Florida Aging Office Says 6,538 Seniors Died While on Waiting Lists for Services

The Florida Department of Elder Affairs has released data showing that 6,538 older Floridians died while they were on waiting lists for home and community based services in the state.  The information was provided by the office after the chairman of a state health legislative committee asked the department to provide it.   The news report from Politico Florida also noted that the state has been increasing funding for some of the programs to address the waiting lists but not enough to keep up with the growing numbers of older persons in the state.  AARP in Florida estimates there are nearly 59,000 on waiting lists.

The report stated the seniors died “during the 2014-2015 fiscal year while they were on a waiting list for one of four programs aimed at keeping the elderly out of nursing homes. The four programs include: Medicaid managed long term care, the Home Care for the Elderly, Community Care for the Elderly and the Alzheimer’s Disease Initiative.”

Waiting lists are a major issue in New York State as well among senior advocates and service providers.  At a conference early this month which I reported on, three organizations, Lifespan, LiveOn-NY, and AARP called for an investment of $177 million in five service areas to address waiting lists and help older persons stay in their homes.  There have also been some increases in funding for programs such as the Community Services for the Elderly (CSE) in New York and other initiatives like caregiver support for Alzheimers.  When I was Director of the State Office for the Aging in 2007-2010 we were certainly hampered by the Great Recession which led to budget cuts across the board.

With the state now having a large budget surplus there is an opportunity to push for additional funding but advocates are going to need to get the kind of data that has come out in Florida regarding the number of people receiving services and those who have died waiting.  Of course, to be fair, there is a natural level of deaths which would occur over any twelve month period so it is important that the advocacy case provide as much detail as possible to show the impact of services. Of course, the larger issue is the dilemma that seniors and their families have when a person is in great need of help and has made a request but can’t get that help before they die.

An AARP public relations person in Florida commented, “We’ve only just begun to see the types of social changes that will be sweeping over Florida for the next 30 years. What are they going to do 30 years from now?”

Fiscal Policy Institute Praises Cuomo Plan on Minimum Wage but Says Tax Cap and Budget Are “Unforced Austerity”

The Fiscal Policy Institute issued its annual report and analysis of the Governor’s budget and state finances earlier this month.  Executive Director Ron Deutsch and Chief Economist James Parrott and economist David Kallek outlined the status of various issues including the minimum wage, the state tax cap and the impact of the budget on human services and education.  FPI has been highly critical of the Governor’s budgets in recent years, attacking the tax cap and other tax policies that make the state’s tax system more regressive.  This year’s analysis includes praise for the Governor’s stand to move the minimum wage to $15/hour over the next five years as well as praise for initiatives on paid family leave, housing and homelessness

However, the report is critical of the state continuing a tax cap which now mandates spending at 2% or the rate of inflation which is well below that at under 1%.  The report says that this is “unforced austerity” that is putting the state in a “fiscal straitjacket” that will cause local services to further diminish and deteriorate.

This week the Assembly said it was considering options on the tax cap in light of complaints from local governments.   Some of the options would be to have the tax cap set at 2%.  Other options are to increase local aid from the state since revenues are growing at 4% to 5% and the state has a lot of extra cash.   The Governor said this week though that he is opposed to changes and that the current tax cap allows localities to override it if 60% of local boards vote to do so.

Here is an excerpt of the Executive Summary of the new FPI report on the 2016-2017 proposed budget.

Governor Cuomo’s 2017 Executive Budget advances some bold and progressive proposals that well reflect the values and needs of New Yorkers. In particular, the governor has shown great leadership and vision in forcefully advocating for a first-in-the nation statewide $15 minimum wage. If enacted, the minimum wage increase would lift the incomes of 3.2 million New Yorkers who desperately need a raise. The governor’s proposal to build a system of paid family leave is another important step that would improve the lives of New Yorkers.

