Coalition of Institutionalized Aged and Disabled, Inc.
425 East 25th Street New York, NY 10010
TESTIMONY FOR A HEARING ON:
Adult Care Facilities
THE NEW YORK STATE ASSEMBLY COMMITTEE ON HEALTH
RICHARD N. GOTTFRIED, CHAIR
THE NEW YORK STATE ASSEMBLY COMMITTEE ON SOCIAL SERVICES
ANDREW HEVESI, CHAIR
THE NEW YORK STATE ASSEMBLY COMMITTEE ON AGING
DONNA A. LUPARDO, CHAIR
September 19, 2017
Good afternoon. My name is Geoff Lieberman. I am the Executive Director of the Coalition of Institutionalized Aged and Disabled (CIAD). The Coalition was established in 1973 to bring pride, purpose and self-determination to long-term care residents and to improve the quality of their life and care. We do this by educating residents about their rights, helping them to organize into resident councils and supporting their participation in the policy issues that affect their lives.
For many years, our work has focused on the NYC adult homes that house a significant number of residents on SSI who have a mental health diagnosis. These homes are large and institutional in nature, with an average capacity of 195 beds. Consequently, we have no experience with or knowledge of adult homes in upstate New York, and cannot comment on the reasons why twenty adult homes closed their doors in the last five years. We certainly recognize the deleterious impact a home’s closure can have on the residents who have made it their place to live, whatever the reason for the closure. And we think it’s critically important to preserve and create small and non-institutional housing for the elderly and people with disabilities.
We do know that the three homes serving an SSI population that have closed in New York City in the same 5 year period were not as a result of a stagnant rate. The Chai Home and the Rockaway Manor Home for Adults never reopened from the devastating effects of Hurricane Sandy. The New York State Health Department Commissioner shut down the Park Manor Home for Adults by emergency order. All the other New York City homes we are familiar with appear to be financially healthy.
For example, the Belle Harbor Manor Home for Adults is a not-for-profit adult home on the Rockaway Peninsula with a 162-bed capacity. Tax documents filed by Belle Harbor last year show that it received income from residents’ SSI checks
in the amount of $2,259,820. The home’s largest expense was its employees’ wages and benefits, totaling about $920,000. It’s second largest expense, however, was $340,000 in donations that it made to other organizations not related to its mission of providing housing and services to its residents.
CIAD has worked with the residents and the resident council at Belle Harbor Manor for many years. Residents have consistently complained about the absence of security and supervision at night and professional case management services. They, like the many other residents we hear from and work with, also complain about the substandard quality of the food. And like residents all over New York City, they want fresh fruits and vegetables and better quality meats to replace the starches and processed foods they are mostly served. CIAD helped residents organize a food committee, and for a time, the food service got better. But residents report that whatever improvements they once gained have disappeared.
A quick look at Belle Harbor Manor’s spending on food might explain residents’ continuing complaints. Last year, it spent $276,358 on food, or about $4.96 per resident per day. That’s $1.65 per meal. By comparison, the former non-profit Rome Home, which closed its doors this year, spent between $7.50 to $11.00 per day per resident. Without a penny increase in the SSI rate for adult homes, Belle Harbor Manor could have more than doubled its spending on food, or increased payroll by more than a third to provide better security at night and more responsive and helpful services to its residents. It chose neither of those options.
In addition to the daily rate adult homes receive through residents’ SSI payments, homes can participate in the annual EQUAL Program, a non-competitive application process for ACF’s that serve an SSI population. It’s purpose is to enhance the quality of residents’ life and care and it cannot be used to subsidize a facility’s daily operational expenses. So, for example, EQUAL has been used to pay for resident clothing, room furnishings, staff training, and recovery & rehabilitative services to help residents become more independent.
Resident Councils decide how they want the money to be used and the application is authorized by the President of the Resident Council. This process helps ensure that the funds are used to directly benefit the residents and it also empowers the Resident Council. However, all too frequently, facility operators view the program as an additional revenue stream for the facility, rather than a program determined by and for the residents. As a result, conflicts arise between residents and management about how to spend the money. The facility may, for example, want to use the funds to do maintenance and repairs, an expense residents may feel the facility should cover on its own, and not take precedence over their own legitimate priorities.
