Life Happens 05-03

Episode Transcript

Speaker 1 (00:00):
Good morning everyone, Welcome to Life Happens Radio. I'm Loupiro,
your host for this morning from Pierre O'Connor and Strauss.
We have a great show for you, so stay with us.
It is all about care, and we care, and we
hope you do, and we hope that your family does.
And as we go through life and Life Happens, we

(00:20):
have to rely on people, and we have to have systems,
and we have to have an ability to take care
of our most vulnerable citizens, people with disabilities, people as
they age, with chronic conditions. People will get in a
car accident, have a traumatic brain injury, people will get
a really bad diagnosis early in life. Those are the

(00:41):
times in life when you need help, You need people
who care, You need systems built to take care of
the most vulnerable among us. And those systems, folks are
at risk. They are under attack. The ability to take
care of our vulnerable citizens is being pitted up against

(01:02):
the desire to have lower taxes and tax cuts, and federally,
that's a debate that's going to be going on for
the next several months, the tax bill versus Medicaid and
other cuts that are looming, and in New York we
are still in budget season. April one is the budget deadline,

(01:23):
but New York has a budget that was kind of
announced but not finalized, and they're still debating some key provisions.
So I am thrilled to have two of the foremost
leaders and experts on long term care, healthcare, home care,
and aging services in the state of New York, people

(01:44):
who have been experienced in this for decades, working with
people and within systems that are just fracturing day by day.
So I'm going to introduce them now to you, and
we're going to bring them on live, and I have
we're here in studio with me. First of all, Al Cardillo.

(02:04):
And Al is the head of the Home Care Association
of New York State and he's been doing care healthcare
within the government, outside the government and the home Care Association.
I'm gonna let A'll tell you about that in just
a second. I want to get our other person on
who's not in studio, but she is live. I'm sure
she's here and she's on the line, and that's Rebecca Prevy.

(02:27):
And Becky is the head of the Home the Area
Association of Aging Agencies on aging. Let me get it right,
Becky and that is a sidecar to the New York
State Office for Aging. She works very closely with the
Office for Aging. But Becky represents the county. So on
the local level, how the counties fulfill their obligation when

(02:48):
the things hit the street, how did they come out?
How does it play out? Not in Albany, not in
the capitol, not in the Legislative office building, but in
your home, in your kitchen, in your bedroom. How do
you get the care, how do you get the services?
How do you get meals and all the things that
you need? So, good morning, ol, Good morning Becky.

Speaker 2 (03:07):
Al.

Speaker 1 (03:07):
Let's start with you. Just tell our listeners a little
bit about the Homecare Association and how you got to
where you are.

Speaker 2 (03:13):
Good morning, Lou and thanks very much, and good morning Becky.
Always great to be working with you, Becky. So, the
Home Care Association is a statewide association that is comprised
of healthcare providers like hospitals, of visiting nurse associations, long
term care systems. But what they have in common is

(03:34):
that they are all state and federally licensed to provide
healthcare services in the home. And these organizations also include
health plans, which are specially licensed like a managed long
term care plan or a PACE plan that are also
specially licensed or certified to provide in home care. These
agencies span across the entire state of New York and

(03:58):
they serve over a million people. So it is a
very comprehensive a plan that New York State has always had.
But as Lou said, there are enormous changes and challenges
that have been besetting the system, and I'm sure that
part of that is going to be a key focal
point today, Lou Becky.

Speaker 1 (04:18):
And I want to bring Becky on right away. Becky,
good morning, Good morning.

Speaker 3 (04:23):
Lou, and thanks for having me and Al. It's always
wonderful to do anything with you. So a little bit
about the Association on Aging in the State of New York.
So we represent the fifty nine Area Agencies on Aging.
A lot of your listeners will know those as offices
for the aging. That term is interchangeable, and the fifty
nine triple as actually work with about one thousand, two
hundred subcontractors who are predominantly in the not for profit

(04:46):
world that provide a whole wealth of services and supports
for the older population and caregivers. We're very well known
for our home delivered mail program. That's only one small
part of our portfolio where we're serving a couple million
older New Yorkers really with holistic care, and the goal
of all of the network is really to allow people
to remain in homes and communities for as long as

(05:08):
possible with services and supports that help their overall health
and wellbeing.

Speaker 1 (05:13):
And so we have in studio live folks, and this
is important, the President and CEO of the Home Care Association,
who is working day to day with the providers that
are charged with caring for those people that I was
mentioning at the top of the show. And we have
Rebecca Prevy, who's the executive director of the Association on

(05:33):
Aging in New York, who is in charge of the
fifty nine counties and the services that they deliver. And
we're going to have a very in depth discussion, as
we always do when I lock horns with these two,
it always gets deep into the weeds, so forgive us
for that, but it's important and the things that we're
going to talk about are important to you, So don't

(05:54):
ostrich us and put your head in the sand. Listen,
and let's start with you out the budget and your
very involved in the budget process because all of your constituents,
your whole home care constituents, and the association are all
dependent on government funding. So where are we.