The Executive Budget rightly recognizes the need to address issues affecting some of the poorest and most vulnerable residents in our state. It proposes to reduce homelessness and high levels of poverty in many of our upstate cities. It includes a multi-year plan to combat homelessness, together with the development of 10 anti-poverty tasks forces; these are productive ways to recognize that child poverty and homelessness are at record levels across the state.

But, in many critical human infrastructure investment areas, rigid adherence to a two percent spending cap is unnecessarily blocking real progress. Last June, the State Budget Director noted that New York State “is in the best fiscal position in many years … with money in the bank, growing reserves and more surpluses on the horizon.” The state now enjoys its highest credit ratings in more than four decades. Although the recovery has benefitted New Yorkers unevenly, the state’s economy is in the midst of a period of sustained employment and total income growth. Tax receipts are growing at an annual rate of four or five percent. Yet despite the strong current economic and revenue picture, state operating expenditures are projected to increase by only 1.7 percent in FY 2017 from the current year—less than the 1.9 percent projected rate of consumer inflation.

This stark juxtaposition between four to five percent growth in tax receipts and a self-imposed cap on spending of two percent or less define a budget policy best characterized as unforced austerity. It is austerity driven by a policy choice, not by a faltering economy.

Unforced austerity budgeting has severely restrained services in many critical areas affecting New York’s children, families, and their communities. The state has simultaneously put a fiscal straitjacket on local governments by insisting that they live under an artificial and rigid tax cap, limiting property tax increases to two percent or the rate of inflation, whichever is lower. The result is that local government spending in most parts of the state has suffered, with a corresponding deterioration in services from schools to parks to libraries, and an inadequate public response to hardships afflicting many families. It is hard to imagine that a reduction in school and local government jobs of nearly nine percent would be possible without a significant erosion in public services.

Note:  I am currently serving as President of the Board of the Fiscal Policy Institute – Michael Burgess

Legislators Push “Aid in Dying” or Physician Assisted Suicide Bill; Votes in Health Committee Uncertain

Assemblywoman Amy Paulin was joined by Assembly Health Chairman Richard Gottfried and others at a press conference today at the Capitol to push her bill for “aid in dying” as they call it or “physician assisted suicide” as opponents call it.  Paulin’s bill is in Gottfried’s Health Committee and she is trying to round up enough support to get the bill scheduled for a committee vote.  It is unclear that she has the votes at this point with some Democrats opposed.  Paulin related a personal story of a family member and said the bill allows a person a choice but opponents are saying that the bill has a number of major problems.

The bill is opposed by all major disability groups in the state and by the Hospice and Palliative Care Association and the Medical Society along with the Catholic Conference and other religious groups.  To me “death with dignity” already exists and it is called “hospice.”  When many people learn of what hospice offers they are less interested in taking a pill to end their lives.

In 1994 the New York State Task Force on Life and the Law, a group of experts appointed by the Governor, issued a report on assisted suicide and came to the following conclusion which still is valid today:

Recent proposals to legalize assisted suicide and euthanasia in some  states would transform the right to decide about medical treatment into a far broader right to control the timing and manner of death. After lengthy deliberations, the Task Force unanimously concluded that the dangers of
such a dramatic change in public policy would far outweigh any possible benefits. In light of the pervasive failure of our health care system to treat pain and diagnose and treat depression, legalizing assisted suicide and euthanasia would be profoundly dangerous for many individuals who are ill and vulnerable. The risks would be most severe for those who are elderly,
poor, socially disadvantaged, or without access to good medical care.

In the course of their research, many Task Force members were particularly struck by the degree to which requests for suicide assistance by terminally ill patients are correlated with clinical depression or unmanaged pain, both of which can ordinarily be treated effectively with current medical techniques. As a society, we can do far more to benefit these patients by improving pain relief and palliative care than by changing the law to make it easier to commit suicide or to obtain a lethal injection.

