 22 SENATOR GOLDEN: Thank you, Senator. 23 SENATOR VALESKY: And the participants here 24 have, actually, done a lot of homework already, 25 before this meeting. 1 And, Laura began -- actually, Mike began. 2 They have actually put a proposal together, 3 that would actually strengthen the role of NYSOFA, 4 as opposed to potential of diluting that role. 5 SENATOR GOLDEN: I happen to agree with them. 6 SENATOR VALESKY: I do too. 7 [Laughter.] 8 SENATOR VALESKY: Very wise. 9 Let me, just, to your point, you had said, 10 many seniors, who view NYSOFA, and use NYSOFA, and 11 your point about them not being sick. 12 You know, we have all heard the potential of 13 NYSOFA being, in some way, shape, or form, folded 14 into, or swallowed up, by one of the largest 15 agencies in the state. 16 When you think of state bureaucracy, you 17 know, you think of the department of health. 18 Can -- I would just like, maybe, some folks 19 to speak to that particular issue, and what that -- 20 the message that that could send to seniors in the 21 state, if, in fact, that's what -- 22 MR. JELLINEK: Igal Jellinek, Council of 23 Senior Centers and Services. 24 I think we're at a critical time in services; 25 in aging and health services. 1 And I think we -- there's an opportunity here 2 to really do some culture change. 3 With the longevity revolution, people are 4 living longer. The issues out that there are no 5 longer acute care. 6 The system has to shift into chronic-based 7 care. And that's the home and community-based 8 services that folks around this room provide. 9 And that is also, less expensive. It makes 10 sense. It gives us social supports in the 11 community. 12 One of the other points that we thought of, 13 we came to the conclusion, is that, the state Office 14 for the Aging needs, as representing all the seniors 15 in New York State, not just the people who are on 16 Medicaid, is, needs to have an identity of its own, 17 and needs to report directly to the Governor, not to 18 the health commissioner. 19 I think it medicalizes the process. 20 And I think, if we're going, and with the 21 baby-boomers coming, I think it's critical that the 22 state Office for the Aging be enhanced with the 23 social supports. 24 So, instead of things going over to health, 25 is that, health -- some of the health programs that 1 have been stated here, and I'm sure there's many 2 others, be brought over to SOFA, and really make it 3 a robust state Office for the Aging, because that's 4 where the needs are going to be, and that's where 5 the services, that are in the community. 6 Because, if you want to age in place today, 7 you don't need high-tech supports. You need your 8 Meals-on-Wheels. You need to have a case worker. 9 You need to have -- when you're discharged from the 10 hospital, you need to have a set of services that 11 don't bring you back into the hospitals, which the 12 hospitals are no longer going to get paid for, 13 including falls prevention. 14 So, all I'm saying is, there's an opportunity 15 to really shift this whole system, and rebalance it. 16 And I don't think this comes along a lot. 17 It's really a critical time for us, right 18 now. And I think we all feel very strongly about 19 this; that there needs to be, instead of the state 20 Office for the Aging going over to health and 21 becoming medicalized, it's sort of the reverse, and 22 having an identity, and making it much more robust, 23 and representative of the aging population in 24 New York State. 25 MS. DISARRO: Ann DiSarro, from NYSCA. 1 I think there's also a culture difference -- 2 MS. MESICK: Absolutely. 3 MS. DISARRO: -- between the community-based 4 service providers and the health system. 5 I sit on the board of Northeast Health, which 6 is a local large health-provider organization. And 7 having worked in the aging field, I can now see both 8 sides of that street. 9 The health system is very regulated, and 10 everything is very prescribed. And there is no -- 11 or, little opportunity for responding to, kind of 12 on-the-ground operational efficiencies and needs of 13 the consumer. 14 The aging system has been developed across 15 the country, in a very different mode; looking to 16 having local development of service provisions. 17 One area agency is one area agency, across 18 the state. They are: Take their money, and respond 19 to the needs that are in the community, according to 20 what other community supports are there, trying to 21 maximize the resources among the community. 22 It's a very cost-effective way of organizing 23 service-delivery system. 24 And that's why we think, if we look at 25 companion services in the department of health, and 1 bring them to Aging, we actually think we can help 2 save money. 3 This is an opportunity to kind of take the 4 Governor's challenge to all of us, to look at how we 5 can be more efficient and effective, and kind of 6 turn the idea on its head, and say: We agree. We 7 think there's an opportunity to save money here. 8 But, it's to look at this more, 9 community-based. Use the power and strength of the 10 community. And, also, of older people. 11 We're very committed to using the 12 independence and power and strength of older people, 13 to advocate for themselves. But, also, they can be 14 a force of doing good things in the community, not 15 just receiving services. 16 Aging is not a health issue. It's actually a 17 resource that we can look at in the community. 18 So, there's a very acute culture difference 19 between the two organizations. And we think that 20 there is a danger that the strength and the 21 cost-effectiveness that the Aging Network now 22 provides, will get lost, if we made this move into 23 health. 24 SENATOR VALESKY: Let me just come back to 25 you. I know that David wanted to jump in, and then 1 we'll come back with you. 2 MR. McNALLY: Well, thank you, 3 Senator Golden, and Valesky, for this opportunity. 4 We very much appreciate it. 5 Well, this is upside-down conversation for 6 sure. 7 I think she referred to it as "a funnel," and 8 said to think of everything in reverse. 9 I mean, to take a well-run, fairly small 10 agency, that has a very targeted purpose, and has a 11 very clear mission, and to dump it into the abyss of 12 what is now called "department of health," makes no 13 sense, politically, economically, and even from a 14 public-policy perspective. 15 And I don't want to repeat all of the words 16 that have been said here, but, you know, I'm -- 17 I am David McNally, with AARP, by the way. 18 Hello. 19 [Laughter.] 20 MR. McNALLY: You know, we have 2.4 million 21 members. 22 50-plus, and aging, is not about a disease. 23 Aging is not an illness. Aging is not a 24 disease. 