Speaker 2 (06:11):
So, as you said, the budget is ordinarily due by
April one, is when a new budget is supposed to
be in place. And really as of the end of
this week, the legislature and governor have agreed to another
extender through the middle part of next week. You know,
we understand that, you know, they're still considerable distance in

(06:34):
resolving issues related to the amount of funding for health
and medicaid. So that's one of the big outstanding issues
out there. I think your listeners have probably you know,
heard about some of the major issues that are not
health related that you know have been really I think
at the center of the let's say, the delay in
the budget process, the protracted process, you know, bell to

(06:55):
bell phone phone control in the schools, masking requirements, mandatory
confinement for mental health and other related issues, and discovery, yes,
and discovery that was holding up a budget. Absolutely not
a budget, it right, And that's and I think that's
really at the seat of a lot of what's going on.
You know, the budget is ordinarily you know, voluminous in

(07:19):
terms of policy, but when policy really takes the override
of all the fiscal concerns, then it's really hard to
get a budget in place, which is exactly what you're seeing.

Speaker 1 (07:27):
Yeah, and now for those that don't know what discovery is,
you didn't go law school. It's in a litigation where
you have to turn over certain things and the district's
attorneys are are lobbying for rule changes, and that's been
a bone of contention, and that for weeks was what
was being Oh, we haven't we don't have agreement yet
on this discovery portion, which while all of these other

(07:48):
things are waiting in the wings. Our budget is two
hundred and fifty four billion dollars, folks with a bee,
and a good chunk of that is medicaid.

Speaker 2 (07:59):
Yeah, over one hundred twenty billion dollars as a forecast
to be on the medicaid side, So you figure between
forty and fifty percent of the entire state budget is medicaid.
But you know, that's also reflective of the of the
depth of the need and the direction of the programming
that's really been building, especially i would say over the

(08:20):
last fifteen to twenty years. The use of medicaid to
try to address many of the issues that are really
open issues within our society and need and you know,
we you know right now, what we're hoping for is
that the final budget, because we've been advocating for this
for the last ten months. We need basic support for workforce,

(08:41):
for provider sustainability, you know, and for services which in
so many areas are difficult to come by.

Speaker 1 (08:47):
And we're going to dig into that as we go
through the show. And we we are a law firm.
We practice elder law, and elder law is a service
we provide to clients. We also have an affiliated case
management or care management entity that helps people find care.
And when clients come to us and a person has

(09:07):
just had a stroke or broken a hip and they're
in the hospital and they're discharging and they have to
have a discharge plan, well there really is nobody planning,
so you need to do your own plan and you
need to go find home health AIDS And that has
become the holy grail of healthcare is trying to find
the people, the staff positions and what is the vacancy rate.

(09:28):
Now you always have the statistic Candy Well, one.

Speaker 2 (09:32):
Of the one of the greatest challenges is the is
the turnover rate, which is around thirty percent, so you know,
the vacancy rates are high. I mean, for example, in
this area, you know, there's an agency that has had
seventeen nursing vacancies for as long as we can remember,
you know, and part of that was exacerbated in COVID.

(09:54):
But the other part is that the system, the states policies,
federal policies, the p system is really not oriented to
the recruitment and the retention of the staff. So people
come in and they leave. There's just one shocking, you know, statistic,
even for me, that was presented a couple of years
ago at a conference where we had the American Nursing Association,

(10:16):
and something like thirty plus percent of nurses leave the field.
New nurses leave the field after a year. And it's
really astounding because the system turns on these professionals.

Speaker 1 (10:27):
It does, and nurses in terms of this level are
at the higher end of the food chain, you know,
below doctors, but home health aids, personal care aids are
at the bottom of that food chain, and that's where
the wage scale really bottoms up. So we're going to
talk a little bit about that there has been movement

(10:47):
and attempts to reconcile that, but they have not done well.
They have not leveled the playing field so that we
have enough people. And I'm going to talk a little
bit about an event that both of you are going
to be part of May fifteenth. It's called the Elder
Law Forum. And two years ago the Mishone Mazaco, who's
I think the chair of your board at the Home
Care Association, talked about the fact that they had at

(11:10):
one point in their home health agency and we won't
get two technical, but they had four hundred home health
aids that they employed. They were down to forty and
they couldn't recruit, so they closed the agency called a
license alixa home License, home Health Age. They still have
home healthcare, but not that one agency. And that, Folks,
is something that's happening across the country that agencies just

(11:33):
cannot find the right people in the right spots. And Becky,
where are you coming to us from this morning?

Speaker 3 (11:41):
I am coming to you from upstate New York and Franklin.

Speaker 1 (11:44):
County, Franklin County, and how is the population of home
health aids in Franklin.

Speaker 3 (11:48):
County Unfortunately, depending on where you live. In most of
the North Country, we have pockets where, regardless of pair source,
you do have access to a home care worker. Those
cases can't be filled. They haven't been able to be
filled in years. And you know, to Al's point, this
is definitely a wage issue, it's an access issue, and

(12:11):
it's because, quite frankly, they've never valued monetarily direct care
workers for the work that they do, which is incredibly
difficult and incredibly meaningful.

Speaker 1 (12:21):
And we've kind of chronicled this over. I've been here
fourteen years doing this radio show, and the Elder Law
Forum is in its thirtieth year, so we've been doing
this a while, folks. And when you look up and
say we're hiring at twenty two dollars an hour, and
that's burger king, and you're flipping a burger for twenty
two bucks an hour, and you are a home health
aid working in a very very difficult job, hands on

(12:42):
with patients in the home at eighteen, how are you
going to compete to get people to do those jobs?
And Becky, there's kind of frightening news on the federal side,
depending upon where we go, but on the state side,
this budget didn't so bad, and we talk a little
bit about that, just talk about it from the aging

(13:03):
services perspective.

