Budget Cuts Impact Aging and Social Work Services

Bobbie Sackman, M.S.W., Director of Public Policy, Council of Senior Centers and Services of NYC

Impact of the City Budget on Services

The Bloomberg administration is proposing $37 million in cuts to DFTA which include elimination of a sixth weekend meal given out on Friday at senior centers, closing of senior centers, elimination of mental health social work program, renovation funds, across-the-board cuts and elimination of City Council discretionary funds which pay for core operating costs of programs. Despite DFTA's contention that no seniors will lose services, a myriad of other services will be lost such as elder abuse services, intergenerational programs, transportation, and ESL for elderly immigrants.

DFTA's budget is 75% city funds, making it the most dependent of human service agencies on city money. Losing $37 million is a setback of at least a decade in progress made to build a community-based system as it wipes out the money won over the past six years - $40 million. Progress is painfully slow. It will take many years to win these funds back, if ever. Forcing seniors to lose a decade of progress is inappropriate social and economic policy as nutrition and other preventive services allow seniors to age in place while saving medical costs.

The aging services network provides a continuum of care from the preventive wellness end to in-home services for frail elderly allowing them to age in place. Services include multi-service senior centers, meals-on-wheels, transportation, adult day services, naturally occurring retirement communities (NORCs), case management, home care, mental health, housing and other services.

Already stretched

The infrastructure of the aging services network going into this fiscal crisis is stretched. Staff has not received a salary increase in three years breaking a 23 year city policy of tying increases to the rate won by municipal unions - worth $4 million a year. Increased core operating costs such as rent and van insurance have not been funded in three years at a cost of $3.7 million to the network. Unmet needs grow pressuring this fragile system.

There is no law or court mandate that requires the city to fund maintaining the elderly in the community who are above the Medicaid level. The aging services network serves both low-income seniors and the four out of five seniors who are not Medicaid eligible even thought the network receives a fraction of the funding Medicaid does. Not surprisingly, this results in waiting lists for meals-on-wheels, transportation, case management for homebound elderly, and home care.

It is disingenuous for DFTA to state that meals-on-wheels and other in-home services won't be impacted by these cuts when long waiting lists exist. Try telling that to Mrs. M., an 86 year old widowed woman living alone who cannot prepare her own meals due to blood cancer and the need for frequent blood transfusions. She waited four months to receive a case management assessment and meals.

Mrs. M. also had to wait 4 months for transportation to a doctor.

Impact on Social Work Practice

Social work practice is impacted both in the provision of direct services and social workers as advocates.

The Expanded In-Home Services Program (EISEP) provides case management and home care for seniors above the Medicaid level with most clients being near poor. The average caseload is 91 with waiting lists for services making it difficult to provide comprehensive social work. CSCS has advocated for lower caseloads and higher salaries. Low salaries make it hard to attract MSW social workers although complex cases require trained professionals. Budget cuts will force seniors to languish longer on waiting lists while case managers will be increasingly limited in the social work services they can provide.

After four years of advocacy, $3.5 million was won to fund 68 social workers to provide mental health services in senior centers. Seen as a beginning step, there would be one social worker per five senior centers that would circuit ride providing mental health services, no matter where a senior lives, in the comfortable environment of a senior center. Issues of grief, depression, and substance abuse could be addressed. DFTA delayed in getting the funds out and September 11th stopped everything. Most of the funds were lost in the last budget modification of the Giuliani administration. Advocacy for this new initiative continues, as the loss of 68 MSW gerontological social work positions is a major blow.

As a social worker trained in the early 1970's, I entered the field at a time when the core values of social work practice included working to improve service delivery systems and addressing social justice issues such as poverty and racism - and now ageism. By moving away as a profession from this historical role, we have narrowed the definition of social work practice. The devaluing of social workers and cuts to human services cries out for social workers to recapture its advocacy role through educating social work students and practitioners. Rather than keeping waiting lists, we have a responsibility to eradicate them.

Olmstead Decision

In 1999, the Supreme Court ruled that, under the American with Disabilities Act, disabled individuals, including the elderly, have a right to receive services in the least restrictive environment - the community, not nursing homes. This applies to both Medicaid and non-Medicaid services. States are required to develop a plan to comply with Olmstead. The decision has made this a civil rights issue and holds great promise for the strengthening of community-based services. For further information, go to www.cscs-ny.org. Proposed cuts moves NYC away from compliance with Olmstead.

The tension that exists for community-based services for the elderly is that of developing a continuum of services allowing the elderly to age in place in their homes and communities vs. $37 million in proposed reductions that cut below the bone. The Olmstead decision gives a legal foundation for expanding community-based services while already inadequate funding coupled with deep budget cuts will significantly impair the ability to provide community-based social work services to older New Yorkers. The age revolution and its impact on family caregivers is too compelling to ignore.

They say the devil is in the details. The devil in these budget cuts includes hunger, poverty, elder abuse, mental health issues, isolation, transportation, Alzheimer's, and other critical needs of the elderly. Let's not make growing old the devil.