25 And when we put it in the department of 1 health, that's immediately what it becomes, in 2 everybody's mind. Okay? 3 So, rather than saying, maybe we've -- maybe 4 the staffs for Aging should, somehow, be put into 5 that abyss of DOH, DOH ought to be taking some 6 lessons from what SOFA does. 7 And I think the whole idea that this is just 8 about the medical model is a terrible way for this 9 state to go, again, both from a public-policy 10 perspective and from cost perspective, as Ann and 11 Michael and Igal have suggested. 12 The -- this is an opportunity, for sure, 13 though. 14 Aging is not just health. It's 15 transportation and housing, and older workers, and 16 discrimination. And those issues are -- do not 17 belong anywhere in a place called "the department of 18 health." 19 But, I do -- as Ann said, this as challenge 20 by the Governor. We should take that up and run 21 with it. That this is the time to create a robust, 22 fully integrated opportunity for us to -- for all 23 aging in New York. 24 And aging is not just 65-plus. We're all 25 aging. And it's an office that is called upon 1 frequently by those who are not, what we consider, 2 older, but those who are grappling with trying to 3 provide those services to the aging, of caregivers, 4 of family members. 5 So, it is an office critical to people of all 6 ages. 7 And I might say that, I think we learned, I 8 think, a terrible snapshot of what the future might 9 hold. We kind of saw this most recent budget with 10 New York Connects. 11 We almost lost New York Connects because, the 12 health department, or DOB, or somebody, said, 13 "Oh, here, we need this one," without thinking about 14 the long-term consequences as it relates to state 15 and federal health-care reform. 16 And we needed an ABRC. And, here, we 17 almost -- we've got one on the works here, and it 18 was almost thrown out because we needed to save 19 money. 20 Again, I think that we're going to see more 21 and more and more of that, if SOFA does not remain, 22 and become even more, a powerful voice for the 23 senior. 24 And the last piece I want to add is what Ann 25 alluded to about, about, this isn't just about -- 1 this is a two-way street. 2 This is: How do we provide the supports, and 3 services, so people can remain in their homes and 4 their communities, which we know costs less money, 5 which we know have better outcomes? 6 But, it's also the other way around; how can 7 all of us create opportunities to help to provide 8 those services? 9 We have a vast array of volunteer 10 opportunities before us, if we could seize just a 11 moment to create the communities, or "villages," as 12 some are calling them. 13 A volunteer; you know, we see what high-cap 14 counselors can do. But we also know, there's 15 bill-paying programs, and delivering meals, and 16 escorts to medical appointments, in the community. 17 These are all, yes, sometimes they need to be paid 18 for; but, many, many times, they can be developed 19 into volunteer opportunities. 20 Again, we're saving money. We're providing a 21 method to deliver them in the community, and the 22 locality. 23 And, even pet walking, frankly. We all know 24 the importance of pets in some of the older people's 25 lives; in particular, when it comes to isolation. 1 That's another type of service. 2 But, we should be seizing this moment, for 3 sure. And, not running from it, but running to the 4 SAGE Commission and saying: This is our moment. We 5 need to plan for the future, and for the burgeoning 6 elderly population in the state. 7 SENATOR VALESKY: I couldn't agree more. 8 That's a great point. 9 Michael, before you do it, I just wanted to 10 ask a question, and correct me if I'm wrong. 11 But, this notion of an aging -- an 12 "Office for the Aging" director, reporting to 13 someone other than the governor, and, therefore, not 14 a cabinet-level position; does not the federal 15 Older Americans Act require, for receipt of certain 16 federal dollars, require cabinet-level position 17 for -- and I'm looking to you, Michael? 18 No? 19 MR. BURGESS: There has to be a director. 20 But, you know, a lot of these states have a 21 health -- have, like in Washington, health and human 22 services, and then there's an Aging division within 23 that. 24 But, a lot of them are independent. 25 In our elder law, which was enacted, it says 1 that there has to be a director, I believe, 2 reporting to the governor. 3 And I think the point here is, that, if there 4 were a proposal to change that, you would be 5 changing the elder law. And we'd like to know if 6 that was the intent, if that's what the 7 SAGE Commission comes up with. 8 But I think that's a good point, because the 9 director should have the governor's ear, and should 10 be confirmed by the senate. Otherwise, it's just a 11 division within another department. 12 SENATOR VALESKY: Mike? 13 MR. ROMANO: Mike Romano, from Oneida County. 14 And I just thought it was important to speak 15 to the fact that there are a number of counties in 16 New York State who have effectively blended 17 Older American Act programs with Medicaid long-term 18 care community-based programs. And it has proven to 19 be cost-effective and consumer-oriented. 20 For example: Those counties, at the 21 programs, can, you know, seamlessly transition 22 consumers from non-medical programs into more 23 skilled-type community-based services, fairly 24 seamlessly. And it has proven to be a good model of 25 Aging services. 1 The key to that, though, is that, the 2 Aging Network really needs to be the focal point for 3 those types of programs and services. 4 The Aging Network, especially in the last few 5 years, has really taken some federal dollars and 6 federal programs, and created consumer-directed care 7 under the Older Americans Act. 8 So, it's proven to be able to administer, you 9 know, flexible consumer-directed services. 10 I feel that any model that the Aging Network 11 is not the lead of, you know, would be a detriment 12 to the aging population, and their consumers. 13 And just one final point, is that, just 14 within the last two years, other networks, such as 15 the Veterans Administration, has looked upon the 16 Aging Network as a leader for community-based care, 17 and has established partnerships with several 18 counties here in New York State, to provide services 19 for veterans; long-term care services for veterans. 20 SENATOR VALESKY: Richard? 21 MR. HALDEMAN: Yes, Senator, thank you for 22 inviting us here today. 23 My name is Richard Haldeman. I represent the 24 Ombudsman Alliance. 25 By the way, the "Haldeman" name has no 1 reference to any past political parties down in 2 Washington. 3 [Laughter.] 4 MR. HALDEMAN: As the ombudsman program is 5 listed, we came here to Albany, February 8th, to 6 make our legislators aware of the ombudsman program. 7 Many people in this state, when you mention 8 "ombudsman," they look at you, like, funny, "What is 9 that?" 10 We're the largest volunteer organization in 11 the state of New York. 12 We are under the Department of Aging. We're 13 funded by Title 7, the Older Americans Act. So, we 14 have the money from the money stream that does come 15 from Washington, and it's disseminated through the 16 Office of Aging. 