Speaker 3 (13:05):
Sure, And I think what's always really really important, Lou
and I know that you've had Greg Olsen on the
show before. I always like to start the conversation about
asking for investments in the aging services budget by talking
about the inherent value of the older population, because when
you look, you know, at this two hundred and fifty
four billion dollar New York State budget, we have to
think about who are paying those taxes, and a lot

(13:25):
of times the older population has kind of talked about
from a very negative perspective where people think that older
people are takers. That's overwhelmingly not true. So of that
two hundred and fifty four billion dollars, older people in
the state of New York are paid seventy two billion
in state local taxes. So they're the economic driver. And yes,
we do have a subset of the older population who

(13:47):
has some care needs, and that's really where we come
in utilizing those New York State Office for the aging dollars.
So our network supports non Medicaid eligible individuals. So again,
if you have Medicaid, your eligible for home care services
and a variety of others. But if you're above that
that income benchmark for Medicaid, but you're not a high earner,

(14:08):
there's no way you can afford to privately pay forty
forty five dollars an hour for a direct care worker
to come to your home. So we subsidize services for
people over the age of sixty that have needs in
their homes and communities but can't afford to privately pay
for those services. And that's really our mission is to
be able to keep people off Medicaid, to save Medicaid dollars,

(14:28):
but to be able to support them in homes and
communities with case management, home delivered meals, personal care workers,
health insurance counseling, and a variety of other core services.
And what we have found is looking at our own
New York State data, we know if we can't serve
someone in their placed on a waiting list. So if
you called your local offs for the aging and said,
my mom needs the home delivered meal and someone to

(14:50):
help her shower two days a week, if the county
doesn't have funding to provide that service, that individual is
placed on a waiting list. And so over the course
of the past couple of years with talked a lot
about that waiting list because we know absence of services,
ten percent of people are going directly to a skilled
nursing facility to the two of one hundred and sixty
thousand dollars a year, and another seven percent are impoverishing

(15:11):
themselves down to Medicaid, which is a very high cost.
So we were actually able to work with state government,
with our friends in the Senate and Assembly, to talk
about the fact that an investment on the front end
would actually save Medicaid dollars in the long term. So
in the proposed executive budget this year, the governor actually
put in an additional thirty five million dollars to address

(15:32):
those individuals who are waiting for a service, which is
the largest investment into the New York State Office for
the aging budget we've ever seen. So we're very, very excited.

Speaker 1 (15:41):
Yeah, it doesn't seem like that should be a novel
concept in government, that you spend a dollar to save ten,
but it is. And so we're going to take a
short break and when we come back, we're going to
talk about the state budget, and then we're going to
get into the federal debate over the federal budget, and
I think the President just announced his proposed budget, so
we're going to talk a little bit about that where

(16:01):
it's all headed and folks, this affects you, So stay
with us Where Life Happens Radio every Saturday morning at
nine am on Talk Radio WGY. We'll be back right
after this short break. So many issues it is hard
to fit it all in, So I want to go
back to what I think is a unique situation in
New York. We have two leaders, and I'm going to

(16:21):
put you in that pairing Becky with Greg Olsen, who
are dedicated to the seniors of the State of New
York like nobody's business. And when I say when I
say this, I don't say this lightly because I've been
working with them for several years now and watching the
energy and the creativity and the innovation that they bring
to their jobs, looking at it practically, pragmatically, not as

(16:43):
government bureaucrats sitting back saying no, when do I retire,
you know, looking out the window, What's what's my retirement date?
That's not what this team's about. And Becky, what you
and Greg have brought to the table to New York
State is somewhat unique in the country and just talk
a little bit about all of the different services, the
dedication to innovation that you guys have, and the things

(17:04):
that you're doing across the state.

Speaker 3 (17:07):
Well, I really appreciate that, Lou and I think you
know I share the same energy that the how we
value our most of our world population is a reflection
on us. Right. So what's really unique about the State
of New York is a lot of people. Every state
has a state unit on aging. Every state functions under
the Older Americans Act, and you do have to provide
these core services. But really what we have seen with

(17:30):
the advancements in technology, the fact that we're serving people
from the age of sixty to one hundred and ten,
so tech really is something that a lot of older
people are utilizing. We realized there were cheaper ways to
reach a lot more people based on the availability of
these tech partnerships, and realize that we couldn't just continue
to do services the way we've done since nineteen sixty

(17:50):
five when the OA was signed. So we have currently
twenty nine public private partnerships, predominantly with technology companies, to
serve well over and additional two million people in the
State of New York and Ali or Blue. I would
need an hour to go through all of our sustainable projects.

Speaker 1 (18:08):
I think you can point people through the resource, Becky,
because there are resources on your website. The videos are
amazing and all the things that are there and available
to people. So if you want to just do that now,
just let them know where they can find all this information.

