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What Does the Future Hold?
Editor’s Note: An interview with Mr. Mendez-Santiago at the start of his tenure as Commissioner of the NYC Department of the Aging was featured in the May 2002 issue of Currents. Now, three years into his term as Commissioner, he was asked to respond to four questions to provide his view of the future of aging services in New York City.
Edwin
Mendez-Santiago, LMSW, Commissioner, New York City Department for the
Aging
Projecting
5-10 years into the future, if we are not careful in planning, what potential
gaps might develop in social service delivery to elders?
Emerging demographic trends - as well as some of the new ideas about the
potential for healthy and productive aging -demonstrate a clear need for
mission change. The next wave of seniors is, for the most part, better
educated, more affluent and more culturally diverse than our current senior
population. They will want and need different kinds of social services
than their elders. And they will view and expect others to view aging
as a positive reward for a life well lived. We as providers of aging services
must realize that aging is a positive force we need to harness and use
as a resource.
The increase in longevity, with the greatest growth in the population
age of 85 and over, will result in a need to support the safety and quality
of life of frail elders who want to remain in their own homes and communities
for as long as they are able.
New York City is ahead of many other places in the country in anticipating
issues. These issues could include the 85-plus year olds, old isolated
elders, immigrants who may not be able to navigate complex social service
networks, the mentally ill, and caregivers who are unable to reach out
for aid.
How do the changing demographics of NYC play into this scenario?
New York City has always been diverse. A society as diverse as ours requires
that we recognize and embrace this diversity as its great strength, and
begin to demand that our institutions and service providers put this recognition
into practice. English-only, culture-neutral services are increasingly
ineffective and even counter-productive. Cultural competency – the
recognition that culture does matter in the interchange between patient
and doctor, client and social worker, community and institution –
needs to be stitched into the very fabric of all our services, if we are
ever to overcome the health disparities and inequalities in service access
and utilization that mar our current system. We must develop models of
care that are flexible and meaningful to different cohorts.
What needs to be done to protect the system from developing these
gaps?
Our system is evolving to protect the people it is charged to care for,
however, there needs to be government support, especially at the federal
level, for this evolution. This support should not only be monetary, but
legislative as well. We are encouraged by the direction of the Olmstead
Act, several federal initiatives, like the National Family Caregivers
Support Program, CMS’s Freedom Initiative, and the more than forty
waiver models promoted across the nation to support reforms of long-term
care. With these legislative initiatives to provide home and community-based
services, it will be more important than ever to make our communities
positive places in which to grow old.
This October, at the White House Conference on Aging, we can address issues
that will help us meet the demographic challenges of increased longevity
and changing population. The conference will be an important forum for
input to help move the aging network and the Older American’s Act
forward to the new realities in aging. We should think about looking for
a cultural competency model of care with funding levels that will meet
our future needs. We must also continue to address the health care and
service disparities that limit extending the benefits of longevity and
supportive services in an equitable manner to all seniors in our society;
women, those over age 85, the frail, low or moderate income populations,
LGBT seniors, minorities and immigrant populations. The principles of
targeting within the Older Americans Act have to be reaffirmed.
With the challenges ahead, we need to use this Conference to urge an agenda
that not only protects but also transforms the system.
What would need to happen, both locally and federally, to bring
about these protective strategies?
At the local level we have to break down the barriers between health,
mental health, and social services for the aging, and talk and work in
partnership with each other. We need more dialogue and better understanding
among all parts of the aging services network and among all providers.
This effort of promoting dialogue, coordination and collaboration among
providers is crucial.
We will need additional culturally competent mental health services to
meet the needs of this population. These services will be critical in
identifying and reducing social isolation among the elderly.
Social workers trained in gerontology must be available for this burgeoning
older population. Despite the growth in the profession as a whole, the
growth rate in the field of geriatric social work is about 5 percent –
not nearly enough to keep up with anticipated demand. There are many reasons
for this lag between need and supply. These include low salaries in aging
services, and a kind of ageism that views working with older persons as
depressing, and aging itself as a process of inevitable frailty, decline
and dependence. We need to address these issues. Social workers should
be compensated at professional levels for the professional work they do.
We also need to change the misconceptions and prejudices about aging that
we now know distort the reality of the aging process.
We must speak with a unified voice that shows that we are advocating for
the needs of seniors and caregivers. The aging network must continue to
fight ageism and work towards the promotion of policies and funding to
support the establishment of “senior–friendly” communities.
The “social capital” of seniors must be utilized in meaningful
ways as resources to support this transformation. Services must be provided
to enhance the interdependence of seniors with their families and communities.
Seniors must be seen as much more than recipients of service.
Fully engaging the elderly in these efforts will promote empowerment and
increase their quality of life.