17 Last year, our volunteers provided over 18 206,000 volunteer hours, to nursing homes, assisted 19 livings, family-type homes, adult homes. 20 If the department of health had to take over 21 that, that equates to about $5.8 million that the 22 state would have had to spend to send people from 23 DOH out, to do the same job that our volunteers do. 24 So, we're probably one of the few programs 25 that don't normally come in and ask for money. Our 1 funding does come from Washington. 2 And some of our concerns would be: 3 If we were to go under a department of 4 health-type environment, how would that money stream 5 be disseminated? 6 Would it be, continually with, the Aging, you 7 know, budgeting program? Where would it go? 8 Also, another concern that we have is, our 9 program is very unique, in that, as we certify our 10 volunteers -- which we are doing around the state 11 now, again -- we are exempt from all HIPAA laws when 12 we advocate for residents in nursing homes, assisted 13 living. 14 Our advocacy is that of, you know, a 15 doctor-patient, lawyer-client. 16 We also spend a lot of time in these 17 facilities that, normally, a person in a working 18 environment would not be able to do. Our volunteers 19 are in nursing homes, two, three, four hours a week, 20 trying to maintain, and indicate, that the care is 21 being provided, that's supposed to be provided, in 22 those facilities. 23 So, we advocate for that. 24 Protections under the Older Americans Act, 25 are unique to us alone. And our concern, that if 1 Aging did move into another entity of DOH, DOH is 2 part of what we work with. But, also, when we find 3 problems in facilities, we have to move that, 4 sometimes, up the ladder, to DOH, and -- to look 5 into it. 6 And if they decide that it's not something 7 that they feel is a complaint in a nursing home, 8 they could kind of overrule, or cause a conflict, if 9 you will. 10 So, conflict is another issue that, you know, 11 we really can't be a part of, being the unique 12 program that we are. 13 In our autonomy, is what I was talking 14 before, DOH being a licensing agency, also, could 15 overrule some of the concerns that we would have in 16 our advocacy. It would put us in a very difficult 17 position. 18 And, perception, more than anything else, if 19 we were to tie into an entity, such as DOH, the 20 people that we advocate for, and the staff and 21 people that we become involved with in facilities, 22 know that DOH comes in and does surveys every 12 to 23 15 months. 24 They come in, looking for critical issues 25 that, you know, they want to cite you for one thing 1 or another. 2 By being autonomous, we, many times, hear 3 from staff, administrators, about issues that are 4 very high concern, through the department of health. 5 So, when you get down to where the rubber 6 meets the road, our autonomy, and 7 conflict-of-interest issue, is extremely important, 8 to ensure that this program is viable, and 9 continues. 10 And I heard around the table, saying, that 11 the population is aging. 12 Well, it is. We're all aging. And I'm doing 13 it pretty fast myself. 14 [Laughter.] 15 But, when you look down the road, with the 16 baby-boomers coming through the doors, nursing homes 17 are going to be expanding. I hate to say that, but 18 it's going to happen, even though you're going to do 19 a lot of care in home, you know, in-home care. 20 So, you know, the ombudsman program is very 21 vital. They're probably the most vulnerable part of 22 our society. 23 We don't want to see that interrupted, and be 24 in conflict with, or have another interest, that, 25 you know, may be detrimental to what we do. 1 And I got to tell you: We're teaching an 2 ombudsman certification course right now, up in 3 Saratoga. We have 24 people. 4 People come from all walks of life to become 5 volunteers in this program. And they are the 6 most -- I just can't -- their advocacy is just 7 something that they bring to the table, they bring 8 it to these people, in nursing homes, and assisted 9 livings. You know, it's almost like it's their 10 family. People create that relationship. 11 We would not want to lose that; that ability 12 to do that. 13 And we, also, and I think, the gal that 14 mentioned before, I think that the SOFA, director, 15 or whatever may be the outcome of this, should have 16 the ear of the governor's office. 17 And I don't really have anything else. 18 MS. MESICK: Senator, one other comment from 19 one of the other meetings that we had: We heard 20 from a North Country local Office for the Aging, 21 that talked about their blend, also, of the medical, 22 with social supports, again, directed by the local 23 Office for the Aging. 24 And they talked about difficulty in getting 25 answers and direction from the health side for some 1 of the work, from the state Department of Health. 2 And only recognizing, kind of the size of the 3 bureaucracy, and the way in which questions, by 4 culture, need to be answered; as opposed to the way 5 that the Office for the Aging -- the state Office 6 for Aging is able to provide support. 7 So, again, it's an example to your question 8 of: What are some of the issues we see, if we were 9 to make the move in that direction, as opposed to 10 really strengthening the state Office for the Aging. 11 MS. AULDRIDGE: If I could build off the 12 point you're saying, I also think -- 13 My name is Allison Auldridge, from 14 Services and Advocacy for GLBT Elders. 15 -- and I wanted to raise the issue of the 16 population of older adults who are in the greatest 17 social and economic need, which is something the OAA 18 spells out as a mandate for state units on aging, 19 which is -- which are groups that, I think, that 20 most of us are concerned about, kind of losing a 21 focus if NYSOFA were to be absorbed into DOH. 22 These include: People of color. GLBT 23 elders. Older adults with HIV, disabilities. 24 A number of these groups experience extreme 25 health disparities. They have lower rates of 1 health-insurance coverage, higher rates of diseases. 2 They experience more stress than other counterparts 3 of their age. 4 So, I think that that's another concern that 5 we also outline in our principles, as a concern for 6 what happens when the DOH is overseeing all of 7 these. 8 MS. MILLER: I think, also -- 9 Nancy Miller, from VISIONS. 10 -- that my experience with the department of 11 health -- and we are not funded in any way by DOH, 12 so I don't speak as a contractor -- it's a very 13 rigid system by -- by its funding streams. 14 NYSOFA is, soft, and cushy, and it molds to 15 the need. 16 And I think that -- 17 SENATOR VALESKY: Is that your legacy, Mike? 18 MR. BURGESS: I hope not. 19 [Laughter.] 