Speaker 3 (18:21):
Absolutely so. You can go to our website which is
agingany dot org, or you can go to the New
York State Office for the Aging website, and that has
a whole variety of information about all of the special
projects that we've done using artificial intelligence, using robotic animals,
caregiver support platforms, and many of these are completely free

(18:42):
for any New Yorker, so you don't have to go
through a full assessment process to get access to some
of these programs, including online learning, exercise and fitness classes
caregiver supports. You can just access those through our websites
at no cost to you. And what we have foundu
which is really really important because data obviously drives these conversations,

(19:05):
is our online caregiver platform has reduced inappropriately inappropriate emergency
department utilization by twenty five percent and it has extended
the time from an individual thinking about nursing home placement
for a loved one to actually going to a nursing
home by over fifteen months. So we are absolutely moving
the market and keeping people in homesome.

Speaker 1 (19:25):
Communities and reducing the cost. And I just want to
make a comment, and I'm going to come back to you, Al,
because you're involved in this world too, in pilot programs
and testing some of these theories and some of the
things the technology that's out there. But there are all
of these studies done. MIT does a study, they have
an aging lab, Harvard does a study. They take three years,

(19:46):
they get grant money, and at the end of three years,
there's a report, one hundred page report that goes into
a file and never sees the street. The theories, the
things that they test. The money runs out, the answer
run out, and it never gets to the street. It
never hits the pavement where people can actually utilize the

(20:06):
things that are being studied. The difference here is that
what the Office for Aging and the Area Agencies on
Aging are doing is not going through all of those hoops,
all that red tape that Becky just talked about. They're
just doing it. They're putting it in the street, they're
giving it to people, they're bringing the technology into homes
and doing it on a cost free basis. Because the

(20:27):
people in these companies want to partner with New York,
they want to be here, they want to help serve
this population. And now you're involved in a pilot programer several.
Just talk a little bit about that process and how
hard it is to get all of the stakeholders together
to make that work. And that's really one of the.

Speaker 2 (20:44):
Key points you just made, which is that you know,
we have a lot of resources in community, so you know,
in between all of the cracks and the fractures of
the system, there are a lot of resources.

Speaker 1 (20:57):
Go ahead and partners. So I just want to comment
on that because I was part of one of those
studies at the University at Albany and it was funded
with a grant, two year grant, and it was the
Aging Prepared Community and a gentleman by the name of
George Hurst, head of the Hearst Corporation at one point
and part of our local fabric of our society here,

(21:18):
and George chaired a committee. I was on his committee,
and George had the comment well, there are all of
these islands of excellence but no bridges. Yes, and the
islands of excellence are out there in healthcare in long
term care, but they don't talk to each other and
they are siloed. So kick it back to you, perfect.

Speaker 2 (21:37):
Point, great metaphor, and this is something that I've described
in the work that we do, is that in many communities,
the providers and service organizations coexist, but they definitely are
not collaborating. They may think they are, but when push
comes to shove, what really is discovered is that they
really don't know that much about one another. They're not

(21:59):
really integrating in a way that optimizes those services and
coordinates the attention and the care planning that individuals need.
So we launched a project with the support of the
Mother Cabrini Health Foundation, and this is the Home Care Association,
the Iroquois Healthcare Alliance, which is the large hospital association

(22:21):
that represents most of upstate New York, and IPRO, which
is a quality improvement organization that contracts with the state
and federal government. So we have been working with seven
regions of the state. Started out as three, it's now seven,
and in those regions we bring together the hospitals, the
home health Agency, emergency medical services, physicians and other partners

(22:46):
to work together so that individuals who are moving across
the system or who have needs that can't be met
in one program or another, that the bridges are exactly
created so that that happens. So just one example, like
in Columbia County, the partners are the Columbia County Medical Center,
Balaysia EMS, the Eddy Visiting Nurse Association, the Albany of

(23:09):
Issy Nurse Association, and the primary care doctors will. They
work together to make sure that individuals who are either
transitioning home from hospitals or who are vulnerable in the
community are able to receive services because they can coordinate together,
they integrate their health information, and they work together to manage.

Speaker 1 (23:27):
And that is such a vital concept for the future
because the numbers, folks just don't work. The number of
people who are aging baby boomer is aging out right now,
sixty five turn ten thousand, turning sixty five every day.
But the fronted edge of the baby boom wave is
now in the mid to late seventies. They're going to
be coming into long term care in another five to

(23:47):
ten years and when they do this BNZ, the whole
curve Benz. So where's the money going to come from,
Where the service is going to come from. Innovation is
part of that. It has to be a key in communication.
Stay with us for the second and half a lot
more to come. We're going to talk about state, federal.
Be back after this. We are back. We're gonna take

(24:18):
a breath here. We're in the midst of a very
very intense discussion about home care, healthcare, the state of
New York, the Aging Services Network, what's going on, good
things that are going on, innovations that are going on,
what's going on at the state level right now, trying
to hammer out this final budget. And as Al said, eh,
what's a few hundred million here, a few hundred million there,
sooner or later you're talking real money. But that's what's

(24:40):
being debated now in terms of medicaid. To get to
that final budget number in Washington. We have a whole
set of unknowns We're going to talk a little bit
more about, but I want to give you guys a
heads up on some things that are coming up. And
as you know, Pierre connoran Strauss is a law firm
and we collaborate with a number of other people to
do innovative education programming, and one of those people is