 

 

Hospitals Paying NonProfits to “Activate” Medicaid Patients

You can view all of our blog posts at our re-designed website http://www.generationsofnewyork.com

Hospitals across the state, as part of the Medicaid reform initiative known as DSRIP (Delivery System Reform Incentive Program) are entering into agreements with local community based organizations to help them administer a tool called PAM (Patient Activation Measures) for Medicaid beneficiaries as well as uninsured and underinsured persons.   The state Department of Health has contracted with a company called Insignia and is requiring all health care systems participating in DSRIP to administer the ten question survey to hundreds of thousands of persons in the next few years, with initial goals to survey thousands by March 31, the end of the first DSRIP program year.

The PAM survey seeks to assess how “engaged” patients are in their own health care on a scale of 1 to 4 with 4 being most engaged.  A score is given by the program after responses are entered into a database.  The purpose of the survey is to get those with low engagement to improve.  For example, a person who scores a 1 and is determined to have little engagement in their own health will be coached to improve and take some concrete steps to improve any health conditions they have.  If the patient takes some of those steps they would be assessed higher the next time the survey is conducted.  The information will be shared with the patient’s primary care doctor or a clinic where they receive services.

Since completing the PAM surveys is a requirement of DSRIP, health systems are seeking help from many community services providers who interact with Medicaid beneficiaries and the uninsured.  The Albany Medical Center DSRIP project is paying nonprofits $36 for each survey completed.  The Alliance for Better Health Care which includes St. Peters Hospital in Albany and Ellis Hospital in Schenectady and St. Mary’s in Amsterdam is paying $25 per survey and an additional $50 for coaching the patient to improve their self management of their own health care.  Of course, the health systems are using their own staffs to conduct the survey for those who they interact with at hospitals and clinics.  However, the sheer number required for them to complete have led them to enlist as much help as they can from community services agencies which may not be directly involved in medical care.

Surveyors are given training on how to approach patients, administer the survey and then how to enter their answers into the software.  Some nonprofits have expressed concern and wonder how much on-going involvement is required for the payment provided.

 

 

Assembly Aging Committee to Vote on Social Adult Day Care Bill

to read all blog posts, check our newly redesigned website at http://www.generationsofnewyork.com

Here is a follow up to a story published earlier this week on social adult day care centers controversy

On Monday, February 8, the Assembly Aging Committee meets and will address a bill that would make all social adult day care centers meet regulations established by the State Office for the Aging.  The bill sponsored by Assemblyman Cymbrowitz, chair of the Committee, is intended to regulate the operation of an increasing number of sites set up calling themselves social adult day care but not meeting current standards of those funded by the Office for the Aging.  We reported that Attorney General Schneiderman has gotten settlements from some managed long term care companies that fraudulently referred persons attending social adult day care to Medicaid services they got reimbursed for.

The committee will also vote on a bill that would exempt certain non-recurring income from calculations when determining eligibility for the EPIC program.

The committee is meeting Monday off the floor which means sometime during the Assembly session on Monday.  Call the Assembly committee chair’s office for further information.

Here is the link to the committee meeting agenda:

http://assembly.state.ny.us/leg/?sh=agen2&agenda=2016-02-04-16.14.33.276363&ver=2016-02-04-16.14.34.188102