20 MS. MILLER: But the point is, that -- and I 21 think it's been mentioned by most of the speakers, 22 that there's a creativity and flexibility that is 23 allowed by an agency that has to look at, new ways, 24 pilots, demonstrations, new ways of communicating. 25 I think the strength of NYSOFA is actually in 1 this room, if you see the diversity of the various 2 Aging cohorts that are being represented, that's 3 natural for NYSOFA. We all sit together, and figure 4 out how to blend what is there. 5 That's not the culture of DOH. And it's much 6 harder to get to the level of a decision-maker; 7 whereas, the director of the state Office for the 8 Aging has always been extremely accessible. You 9 pick up a phone, and you can actually get to that 10 person. 11 And that's what state government should be. 12 Why is state government in business? It's 13 for the people. 14 NYSOFA is state government, that is 15 accessible to the people; the little people, as well 16 as the advocates. 17 And that's something you would lose through 18 the culture of DOH. 19 SENATOR VALESKY: Well said. 20 MR. BURGESS: I just want to make one point 21 about what Rich said, because I want to illustrate, 22 there was a real conflict of interest that we faced 23 last year. 24 The ombuds program was appointed by the 25 bankruptcy court to represent the patients -- or, 1 the residents of four nursing homes, Northwoods, 2 that was go through a bankruptcy proceeding. And 3 that court put the ombuds program -- the judge said, 4 "I will decide this case on the best interests of 5 the patient" -- "of the residents." 6 And what the ombuds director says -- and the 7 local ombuds' director, not the state office -- 8 "Will be what I determine." 9 That situation was not exactly -- I mean, the 10 health department did go in and inspect these 11 facilities, and try to make sure that they were not 12 short-staffing during this bankruptcy proceeding. 13 But if the ombuds program had said, they 14 are being mistreated, and whatever, and those 15 facilities had closed, that wasn't necessarily a 16 gift to the health department, because they would 17 have had to look at finding a place for all of them. 18 So, that's an example of where there was a 19 direct difference between what the ombuds program 20 would be doing, and I'm not saying the 21 health department didn't care, but it would have had 22 a different role, and a different purpose. 23 And I wanted you to be aware of that because 24 there are other responsibilities that the ombuds 25 program has. And recognizing -- the bankruptcy 1 court recognizing them is something totally outside 2 of state government. 3 SENATOR VALESKY: Deb? 4 MS. RITANO: Hi. Deb Ritano, from 5 Jewish Family Services, the neighborhood NORC 6 program; and, so, I have the opportunity to really 7 give direct service. 8 And what I wanted to say, something that 9 Nancy had said, when she was describing the 10 "cushy" NYSOFA, was, for us to be able to pick up 11 that phone and speak to them directly is very 12 important, because they are the agency that combines 13 their head and their heart when they're dealing with 14 an individual. And you can call, with an 15 individual, through the NORC program. 16 And for us it would be disastrous, if, in 17 fact, as you said, we were swallowed up by the 18 department of health. 19 Our seniors are -- we do not have a medical 20 model. We have social model. 21 We do, now, have a part-time nurse who can 22 follow up, so that we can prevent re-admission to 23 the hospital. 24 We have a handy man that the seniors can 25 call, to come and change that light bulb, or to be 1 able to clean out those gutters so that they won't 2 fall. 3 We're able to do those kinds of things. 4 But, the bigger part of it is, is that, on 5 that grant, we're a bigger -- has -- is a bigger 6 partnership, with all of these senior services and 7 Catholic clarities, and all of the other people 8 around the community, who are able to support that 9 NORC initiative, to be able to respond to the needs 10 of the seniors in the community. 11 MS. KRAKOWSKI: Molly Krakowski at JSA. 12 Actually, I wanted to go back to what Nancy 13 said, and what we talked about, in terms of that 14 point of entry, because I think that that speaks a 15 lot to the difference between the two directions 16 that are sort of in front of us. 17 A lot of energy went into bringing us all to 18 the table, creating these points of entry, looking 19 at how we can all work together, being community 20 partners with the state Office for the Aging. 21 We were reached out to when it came do the 22 Medicare Part D enrollment, education. A lot of us 23 had been involved with the advocacy when it came to 24 you know, Part D, for example. But, then, we were 25 the same go-to people when it came to trying to 1 educate people, and help them to figure out how to 2 navigate the system. 3 I think that it's, both, tangible, and it's 4 also the perception of, if you fold in aging into 5 this vast DOH, or other, you know, medical model, it 6 loses that exact piece and component which all of 7 us, I think, are connected to, which is, that we are 8 a partner with this state. 9 We are very effective at getting out the 10 information, communicating with people, and saving a 11 lot of money in the process by funneling people to 12 the right direction -- you know, getting people to 13 the right service, in the right way, and so that 14 they're not inundating a health-care model or a 15 health system. 16 And I think, also -- and I'm not a dollars' 17 person -- but, I think it's clear, that once an 18 Aging department would be folded into a health 19 model, we're no longer really on the -- we're no 20 longer a point of interest in terms of looking at a 21 budget. 22 I think it then becomes this enormous budget 23 that we always look at. And, how can we cut the 24 budget? And, how can we slice-and-dice these huge 25 departments? 1 And, Aging is just inside there, somewhere, 2 but it's no longer on the radar as a distinct budget 3 cut, or as something very clear, and how it's going 4 to affect all of us in the community. 5 So, you know, we are a lot of big and small 6 agencies out in the community. And we do represent 7 very different but conjoined -- you know, conjoining 8 organizations. 9 And, that network, I think, would be 10 completely decimated once folded into a different 11 model. 12 I think that things we do now with VISIONS, 13 for example, or other groups which are now under 14 state Office for the Aging, would then fall under 15 some other category within health. 16 It wouldn't necessarily be that same flow 17 that we currently have, and where we are able to 18 pull together and say: 19 Okay, what do we all need? 20 And, how can we word this so that it's 21 inclusive? 22 Or, that, you know, we're really recognizing 23 where the state is coming from, but also not losing 24 where we all are. 25 And the other thing is, this idea of block 1 grants being the answer, when a lot of us have been 2 doing services in the community, and have a lot of 3 experience doing really good work in the community. 