(25:01):
none other than our own Dave Kopek. So we're gonna
be doing a seminar with Dave coming up Tuesday, May twentieth,
and you are all invited. It's at the Crown Plaza
in Albany the Desmond. Free Seminar dinner is included. It's
gonna be hosted by Dave, myself, my partner Aaron Connor,
and space is limited, so please call now to reserve

(25:22):
your spot. We are filling up, and you can register
at WGY Seminar hotline. That's WGY seminar dot com, so
you can go right on right now, just log in
WGY seminar dot com sign up for the May twentieth
dinner seminar at the Desmond or you can call if
you want to call us at five one eight seven

(25:44):
six seven seven seven seven four. That's a lot. I'm
gonna give it to you one more time five one
eight seven six seven seven seven seven four, or again
WGY seminar dot com. We would love to see you.
We're gonna talk about some vital concepts to plan for
your future financially legally, and how to merge those two

(26:06):
plans together. Dave and I and Aaron look forward to
seeing you there. And I want to talk about one
other event that's upcoming, and this is something that I
have a certain amount of pride in. It is the
thirtieth Annual Elder Law Forum, and so for thirty years
we've been exploring in depth the topic that we're talking
about today, how do we take care of our most
vulnerable citizens in New York State, And it's a New

(26:29):
York State focused program. We are going to have Congressman
Paul Tonko talking about the issues going on right now
as we speak live in Congress. We have John MacDonald
and two other legislators in New York. Hopefully by May
fifteenth that will have a budget, and so we're going
to be talking about the results of that budget and
how it's going to impact the care and health of

(26:49):
New York State. And we have panels including Rebecca Prevy,
talking about different models of care, pace programs, other types
of insurance programs, and all of the things back he's
talking about that the officer aging offers at a very
low cost to the State of New York and now
of all things, is going to be on a homecare
panel representing the Home Care Association of New York State

(27:11):
and talking about how home care is working, how it's
not working. And I'm going to jump right back to
you l to talk about the pilot that you just
mentioned the home care in New York, the fragmentation I
call it the silos of care. And you have two silos.
You have provider silos and you have payer silos, and
paces is both, so you have one silo which is

(27:31):
hopefully not a silo because you have all of the providers.
And that's kind of why I put that panel together,
is to look at a model that brings all of
these things together, but just finish us out with the
statistics and the results that you're achieving with the ability
to integrate different providers in one system.

Speaker 2 (27:48):
So thank you, lewis So. In the project that I
was referencing just prior to the break, the findings so
far are that hospitalizations have been reduced by over seventy
percent in this population. Trips to the emergency room following
a call to nine to one one have been reduced
over eighty percent, and so one of the really at

(28:15):
the root of this is the fact that you've got
organizations that are working together, as I mentioned earlier, working
together for the common interest of the patient.

Speaker 1 (28:24):
So the patient is at.

Speaker 2 (28:26):
The center of the system, and organizations that typically coexist
are really put in a collaboration mode. And so you know,
this project is in the Hudson Valley area that I'm
specifically referring to, but around the state, there's another program
like this in the Southern tier, in the Mohawk Valley region,

(28:47):
in the Finger Lakes region, in the Saint Lawrence region
at Irondeck, and in the North Country. So a huge
part of the geography of the state is being served
under this pilot project, and we're hoping that the results
will be a prototype statewide.

Speaker 1 (29:03):
And I'm a cynic if you didn't know. I'm an optimist,
but a cynic because the systems that you're talking about
should have been created thirty years ago. I sat in
the Governor's Task Force on long term care reform in
nineteen ninety six and we identified every one of the
problems that we're talking about today, and there were bright
people in the room all around the table that proposed solutions,

(29:26):
how can we fix this? And they were good solutions
that never saw the light of day. And in government
and in business, money is the bottom line. And when
you have a project that reduces utilization, there's somebody that's
not getting paid because you're reducing the profits of a provider,

(29:50):
a company that's providing all those services that you just
put in a category that eighty percent are gone. So
I actually sat in a meeting with a I won't
name names. We went through the whole thing, and we
can reduce hospitalizations that I had people from the state there,
and at the end of the conversation it was okay,

(30:11):
and we can reduce your emergency room admissions by eighty percent,
And it was, well, we can't do that because that's
where we make money, so we need those admissions. We
have contractors, we have doctors, we have people that are
that we've hired. We can't allow that. So basically, close
the book. I walked out of the room, and the
project never went forward. Yours did and it's showing these

(30:33):
meaningful results. And Becky, I know that you have had
similar results with things that are very simple, as much
as advising people on which Medicare program to choose. So
talk Becky a little bit about the things that you've
done and experimented with and the results and how that
and high cap is one of the programs on the block,
by the way, so let's talk a little bit about

(30:55):
that and all the things that you've done with Greg
and the State Officer Aging and the area agents.