One of CIAD’s important organizing activities is to educate resident councils about the EQUAL Program. And each year, CIAD helps councils push back on facility managements’ unwillingness to include a resident clothing allowance in their application, a major priority for many residents. In one particularly egregious case at Belle Harbor Manor, the operator threatened to never submit an EQUAL application if the residents did not comply with how the facility wanted to spend the money. CIAD alerted DOH, DOH intervened, and the residents’ priorities prevailed: a $150 clothing allowance and TV’s in residents’ rooms. But even with that victory, Belle Harbor Manor unilaterally reduced the allowance to $50.00 per resident, claiming it was all that was left of the grant. Belle Harbor Manor received $65,569 in EQUAL funds last year. A $150 clothing allowance would have cost $24,300 to provide a needed winter coat or new shoes, underwear or other clothes to replace what may have gotten lost in the facility laundry.
Queens Adult Care Center also shows no signs of financial duress. It’s one of the largest adult homes in New York City with 352 beds. Like many of the adult homes in New York City, it recently converted a significant number of its beds to
the Assisted Living Program. The Assisted Living Program provides additional services to residents such as assistance with Activities for Daily Living for residents who are eligible for nursing home care but who can receive those services in lower cost settings.
In Queens Adult Care Center’s 2015 Assisted Living Program application, it projects revenue of $10,796,000 and a net operating profit of $1,696,000. It anticipated spending $590,000 for food, or $4.62 per resident per day. Why couldn’t some of the surplus be used to improve the quality of the food, address the serious concerns residents have about the absence of security and supervision at night or hire more competent, respectful and well-trained staff, all issues that the residents of the home have complained to us about.
The overriding concern we should all have is to ensure that adult home residents are receiving the highest quality services in a safe and comfortable environment. If, indeed, there are homes that are providing quality housing and services to residents, are managed well, and are not financially viable because of an inadequate rate, New York State should focus its efforts on devising a more adequate rate so that these homes can continue to serve its residents. For New York City facilities that appear to us not only to be financially healthy but quite profitable, the crucial question is, how do we ensure residents are getting what they pay for. What do they have a right to expect by way of their government checks? If it is established that a rate increase is necessary, how will that rate increase benefit the residents? How will it improve staffing, food and case management services so sorely needed by residents?
We therefore make these recommendations.
1) Strengthen the NYS Health Department’s inspection and enforcement process and provide the department with the power and capabilities to audit adult home financial records.
Better oversight is the key to holding adult homes accountable for the quality of the housing and services they provide. CIAD has long advocated passage of A2743 so that the New York State Department of Health has better tools to protect residents and address repeat violations and patterns of systemic problems in facilities. In addition, the Health Department should be provided audit capabilities to ensure that current funds are being used for the primary benefit of the residents.
2) Ensure that a rate increase is justified and going to facilities that need it.
New York State should analyze how money is being spent in adult homes
and establish what is acceptable in regard to profit margins and administrative costs.
3) Ensure that the facility rate benefits residents.
Limit spending in administrative costs and establish minimum standards for food expenditures. Ensure residents have input regarding where money should be spent and where improvements are needed.
4) To ensure fairness and equity for SSI recipients, provide a PNA increase for residents commensurate with the percentage increase operators receive.
The SSI rate that residents pay the adult home does not and is not meant to cover all the expenses an individual resident will have. Toiletries, periodicals, gifts for grandchildren, entertainment and cigarettes are items that residents have traditionally spent their Personal Needs Allowance on. But residents are also using their PNA to buy food from outside vendors and to do their laundry at outside laundromats because of their dissatisfaction with the
5) Develop appropriate supportive housing alternatives for residents throughout the state.
The only options adult home residents in upstate New York appear to have are other adult homes or nursing homes. In order to meet its Olmstead obligations, New York State should provide housing and services for disabled New Yorkers to live in the most integrated setting appropriate to their needs.
Thank you for this opportunity to speak. CIAD looks forward to working with you to improve the quality of adult home residents’ life and care.