4 And trying to sort of not lose sight of what's a lot 5 of work has gone into over the years, in developing 6 that other model. 7 MS. TINNEY: Carin Tinney from 8 United Neighborhood Houses. 9 I just wanted to build on a lot of what's 10 been said here, and to speak a little bit about what 11 happens when you medicalize a service. 12 When you think about somebody who has, say, 13 dementia, and they go in to a doctor; and, what does 14 the doctor do? 15 They prescribe, like, an anti-anxiety 16 medication and anti-psychotic, Aricept. They treat 17 the symptoms. Right? 18 The programs offered by SOFA will look at the 19 whole person, and look at the whole family and the 20 whole support system, and help that person and that 21 family get along in society, that's the community, 22 which is often the sick part. Right? 23 They'll look at, you know, if somebody is in 24 the third stage of dementia, or they're speaking in 25 tongues, and they don't know, you know, what 1 their -- their spouse doesn't know what they're 2 saying anymore, they'll help their spouse, as well 3 as the person who has dementia. 4 So, SOFA programs often look at the broader 5 picture. They're not just looking at blood-pressure 6 outcome. They're looking at the whole person, the 7 whole community, the whole support network. 8 So, that's -- you know, that's one of the 9 downsides of a medical model, is that, you're losing 10 sight of the whole self -- to which SOFA does, 11 amazingly so, with NORC programs, with 12 SAD programs (social adult day), with 13 case-management programs, caregiver-support 14 programs -- you know, in addition to the financial 15 cost of medicalizing something, that that is there, 16 and that's very much a reality. 17 I also just wanted to, you know, point out, 18 like, something that I've often thought of, is that, 19 we've never really prepared our own communities and 20 our neighborhoods to deal with an older-adult 21 population. Because of longevity, we are living 22 longer. 23 So, things like -- you know, and AARP has 24 done amazing work on this, and level of communities 25 has done amazing work on this -- is that, you're 1 looking at things, that, we don't have the 2 transportation systems to support somebody once they 3 have not -- where they've stopped driving. Right? 4 You're looking -- you can go outside and 5 probably find five broken sidewalks, you know. 6 You can -- you know, just this -- the pure 7 computerization of every service out there, you 8 know. And computers are like a third and fourth 9 language to a lot of older adults, so it's a 10 preventive factor from going out and doing the 11 business that they used to do. 12 And, you know, and on fixed incomes, and 13 somebody mentioned before, you make something like, 14 $1,400 a month. 15 You know, the cost of a meal; you know, for 16 somebody who cannot -- can no longer really pick up 17 a pot because it's too heavy, and can't buy a pot 18 because they're on a fixed income, you know, that's 19 lighter, a cost of a meal is preventive to living 20 wholly in the community. 21 So, I often, really feel that our communities 22 are the ones that are sick. You know, not 23 necessarily the people who are receiving services 24 from SOFA. 25 So, I think that the SOFA services that we 1 have are, often, fill the gaps to make the community 2 whole, so that somebody can live very independently, 3 and with dignity. 4 And that's a huge word: with "dignity." 5 The other point that I just wanted to make; 6 you know, I've worked in nursing homes that are -- 7 you know, have not subscribed to culture change, and 8 I've worked in nursing homes that have subscribed to 9 culture change. 10 And culture change is trying to undo that 11 medical model. Right? 12 So, you know, an advocacy point for not 13 putting SOFA in DOH, is that we don't want to do 14 what they've done in the nursing homes; is, go to a 15 place where the language is foreign, and, like, 16 everything there is medicalized. Right? Because 17 they're trying to get out of that now. 18 Why would we want to go into that? 19 So... 20 And the last point is, that, you know, when 21 this population was school-aged, they had to expand 22 the schools. Right? Had to add more classrooms to 23 on to deal with this. 24 You know, when they started to get jobs, you 25 know, the workforce was increased. You know, and 1 the numbers of houses that were built, and 2 apartments that were built, were increased. 3 Now this population, that we're facing right 4 now, is coming into communities. We need to expand 5 the services within the communities, to help to 6 support them, to live. 7 So, with that... 8 MR. McNALLY: I want to build off that a 9 little bit. 10 We're not ready, and the future is not, as 11 far as the size of the aging population that Nancy 12 mentioned. 13 If you go to Miami-Dade County, or if you 14 have ever been to Senior Day at the State Fair, 15 that's what our population is going to look like 16 very, very soon. And we're not prepared at all. 17 And we couldn't -- even if everyone wanted to 18 go into a nursing home, and could afford to -- which 19 are two ridiculous "ifs" -- we couldn't build 20 enough. 21 [Laughter.] 22 MR. McNALLY: We couldn't build enough. 23 So, we really need to be focusing on these 24 pieces of the non-medical. And, SOFA is the only 25 place to do it. Or, something like SOFA, or a 1 more-empowered SOFA. 2 But I don't want to miss the opportunity to 3 raise the issue of efficiencies as well. 4 And I'm not -- I don't know anything about 5 SOFA's internal bureaucracy. Maybe Mike can speak 6 to that a little more, or some of the providers that 7 deal with them. 8 But, if there are, HR issues, web-design 9 issues, contracts; all that kind of stuff that goes 10 on in a bureaucracy, if that, somehow, can help save 11 money, that's great, by doing it with other parts of 12 the government. 13 But more important, from my -- our 14 perspective, is -- 15 And I'm David McNally, with AARP. 16 -- is: Does that free the agency up even 17 more, to actually focus on their mission, and 18 delivery of services and programs? 19 MR. NADEAU: Christopher Nadeau, with 20 NYSADSA. 21 I think most big states are moving in the 22 direction of -- of, they're realizing that they've 23 over-medicalized their long-term-care system. And, 24 so, they're sort of moving in the other direction, 25 looking how you can blend in services. 1 And I think that's a lot of what we're 2 talking about here. 3 And the division is, that NYSOFA could be a 4 tremendous gateway to coordinated care. And I think 5 that's the direction that we need to go. 6 And, I think to be on the right side of 7 history here, in terms of home and innovative 8 services, that's what families want. And we know 9 it's cheaper. 