Speaker 3 (31:01):
Sure. So again, when you talk about cost containment, right,
data is really really important. So if you look at
the oxes for the aging and who we're serving, our
average client across all programs is a low income eighty
three year old female who lives alone, has four to
ten chronic conditions like diabetes, congestive heart failure, and needs
assistance with activities of daily living like getting up in

(31:23):
the morning to take a shower. So if you look
at that person from a statutory standpoint, that individual could
qualify to go to a higher level of care. We
serve individuals and homes and communities, and this is our
own New York State data between six and seven years,
for less than ten thousand dollars per year, if that
individual goes to assisted living or to a skilled nursing facility,

(31:45):
almost all of those are paid for with medic eight dollars,
So people spend down impoverish themselves to get those services.
On top of that, when you talk about the provider network,
we are actively losing licensed skilled nursing facility. That's every
day in the state of New York. So we're hall
to almost five million people over the age of sixty.
We have less than one hundred and eleven thousand licensed

(32:05):
skilled nursing facility beds. So we know the game is
in homes and communities. And to your point, there are
things that we can provide to older individuals into caregivers
that allow them to remain in their own own homes.
Health insurance counseling is one of them. Anybody that has
turned sixty five becomes eligible for Medicaid. You're inundated with
you know, sales calls and mailers to get you into

(32:27):
a plan. We only con.

Speaker 1 (32:29):
That was me two years ago. I mean the amount
of mail that I got was like unpopular, Wow, you
for advantage plan in the country wanted me and then
my business.

Speaker 3 (32:39):
And the problem becomes right. Some of these plans have
sales representatives that obtained commission by selling you a plan,
and the plan might not be right for you. We
only provide objective information on health insurance plans. But again,
when you talk about people coming home from the hospital
in discharged planning, sometimes having a hot home delivered deal

(32:59):
and a day daily safety check is enough for an
individual to be able to come home. We provide personal
emergency response systems for people. A lot of people know
those as lifeline buttons. We provide comprehensive case management, so
we're providing you a way to get to your doctor's
appointments and to really coordinate your care. We provide a
whole variety of practices self management, side beat self management,

(33:22):
which unfortunately is completely on the shopping block at the
federal level, along with really making sure that we're assessing
an individual for any and all services. So we might
get a referral for someone that think they need a meal,
and when we go in and do our assessment, we
might find out that they're eligible for HEAP or SNAP
or other benefits where we can put money back into

(33:44):
their pockets on a regular basis. And you know, all
of those things help an older individual remain in their
homes or communities.

Speaker 1 (33:51):
And these are things Becky that and let's turn to
the federal budget. And I know that you're very involved
as is Greg Olsen, and Greg just went down to
Washington and reported his findings to a national association and
I think opened a lot of eyes as to what
these cuts truly mean. And as you said, data matters,

(34:12):
numbers matter, and Greg's sat here a few weeks ago,
several weeks ago and went through all of the proposed cuts,
what the older American Act has meant to people. So
just give our listeners a little hint on what's out
there and what's up for debate in Washington. And I
think this is a lot of people are getting their
eyes opened and starting to show up at town halls

(34:32):
and show up in protests and show up calling their
legislators because these are essential services that if they get
stripped away, are going to take a lot of the
underpinning services that we have now that are not wholly adequate.
Just talk a little bit about that and how where
people can get more information on this, because I know
Greg just put a message out a few days ago.

Speaker 3 (34:55):
Yeah, so this is something we've been watching really really carefully,
and I alway frame this. This is not a political conversation,
this is a factual conversation. So these are the things
that we absolutely know have been placed in writing that
are going to affect the older population and the people
that we're serving. So I want to start with the
fact that since twenty twelve, at the federal government, we've

(35:16):
had what's called the Administration for Community Living, and that
was the federal agency that brought together aging services providers
and the disability community under one umbrella to make sure
that our services were efficient and they were really meeting
the mission of keeping people in homes and communities. About
three weeks ago, that organization was completely dissolved, so it
no longer exists at the federal government, which means our

(35:39):
programs have been split into different areas at the federal level,
which is very concerning, especially with the growth and the
older population. We feel very strongly we needed the Administration
for Community Living as kind of our mothership at the
federal level.

Speaker 1 (35:53):
So just as Alan and I were talking to the
fragmentation the silos, instead of pulling together as his pilot
is doing, we just broke them apart again.

Speaker 3 (36:03):
They did, and they actually terminated about fifty percent of
the staff, including all of the regional reps to the
state units on aging. So that was concern number one,
But that did not come inherently with any budgetary cuts.
There's two things that have happened since then, and again
I highly encourage anyone listening to this that wants further
information or wants to take any action to visit our

(36:26):
website that has a whole variety of information and a
way to contact your federally elected officials. That's agingany dot org.
So the leaked budget documents that came out included a
whole variety of proposed eliminations at the Department of Health
and Human Services that directly affect state units on aging.

(36:46):
The budget that came out yesterday, where we're waiting for
a more completed budget, did have some very specific language
in it on what is proposed to be completely eliminated.
That includes the Low Income Home Energy Assistance. A lot
of people know that as HEAP, that's over four billion
dollars at the federal level that's been proposed to be
completely cut. The Community Services Block grant has been slated

(37:09):
for elimination, claiming that grants to community action agencies are
laden with quote equity building and green energy initiatives. A
lot of us are very dependent on our community action agencies.
Section two oh two Housing for the elderly has been
merged into a block grant in the proposal, the Corporation
for National Community Service, which operates the americ coor Senior Program,

(37:31):
slated for complete elimination. The Title five Senior Community Services
Employment Program, which is where we employ older people to
get them back into the workforce, has been proposed to
be completely eliminated. The budget for the Commodity Supplemental Food
program that's really focused on improving the health of older
individuals again has been zeroed out in that budget document.

