Posted by Nashla Salas, November 19, 2009
When the Bloomberg Administration started reorganizing services for older adults about a year and half ago, it began with two fundamental programs funded by the Department for the Aging: case management and home-delivered meals. The agency realigned its case management system for evaluating and coordinating services for seniors, which resulted in a new route for how the city’s seniors apply for home-delivered meals and other services.
But seniors soon encountered speed bumps along the new route as they sought to receive meals. Rather than having more choices as designers of the new system promised in terms of meals, including frozen meals and frequency of delivery, seniors faced delays.
Under the new plan, seniors could no longer just contact a local senior services agency that provides home-delivered meals and apply for their assistance. The coordination of all in-home senior services is now centralized under a new case management system. While there were case managers before, neighborhood senior centers also often provided service coordination.
The old case management system served approximately 14,000 clients. The new system, which carved the city into 23 service areas with organizations contracted to evaluate needs and coordinate services for seniors, was expected to add about 4,000 new clients during a transition period from April 2008 to June 2008.
But seniors taking the new case management route to home-delivered meals and other services soon encountered roadblocks: many of the new case managers had more cases then they could handle, especially in some service areas. Depending upon the area, case managers were handling caseloads ranging anywhere from 47 clients to 106 clients.
The unexpectedly high caseloads meant that efforts to complete client needs evaluations fell behind schedule. Since seniors needed to complete a caseworker evaluation before they could get home delivered meals, the backlog among some casework providers prevented some clients from receiving meals and other services.
Recognizing the problem, Department for the Aging Commissioner Lilliam Barrios-Paoli told the City Council in late September that in an effort to reduce backlogs and caseload ratios by enabling providers to hire additional staff, start-up funding was extended past the original transition period and the provider contracts for the service areas were modified based on community need. As a result of the contract changes, five providers had their funding increase, two had a decrease, and the maximum number of clients served by any case manager fell to 88.
So seniors would not be forced to wait for long periods before receiving their meals, the Department for the Aging also temporarily waived requirements that caseworkers complete their evaluations before services could begin. Providers of home-delivered meals could start bringing meals to seniors based on the presumption that they qualify. Seniors are then referred to a case management program within 120 days so eligibility can be confirmed and the need for any other services assessed.
The initiative to overhaul the case management and home-delivered meals programs arose from projections of an increasing senior population. Demographers project that New Yorkers 60 and over will make up one fifth of the city’s population by 2030, outnumbering school-aged children. To ensure the city has the capacity to meet the needs of this increasing population, the Mayor began an overhaul of the Department for the Aging’s case management, home-delivered meal, and senior center programs.
The plan to turn senior centers into “Healthy Aging Centers” and address Bloomberg Administration concerns that roughly 40 percent of the city’s more than 320 centers are underused provoked the most controversy and was put on hold. Given the difficult introduction of the changes to case management and home-delivered meals, the plan for senior centers may remain on hold a while longer.