10 So, I think that there's a tremendous amount 11 of synergy here, to move in that direction. I just 12 hope that we have the will to do it. 13 SENATOR VALESKY: Just one second. 14 Yes, Senator Golden? 15 SENATOR GOLDEN: I want to jump in. I have a 16 load of committee meetings this morning. 17 I think it's important. I want to thank 18 Senator Valesky, the chairman, for putting this 19 together, and bringing all of the advocates together 20 in a room, to discuss this issue. 21 There are several things, obviously, and it's 22 been said: From the design of --, they can absorb 23 some of the -- HR, some of the other areas that 24 might be duplicated. Maybe they can do it better, 25 in health, in certain instances. 1 The problem that I've seen with aging over 2 the years, at SOFA, I've seen the, I think, 3 neighborhood NORCs? Tremendous. 4 Open NORCs? Tremendous. 5 Ombudsman; we worked to make sure that we got 6 that done. 7 Mike, we worked with you as the advocate, and 8 as the director. 9 And we've always had one problem, and that 10 was getting enough money for the director. 11 We always seem to be able to fight for, 12 keeping senior centers open in New York City, 13 getting transportation for Upstate New York, trying 14 to get these open NORCs to include areas -- vast 15 areas of upstate and downstate. 16 And, coming up with, you know, the tens of 17 millions of hours that are donated by the 18 caregivers, coordinating that, and making sure we're 19 keeping our aging population out of nursing homes, 20 and out of the assisted-living facilities, and out 21 hospitals; as a last resort, after we have exhausted 22 all of our volunteers, and all of our volunteers -- 23 and we've trained those volunteers, and they can't 24 do it anymore, and it's the only step left, is to go 25 into the medical -- into an assisted-living 1 facility, which saves this state, and this nation, 2 tremendous, tremendous money, with what this SOFA 3 has done, in the past, and can do in the future. 4 There are two areas that we have to -- I 5 think, to be able to expand on, and that's, you 6 know, recommendation that you brought here today. 7 And, getting our message to the Governor. 8 And I applaud the Governor for trying to do 9 the work that he's trying to do here in this state. 10 I think that, the new Medicaid design, I 11 think is going to have some issues. 12 God willing, we'll be able to work through 13 them over the course of next six or eight months. 14 But, I already see a low number of areas, 15 where it's already impacted, and they need help. 16 And that's before we get to the 2014 17 President Obama's health care for our nation. 18 So, when you finish with the state and the 19 nation, what is left here for the consumer, the 20 client, us? 21 What are we to have, as we grow older; what 22 are we to expect? 23 And we cannot allow our dignity, and we 24 cannot allow our quality of life, to be changed to 25 such a degree that it would impact on our health, 1 impact on our families, and impact on our 2 volunteers. 3 So, the second part of this is: How do we 4 get our message to the Governor, and have the 5 Governor understand the importance of, maintaining a 6 SOFA agency, funding more money into SOFA, and 7 allowing them to continue to do, and to enhance the 8 mission, that they have been, and should be, given? 9 I think we all agree here, department of 10 health, I love them, but it's a black hole. 11 And, the commissioner is going to do a great 12 job in trying to coordinate and organize, and do 13 what his responsibility will be. But, his 14 responsibilities in the department of health are too 15 many. 16 There are too many tentacles in the 17 department of health; and, therefore, only one 18 reason to move SOFA into the department of health, 19 is for savings, so that means we're covered. Right? 20 So, the programs we see here today, that we 21 talked about, are going to be cut. So, we can't 22 allow some of those programs -- many of those 23 programs, we have to enhance those programs, bring 24 new programs in, do best practices across this 25 nation, and around the world, to bring the best 1 possible outcome to the seniors here in our 2 communities. 3 So, that's the two, I think, missions that I 4 think Senator Valesky, the chairman, is focusing on; 5 and that's: The recommendation expansion. And, 6 getting our message, and the understanding, that 7 this is something that this state must have. 8 So, that challenge is to you: 9 How do we get this governor, this good 10 governor, to understand the necessity of SOFA? 11 How does that message get delivered to your 12 client base? 13 How does that get delivered to our governor? 14 And, how do we manage this, and create and 15 expand on the recommendations, that the good 16 governor would want to put his name to, and 17 participate in? 18 I think that's the focus. 19 And I might have left a couple of things out, 20 but that's what -- I have had the privilege of 21 working with a good director, and a couple of good 22 directors here. And Mike did a good job. 23 Thank you. 24 MR. McNALLY: Could you tell us a little bit 25 about what your perspec- -- what is going to happen? 1 I mean to say, we keep hearing different 2 rumors of: 3 Whether they've met. 4 Or, are they meeting? 5 Or, are they going to make this May 30th 6 deadline? 7 Is it an up-or-down vote this year? 8 Do they have several years to do this? 9 What is the legislature's -- 10 SENATOR VALESKY: We're the same -- 11 MR. McNALLY: Okay. 12 SENATOR VALESKY: We're in same boat as you; 13 we're hearing the rumors that no official 14 communication, certainly, with me and/or with you. 15 I don't think -- whatever happens, I think 16 the process is, will take a much longer period of 17 time than they may have originally indicated. I 18 don't think we're going to be doing anything, 19 legislatively before the end of this legislative 20 session, on any this stuff. 21 And I think -- I think they're acknowledging 22 that now. 23 So -- but, you know, I think Senator Golden 24 was right. I think the -- one of the great 25 challenges that we have -- and I want to commend 1 everyone for being proactive. 2 I mean, you know, so often in government, we 3 can sit back and wait for something to happen, and 4 then we're forced into reactive mode. 5 You know, from a budget perspective, I guess 6 that's the way the process works. But, we ought to 7 see this, not as a threat, but as an opportunity. 8 And I don't think we're up against a clock, 9 necessarily, that has anything to do with this 10 legislative session. 11 So, you know, rolling out a communication 12 strategy with the commission, and, as Senator Golden 13 says, directly with the Governor, is, I think, all 14 of our collective challenge. And, I think this is 15 the beginning of that process. 