(37:52):
And then if you look at what was proposed in
the leaked document, the impact to health and hospital systems,
including elimination of the Cronic Disease Management Workforce Center, rural
hospital flexibility grants, use violence prevention, traumatic brain injury, Alzheimer's research,
mental health and substance abuse programs, HIV AIDS and Ryan

(38:15):
White programs. We know a lot of the people that
are living with HIV and AIDS are actually older themselves,
including healthcare workforce programs, voting access for people with disabilities,
elimination of the Developmental Disability Planning councils at state levels,
cut to food banks, and I could go on and
on and on and again, Lou, these are factual. We

(38:37):
have five months to take action on this to say
this is not something we want to happen. And I
will tell you the advocacy that was done around social
Security changes worked and a lot of those provisions were
pulled back. So I highly encourage people to get involved.

Speaker 1 (38:50):
Let me ask you this question, Becky, how many of
those programs that you just mentioned are Medicaid programs?

Speaker 3 (38:57):
A large majority of those programs are Medicaid programs. All
of the ones I referenced for older individuals through Office
for the Agent, those are non Medicaid programs. But again,
about forty percent of individuals over the age of sixty
are dually eligible, So any changes or cuts on the
Medicaid side are absolutely going to impact the people that

(39:18):
we're trying to serve. Additionally, if you lose Medicaid and
Medicaid coverage for certain programs, so that doesn't mean your
need goes away. So those individuals are going to come
to their local Offices for the Agent who are already
depleted resources, to say I need assistance, and we're not
going to be able to provide that for them.

Speaker 1 (39:34):
So this, folks, is the social safety net that has
been building since nineteen thirty four with social security, different
health proposals. In the nineteen fifties post World War Two,
you had Lyndon Johnson's Great Society. In nineteen sixty five
with Medicare, Medicaid and other programs coming in. You had

(39:54):
the Affordable Care Act on the healthcare side, which tried
to have a long term care program but couldn't called
the Class Act. It was didn't make it too expensive.
So al this isn't part of the long term care
landscape in terms of the healthcare cuts. But now we're
looking at having that history, that almost one hundred year

(40:15):
history just stripped away, and where do people go. As
you said, Becky, one hundred and eleven thousand nursing home beds.
They can't find staff for the nursing home. So the
nursing homes that are closing wings and nursing homes that
are closing because they can't find enough staff. You're taking
the programs that are keeping people afloat and people who

(40:37):
don't have resources keeping them afloat and living in the
community and in some cases living very inexpensively with services
that are non Medicaid services, and all of those things
are at risk. We're going to come back for the
last segment of the show. We're going to open it
up for some more dialogue here. Internally, I wish I
could open up the phone lines, but this conversation, I

(40:58):
can tell you doesn't happen, folks, And if you're still
with us, stay with us, because this is vital information
for each and every one of you. We'll be right
back after the short break because I'm talking to people
who are in the know, who have information that is
vital to all of you and to me. You know,
as we go through this journey and as we go
through life. If you want to get a much more

(41:21):
detailed and in depth look at all of these issues,
join us for the Elder Law Forum on May fifteenth.
And when I say join us, you can join us
from your living room. It is a live event at
the Desmond and we have right now about three hundred
and twenty five people signed up. We're going to cap
shortly at the number of people who can join us
in the room, but it is live streamed, so you

(41:42):
can attend online and you can sign up right now
and get more information. I can't even go through the
list of speakers. There are about twenty five different speakers,
all experts in their areas, and it's at pyrolaw dot com,
p I E R R O l a w dot
com events and you can get all of the information.
You can see what happened at last year's Elder Law Forum.

(42:02):
But I say this almost every year, but I feel
this year it's it's existential that the changes that are
proposed are existential and have again reversed a whole trend
in history that's been evolving over the last ninety years
or so. So, you know, Becky and Al, I'm going
to kind of throw it up in the air to

(42:22):
you guys, what should we be thinking about? What should
people be doing now? I guess I'll start with you,
since you're sitting in front of me. These silos, the
providers that you have, and as Becky said, private pay
you want to go hire a private pay agency, it's
about forty bucks an hour, thirty five to forty dollars
an hour. Do the math, folks, take your calculator out.
If you need twenty four hour a day care, three

(42:43):
hundred and sixty five days a year, you're now coming
up close to two hundred and eighty thousand dollars a
year to provide care in the home if you're private
paying for it. So people soon get pushed over to Medicaid.
You've got Medicare, You've got all these different systems and
programs and all these silos payers and providers, and you
kind of have everybody in your agency out how is

(43:04):
this going to play out?

Speaker 2 (43:06):
Well, I think one thing that's that's very important for
the listeners to be aware of is that Medicaid, while
there are obviously there's a substantial portion, like fifty percent
paid for at the federal level, states not only not
only contribute financially, but states largely administer the program. So

(43:27):
the decisions on how the money flows, how it gets organized,
who it supports, and how it supports them are largely
made at the state level. So, for example, in New
York State, last year, New York State was awarded an
eight billion dollar amount of funds to spend over a
three year period to improve the structure of the system.