How Assemblymembers Voted on Paid Family Leave

BILL:A03870A  to enact Paid Family Leave program

DATE:02/02/2016

MOTION: YEA/NAY:97/44

Y =Yes

N=No

ER=Excused

Abbate Y Cook Y Giglio NO Kearns Y Montesano NO Richard Y Stirpe Y
Abinant Y Corwin ER Gjonaj Y Kim Y Morelle Y Rivera Y Tedisco NO
Arroyo Y Crespo Y Glick Y Kolb NO Mosley Y Robinson Y Tenney NO
Aubry Y Crouch NO Goldfed ER Lalor NO Moya Y Rodriguez Y Thiele Y
Barclay NO Curran NO Goodell NO Lavine ER Murray NO Rosenthal; Y Titone Y
Barrett Y Cusick Y Gottfried Y Lawrence NO Nojay NO Rozic Y Titus Y
Barron ER Cymbrowitz Y Graf NO Lentol Y Nolan Y Russell Y Walker Y
Benedetto Y Davila Y Gunther Y Lifton Y Oaks NO Ryan Y Walter NO
Bichott Y DenDekker Y Harris Y Linares Y O’Donne Y Saladino NO Weinstein Y
Blake Y Dilan Y Hawley NO Lopez NO Ortiz Y Santabarbara Y Weprin Y
Blanken NO Dingwitz Y Hevesi Y Lupardo Y Otis Y Schimel Y Woerner NO
Brabene NO DiPietro NO Hikind Y Lupinacci NO Palmesano NO Schimminger NO Wozniak NO
Braunstein Y Duprey NO Hooper Y Magee Y Palumbo NO Seawright Y Wright Y
Brennan Y Englebright Y Hunter Y Magnarelli Y Paulin Y Sepulve Y Zebrowski Y
Brindis Y Fahy Y Hyndman Y Malliotakis NO Peoples Y Simanow Y Mr Spkr Heastie Y
Bronson Y Farrell Y Jaffee Y Markey Y Perry Y Simon Y
Buchwald Y Finch NO Jean-Pi Y Mayer Y Pichardo Y Simotas Y
Butler NO Fitzpat NO Johns NO McDonald NO Pretlow Y Skartados NO
Cahill Y Friend NO Joyner Y McDonou NO Quart Y Skoufis Y
Ceretto Y Galef Y Kaminsky Y McKevit NO Ra NO Solages Y
Clark ER Gantt Y Katz ER McLaughlin NO Raia NO Stec NO
Colton Y Barbarino NO Kavanag Y Miller Y Ramos Y Steck Y

Senior Advocates Push $177 Million Plan

12039453_1635504930046411_4873477124146085992_n
Comment by Michael Burgess

Service advocates for older New Yorkers were in Albany on Tuesday to lobby for a major investment of $177 million to serve over three million New Yorkers.  The proposal was presented by LiveOn NY (formerly the Council of Senior Centers and Services), the Association on Aging and Lifespan. The proposal is an ambitious request but it is important to think big because of the rapidly expanding older population.  And, many senior services now have waiting lists making it difficult for older persons to get in home services.  Unfortunately, the tax cap and limits on state funding make it very difficult to increase funding for state funded programs.  The advocates are asking for:

 

— $28 million more for the New York Connects “No Wrong Door” program administered locally by most area agencies on aging

–$15 million more with no local match for the Community Services for the Elderly (CSE) program which is the major state funding for local services

–$25 million annually for the New York Elder Caregiver Support Program

–$10 million annually to support Elder Abuse program services

— $25 million without a local match for the Targeted EISEP (Expanded In-Home Services for the Elderly Program).

At a conference on Monday, Assembly Aging Chair Steven Cymbrowitz said he is concerned about cuts to the State Office for the Aging budget in the NORCs program (Naturally Occurring Retirement Communities).  The Governor’s budget proposes savings in the program to make it more efficient, but it really is a budget cut since all the current funds are not being re-programmed to those services which meet the legislative definitions and guidelines for NORCs.

I believe there needs to be a stronger emphasis to support community self-help programs like NORCs and villages in livable communities because government supported services cannot meet all senior needs.  So it is important to nurture and support those dynamic community efforts that senior groups are developing themselves.

Supporting families and caregivers and building and strengthening community networks should be the overarching mission of the aging network.

Cuomo to Improve His Family Leave Proposal; Assembly Passes Bill Again

IMG_2530

Here was Assemblywoman Cathy Nolan, sponsor of the Assembly paid family leave as she addressed a press conference today with Assembly Speaker Carl Heastie and other members of the Assembly and leaders of the paid family leave coalition. Nolan has sponsored the bill since 1999 and the Assembly passed the bill again this afternoon.   Meanwhile,  Governor Cuomo is apparently planning to improve his proposal for paid family leave to make it more in line with the Assembly version by providing up to 2/3 of a worker’s average weekly wage for up to 12 weeks.