16 SENATOR GOLDEN: And if I may, I do believe 17 that there are people within state government that 18 believe this is a done deal. 19 So, having said that; so, if people already 20 believe it's a done deal, it's just a matter of time 21 before the legislation is sent down: Is the 22 legislation going to be required, or is it just 23 going to be absorbed? 24 Because of the way the SOFA is listed in 25 the -- on this state, I don't know if they need 1 legislation to move you over. 2 MR. BURGESS: This is the way -- 3 SENATOR GOLDEN: Pardon me? 4 MR. BURGESS: This is the way that it's 5 listed, as part of the executive -- 6 SENATOR GOLDEN: Correct. 7 MR. BURGESS: -- department? 8 SENATOR GOLDEN: Correct. 9 Do they need legislation to move you over? 10 MR. BURGESS: Well, the elder law, as I 11 looked at it, I think they'd have to change it. 12 You wrote it, actually -- 13 SENATOR GOLDEN: I know. 14 MR. BURGESS: -- when you were there. Right? 15 [Laughter.] 16 SENATOR GOLDEN: Which they didn't want to 17 take; which, they took three-quarters of it. I wish 18 they had taken all of it. But, we did the 19 neighborhood NORCs, we did the ombudsman; we did all 20 of these programs over the last five years. 21 MR. BURGESS: That's right. 22 SENATOR GOLDEN: And I'm proud of each and 23 every one of them. And, of course, the elder law. 24 MR. BURGESS: Well, I think they would have 25 to say that, you know, there's no longer a separate 1 agency, and no longer a director. 2 That language had to be stricken from the 3 elder law, and repealed. 4 And -- so, I don't know that they could do it 5 without you, the legislature. 6 SENATOR GOLDEN: Okay. So, then, there would 7 be -- I think we would have to do a little bit of 8 homework on that. And then that would be, we would 9 increase, now, the goal of, not just talking with 10 our governor, but also talking with the legislative 11 bodies here, on the assembly and the senate side, to 12 see the importance of delivering for the clients and 13 base across the state of New York. 14 And I think the legislature would understand 15 that, and I think the Governor would understand, 16 when, in numbers, and, in fact, what the savings can 17 be, and how we can expand on those savings for the 18 state of New York. 19 I think that message has to be delivered. 20 And I think the message has to go out, this can't be 21 a done deal. This has to be -- there are, all of 22 the advocates -- and this is, again, just a small 23 portion of the advocates across this great state -- 24 they have to be heard. And we cannot allow it to go 25 forward. 1 So, I agree with my good colleague, 2 Senator Valesky, here. I don't see it as one of the 3 pressing issues. There are a number of pressing 4 issues coming down in the next four weeks. But, I'm 5 not so sure this can't just be absorbed. So -- and 6 come in for the legislative fixes in January or 7 February. 8 So, I think it's important, and imperative, 9 and that we get our message out as soon as possible. 10 MR. BURGESS: Could I just add one thing; 11 that, regardless of whether there is legislation, 12 having been in that job over there, I think it would 13 be unfair to the agency if the Governor did not -- 14 if there's no legislation this year, did not give 15 clarity, and put a director in the agency, whether 16 it's the acting director and make him official; but 17 to keep the agency going as -- in limbo for another 18 year, I think would be unfair to all of us, as well 19 as to the staff there. 20 So, I would urge you, that, if nothing else, 21 that you urge the Governor to make a decision on the 22 status of the director of that agency, so that we 23 have something for the next year. 24 SENATOR GOLDEN: I think it's important that 25 he makes an educated decision. And that educated 1 decision is what you're putting together here today. 2 MS. DISARRO: To the pressure points that we 3 have to make, would you tell us, I mean, is it, to 4 the Governor? is it to the SAGE Commission? 5 Where is -- 6 SENATOR GOLDEN: Both. 7 MS. CERENOS: Okay. We need to make sure 8 that we take your charge, and do it to the right 9 places here. 10 SENATOR GOLDEN: You have to show what some 11 best practices around the nation. 12 You pointed out Dade County. 13 I was down in Hollandale and -- what's the 14 county next-- Fort Lauderdale. And I couldn't 15 believe how that had changed. I was there 40 years 16 ago, with kids. 17 I went down there, recently. It was nothing 18 but people, like me. 19 [Laughter.] 20 SENATOR GOLDEN: The transformation, it was 21 amazing. 22 Then you went to Miami, and this whole part 23 of Miami, there was thousands and thousand of young 24 people. 25 But, the majority of that part of Florida is 1 seniors. 2 I think you have to expand on the 3 recommendations. You have to show savings. And, 4 you have to show what your mission -- what the 5 mission of SOFA, can, and will be able to do, going 6 forward. 7 MS. DISARRO: I understand. 8 SENATOR GOLDEN: And it comes down to the 9 tens of millions of volunteers' hours that are going 10 out there: the transportation, the Meals-on-Wheels. 11 I dare to say, you know, I would ask the 12 SAGE. 13 And maybe I'm pushing this just a little bit 14 too far, this envelope, but I don't want to do that, 15 and I don't want to be dramatic on it, but, if any 16 of the individuals that sit, and think that this is 17 something that we should move, brought into health, 18 they should go on -- in a van and deliver a meal 19 at -- to a family, or to a woman, or a senior. Go 20 inside to some of the homes of our richest 21 communities, our best communities, and you will see, 22 and walk away from that in tears. 23 So, there are people living substandard, our 24 seniors. And if it wasn't for the refrigerators, 25 you would cry again. 1 So, I'm not trying to be dramatic here. I'm 2 trying to get a point across: there is a need. 3 And I believe we cannot allow that need to be 4 absorbed into what can be a bureaucracy that will 5 slow down the process, and put more people into 6 nursing homes, assisted-living facilities, and deny 7 a quality of life for many of our seniors here in 8 this great state. 9 So, I think that has to be, without being 10 with the drama, but I think that it has to be that 11 dramatic; that they have to understand the 12 necessities: 13 The number of meals. 14 The transportation Upstate New York, and how 15 you have to be able to get around. 16 The hospitals; how you keep people out of the 17 hospitals, and out of nursing homes. 18 And, real quickly, I have to close: In 19 Brooklyn, New York, where I represent, you actually 20 wait 40 to 50 hours in the emergency room to get a 21 bed. 22 That's today. That was before any of this 23 went into effect. 24 There are some points of the year, that you 25 can wait over 100 hours for a bed in the hospitals 1 in my community. 