(43:50):
The state makes the decisions on where that goes. In
that eight billion dollars, you won't find anything that is
specifically aligned with care at home. Home care agencies as
part of this over three billion dollars of that is
aligned with something called social care social care networks, which

(44:12):
are intended to address a lot of the community needs,
a lot of you know, the kinds of services that
Becky is talking about, though they're funded from a different source.
You won't find the word home care or hospice in
the entire operating manual of that. So I think, you know,
kind of coming back around, it's important for listeners for

(44:32):
voters to be aware of the fact it's not just
a federal initiative, not just a federal program on the
Medicaid side, especially and on many of the services as
she was talking about where the governor has come through
or proposed to come through in this budget, that there
are a lot of decisions that push the air in
the balloon to other places, despite the fact of the

(44:55):
statistics that Becky referenced, that you've referenced in terms of
where the needs really are in the state.

Speaker 3 (45:01):
Becky, I agree with everything my colleague Al has indicated.
And when you talk about the billion in these waiver
Medicaid dollars, there's also no ability for aging services providers
to have access to any of those funds to support
the people that we're trying to serve. I would just say,

(45:24):
you know a lot of people wait until there is
a crisis that happens with a loved one with a spouse,
and then you're at a point where you have to
make really difficult decisions in a very short amount of time.
I highly encourage anyone that's listening that has questions about
long term care funding, infrastructure services to reach out to
their local office for the aging. We can provide that

(45:44):
information and assistance free of charge. It's objective, and it's
going to help you in your long term care planning.
The other thing that I would like to highlight is,
regardless of political party, anybody that is in a family
or caring for someone really needs to pay attention to
some of the things that are happening at the federal
level because this is undoing programs and services that have

(46:05):
been signed into law since nineteen sixty five, and people
are already dependent on those services. So this isn't that
we're not going to serve additional people. This is going
to be we're going to take home delivered meals away
from people. We're going to take case management away from people.
And again to Alice's point, individuals that vote really need
to be educated about the impact that these programs have

(46:29):
not only for the state of New York, but also nationally.
And it's really really easy to get involved. Again, I
referenced our website. In three clicks of a button, you
can contact your federally elected official and you can let
them know if you have concerns about some of these
plumbing cuts. That's aging Andy dot org. And we're just
going to continue to work with our federal partners to
really talk about the value of the older population and

(46:51):
why we need to support those who are most vulnerable.

Speaker 1 (46:55):
So the process that's playing out all around us. Now,
I grew up, I was a kid, but I grew
up in the sixties, and I watched television and I
watched as people protested. And at that point, it was
the Vietnam War, which kind of coalesced all of those protests,
but there were other things that have happened over time,

(47:18):
and I can't remember a time since the sixties where
more people have mobilized and gotten out to town halls
and gotten out to protests and started to let their
voice be heard. And now I'm going to give a
little bit of my it's an apolitical commentary, but it's
a structural commentary for our government, and that is, we

(47:38):
have a series of decisions at the federal level that
has allowed money to infiltrate politics to the extent that
you don't even recognize what's happening today. You have three
multi billionaires sitting behind the president as he's being inaugurated,
being able to have influence due to dollars. And that's
called citizens united. That was the case, if you want
to look it up. We need to go back to

(48:00):
where citizens are united, to where people are making their
voice heard. We cannot sit silent anymore. We cannot let
these moneyed interests dictate public policy. And right here in
our capital of New York, lobbying is very very prevalent.
And when you come down to legislation, folks and legislators

(48:20):
are trying to determine what goes into the bill and
what nuances go into the bill, and where the dollars
get allocated. And they're under pressure. How many hundreds of
bills get passed in a session, And they're under pressure,
and who are they hearing and who are they getting
memos from the lobbyists, from the stakeholders spending the money
to get the contracts, to keep the status quo, to

(48:43):
keep the system in place. If there are things that
you're passionate about, like healthcare, long term care, get on
the phone, get out to your public town hall, and
get out and let your voice be heard. And I'm
going to give this. We have about two minutes left.
Give it back to you. Al And Becky last words, al.

Speaker 2 (49:04):
Well, I think that we are really at an important
crossroads in the system in terms of where things are
going to go. And I think if there really is
intended to be a commitment to what people need every day,
the policies, the funding, the perspectives really have to flow
in that same kind of direction.

Speaker 1 (49:25):
I can tell you that over the last.

Speaker 2 (49:28):
Maybe fifteen years, within the state of New York, there
really has been a significant marginalization of services regardless of
regardless of how you slice the pie in medicaid, you
really see a heavily ancillari view of these home and
community based services.

Speaker 1 (49:45):
Becky, ten seconds or less.

Speaker 3 (49:48):
I just want to say thank you, Luth, to you
and to al and for all your listeners.

Speaker 1 (49:52):
Get involved.

Speaker 3 (49:53):
This is really important.

Speaker 1 (49:54):
And how do people contact the agencies on aging or
their county.

Speaker 3 (50:00):
So it's very very easy. You can go to the
New York State Office for the using website, which is
aging dot ny dot org, or you can contact your
local office for the aging Every county has one and
they'll be able to provide you assistance.

Speaker 1 (50:15):
Okay, next week, I'm going to be playing clips from Network,
a movie. If you haven't google it, go to YouTube.
Watch the scene from Network. I'm mad as hell and
I'm not going to take it anymore. Watch the scene, folks,
and get that voice. See you next week. Thank you,
Lo