*****

The Assembly Health Committee today pulled back a bill (A308) that would have amended the health care proxy bill allowing only one witness instead of two among other provisions.  Several members of the committee were concerned that wills require two witnesses and that the proxy law should be similar.  Assembly Health Chair Richard Gottfried said sometimes it is necessary to execute a proxy form in the hospital and if getting two witnesses quickly is not possible, the patient would have no proxy.  However, the bill was pulled back without a vote.  Meanwhile, another bill sponsored by Assemblyman Edward Braunstein was approved by the committee (A5161C) that would prohibit making or broadcasting a video of a patient undergoing a medical procedure without their consent.  That happened to a patient in New York City whose procedure and death were included on a broadcast without the family being aware.

Albany Supermarket Offers Doctors on Demand on Video Screen

Price Chopper, the family-owned supermarket chain based in Schenectady, is launching a telemedicine pilot program in five of its stores in Fulton, Johnstown, Poughkeepsie, Bennington, Vermont and Glenmont, an Albany suburb.  For a $40 fee patients can see a doctor on a video screen in the store for fifteen minutes.  The doctors are from Doctor on Demand, a national telemedicine company.    Doctors must have a license to practice in New York.  Doctors can diagnose symptoms and prescribe medicine for non-emergency ailments like cold, flu or sinus infections.

Price Chopper pharmacy staff told the Albany Times Union that the video doctor is not appropriate for someone with a serious emergency.  The store pharmacist would step in and call 911 if necessary.

These Price Chopper supermarket locations already have pharmacies and many supermarkets are serving as mini-clinics to provide flu shots or walk in clinics with health care staff on hand. Telemedicine is an extension of that.   While this trend is another example of health care becoming more consumer oriented, serious health care requires an ongoing relationship with both a doctor and a pharmacist.  So telemedicine is no substitute for primary care.

Telemedicine may be good for those needing an immediate prescription for a non-serious health care problem.  It will be interesting to review the experience of telemedicine and see who those are, whether they are uninsured or patients who could not get access to health care in other ways.   It will also be interesting to see how pharmacies, urgent care clinics and supermarkets position themselves as health care keeps changing and moving out into the community.

Poll Says 80% of Voters Support Paid Family Leave

A new Siena College Poll out today reveals that 80% of voters favor a paid family leave program in New York State with only 18% opposed.  Support was across the board with 87% of Democrats, 69% of Republicans, 74% of Independents.  People under 35 in child bearing years had the highest support at 95%.  Those over 55 supported the proposal with 73%.  95% of Hispanics were in favor, 92% of African Americans and 78% of Whites.

The poll comes just after a rally on Friday by Governor Cuomo and Vice President Joe Biden in support of the idea and a day before a lobby day on Tuesday in Albany.  The issue has generated tremendous momentum in the past month with the Governor’s support and now this poll.  There is also a possibility the Assembly may vote on the issue on the floor tomorrow.  The Assembly passed the bill supported by the coalition and sponsored by Assemblywoman Catherine Nolan.  That bill is more generous that what the Governor proposed and advocates continue to have discussions with the Governor’s staff to request that he support the Assembly version which would peg the benefit at 2/3 of a worker’s weekly salary up to a cap of 50% of the average statewide weekly wage.  The Governor’s bill starts a four year phase in at just 35% of worker’s salary and rises to 50% in 2021.

Meanwhile, a bipartisan group of 17 Albany county legislators has proposed that the county offer forty days of paid family leave to employees and are introducing legislation to do so.  The proposal would cover paid time off to care for a newborn or a seriously ill relative.  County Executive Dan McCoy had previously proposed a family leave program that was not enacted.

The Siena poll showed statewide support for a gradual increase in the minimum wage by a 65% – 33% margin.  The upstate margin was only 52% -46% in favor though.