2 Now, if you know somebody, like a 3 Senator Golden, you pick up the phone to get 4 somebody a bed? Well, great for that individual; 5 but, what about the other 99 people that are 6 sitting, waiting for a bed. 7 Now, in self-injury; you get the bed. Now 8 you need rehab. You've got to go to a nursing home. 9 There's a line of a nursing home. You cannot 10 get into that rehab. You have to actually wait, and 11 make appointments for that. That could be weeks 12 before you get into a nursing home. 13 I have no nursing beds in my community. I 14 don't know where all these nursing beds are. 15 So, I think we have some serious crises going 16 on. I think Brooklyn is definitely going to be a 17 "ground zero" for health-care issues in the future. 18 But, there are a number of Brooklyns around 19 the state of New York. And we have to try to 20 concentrate on that. 21 Just think about that. 22 There are lines, today. And that's before 23 the baby-boomers kick in. That's before we see some 24 real changes that will change that system to a way 25 that we no longer know. And we can't allow that to 1 happen. 2 I have to run to my committee meetings. I 3 know I threw a lot out on the table there. 4 But you have a very qualified and good 5 chairman here. He'll help. And I will work with 6 you, to coordinate, to get our message across. And 7 I think we have to get it across in a timely 8 fashion, and it has to be a concise and decisive 9 piece of literature, and information, that goes to 10 the Governor, and to SAGE. 11 Thank you. 12 MS. MESICK: Thank you. 13 MR. JELLINEK: Senator Golden, thank you for 14 all the good work you have done on behalf of seniors 15 in New York State. 16 MS. MESICK: Yes, thank you. 17 SENATOR GOLDEN: You're quite welcome. 18 You keep up the good work that you're doing 19 for seniors. 20 Tell that "good little Bobbie," I said hello. 21 [Laughter.] 22 SENATOR GOLDEN: Where are we hiding that 23 woman today? 24 MR. JELLINEK: City hall. 25 [Laughter.] 1 SENATOR VALESKY: Thank you, Senator. 2 SENATOR GOLDEN: You're quite welcome. 3 Mr. Chair, thank you. 4 SENATOR VALESKY: Okay, who else? 5 I want to make sure we have -- I don't know 6 if we've heard from everyone? Is there anyone who 7 hasn't had a chance to weigh in? 8 No? 9 To wrap up, the last five minutes or so, 10 anybody have any final thoughts that they want to 11 share? 12 MR. JELLINEK: I think what's exciting about 13 this, for us here, is that we're all embracing this 14 opportunity. 15 SENATOR VALESKY: Uh-huh. 16 MR. JELLINEK: We're not being defensive. 17 We're trying to take advantage of a seed change 18 that's occurring. 19 SENATOR VALESKY: Yep. 20 MR. JELLINEK: And we believe it's the right 21 thing to do. 22 And I think, in the last three months, or 23 longer, we have come together, to unite on this 24 position. And I think that could become a very 25 powerful force. 1 And working with you, and all of groups 2 around this room, and the groups that aren't in this 3 room, I think we can force some of this change. 4 The strategic work that needs to be done, we 5 would love, all of us, to work closely with your 6 office, and see how we can make this happen. 7 And, with the Affordable Care health-care 8 act, hospital is not getting a lot to-- getting 9 reimbursed for discharge planning. 10 Anybody who's discharged, and if someone is 11 telling you, discharge planning is an oxymoron, 12 there's no such thing. 13 So, if they're not getting reimbursed for 14 this, it's the community-based services, that are 15 there, that need to be invested in. 16 To me, it's a no-brainer. 17 I mean, it's -- the services out there, that 18 need to be invested in. And there needs to be a 19 flip, a rebalancing, of how to look at this. 20 And from what I understand, hearing what the 21 health commissioner said yesterday, he certainly 22 gets this, in terms of product-based services. 23 And the last piece is, you need a voice for 24 aging in New York State that's independent, of 25 somebody reporting to the health department. 1 SENATOR VALESKY: Right. 2 MR. JELLINEK: So, I don't want to speak for 3 everybody, but I'm just saying, I think we're pretty 4 united on all of this. 5 And I think the question is: Do we get the 6 seniors -- it's time to go back to the seniors, and 7 start talking once, and putting some numbers to 8 this. 9 And if your staff can be helpful, in helping 10 us to come up with some of the numbers -- I know 11 some people have the expertise -- that would be 12 really helpful. 13 SENATOR VALESKY: Absolutely. 14 MS. MESICK: I just also think, Senator, 15 again, thanking you for your statement at the 16 outset, which is, that you would like to communicate 17 to the SAGE Commission, your own perspective. 18 I think that's very powerful, and important. 19 And we thank you for your willingness to do that. 20 SENATOR VALESKY: Well, that's my immediate 21 next step after this. And, again, communication is 22 key. 23 And I don't -- you know, the SAGE Commission 24 is charged with lots and lots of, or will develop 25 lots of, recommendations across the whole scope of a 1 $132 1/2 billion state budget that funds all our 2 state agencies. 3 But I think that, first, and foremost, all of 4 you coming together, and being proactive -- and I 5 don't have to repeat what I have already said -- 6 but, putting a proactive plan in place, as opposed 7 to reacting to whatever they suggest, number one, 8 critical. 9 Now, it's that communication, from me, and 10 from the perspective of the committee; from all of 11 you, from the perspective of your leadership 12 positions in your own communities. And, then, as 13 you just indicated, going back to your seniors, and 14 others. 15 Because, I don't know that -- you know, I 16 haven't heard, in other areas, this kind of a united 17 front, and communicating to the commission, and 18 then, by extension, to the Governor. 19 So, I think that's, clearly, the next step. 20 I think the one thing that I would just, to 21 follow up to Mike, on the issue of whether or not 22 legislation would be needed? 23 I think in addition to the elder law, you 24 know, I mean, the budget is legislation. 25 I can't imagine that there could be any 1 defunding of any state agency, without that being 2 part of a legislative process. 3 So, I can't -- you know, I could be wrong, 4 but I can't imagine that there is any way that 5 something like this could happen without the 6 legislature's ultimate approval, so... 7 And I don't see any chance of that happening 8 in the next four weeks before this session ends, 9 so... 10 So, this is, again, the beginning of a 11 process, and hopefully the end will be successful. 12 And, you know, everyone, as I anticipated, raised 13 incredibly salient points about why this is so 14 important. 15 So -- 16 MS. MESICK: Thank you, Senator. 17 (Roundtable participants say "Thank you.") 18 SENATOR VALESKY: Okay. 19 All right, thank you all very much. 20 (Roundtable participants say "Thank you.") 21 22 * * * * * 23 24 (Whereupon, at 10:29 a.m., the senate 25 roundtable session concluded.)