Investing in the Future of Every Single New Yorker: Providing our Older Residents with Safety, Comfort, and Security
We live in an aging city. Almost 1.2 million New Yorkers are ages 65 and older, making up about 14% of the city’s population. But the number of older adults living in New York City is projected to grow from 1 million in 2010 to 1.4 million by 2040. We should be proud that, with a life expectancy of 81.2 years, New York City residents live 2.5 years longer than the national average. But we can do better. Shaun has spent his entire career working to strengthen and support communities in our city that have faced adversity. Now, as a candidate for mayor, Shaun is committed to establishing bold policy goals that address the challenges faced by all New Yorkers, tackling issues of accessibility, equity, and fairness.
According to New York City Department of Health and Mental Hygiene (DOHMH) data from 2017, Latinx New Yorkers have the highest life expectancy among racial and ethnic groups, at 82.4 years, while non-Hispanic Black New Yorkers have the lowest, at 77.3 years—the same as the overall New York City life expectancy in 1998. The highly segregated nature of New York City neighborhoods results in an astounding gap in life expectancy of almost 19 years between East Harlem residents (71.2 years) and people living on the Upper East Side (89.9 years), as reported in a 2019 analysis by NYU School of Medicine.
Older residents have given so much of their lives in the service of building our city and our communities. And yet, they are so often marginalized, lacking meaningful political power. It is our responsibility to listen to, understand, and advocate for this vital group of New Yorkers, and ensure that we consider them across all of the City’s decisions. This will be clearly outlined in the Donovan administration’s Bill of Rights for Aging New Yorkers, which will include:
- The right to political power with representation in the Mayor’s Office through a Director of Aging Advocacy;
- The right to high-quality, age-accessible health care in every neighborhood for all New Yorkers;
- The right to live in a neighborhood anywhere in New York City that is both safe and upholds fair policing;
- The right to a healthy life, supported by city government through good food and accessible recreational and social spaces;
- The right to affordable and accessible housing with place-based services that meet the full range of older New Yorkers’ needs;
- The right to safe, comfortable, and well-lit outdoor settings in every neighborhood;
- The right to live free of discrimination by age, race, religion, functional ability, socio-economic status, sexual orientation, or gender identity;
- The right to services specific to our older population’s needs through better data collection by five- or 10-year cohorts; and
- The right to free movement across the entire city through high-quality, accessible transportation options.
The demographic shift in age across the five boroughs, which mirrors a global trend, has the potential to yield tremendous social, economic, and health benefits for current and future generations of New Yorkers. Older adults can stimulate economic growth via spending and employment, and they offer additional social and financial capital to their communities and institutions through caregiving, volunteerism, and philanthropy.
These benefits will only be accessible, however, if our city adapts and improves its outdated social systems, infrastructure, institutions, and attitudes to promote healthy aging and maximize older adults’ health, well-being, and full participation in public life, while addressing deeply rooted health inequities and ageism.
Our plan will focus on:
- Investing in the Health and Wellbeing of People in Later Life
- Cultivating and Retaining a Multigenerational Workforce
- Providing Older People with Affordable, Safe, and Accessible Housing with Services
- Making Transit Work for Everyone
Investing in the Health and Wellbeing of People in Later Life
According to data from the NYC DOHMH 2017 Community Health Survey, 57% of older city residents rated their own health as “good,” “very good,” or “excellent,” compared to nearly 75% of older New Yorkers statewide. Positive perceptions of health vary even more significantly by race and ethnicity with only one third of Latinx and Asian/Pacific Islander older adults in New York City rating their health so highly, as compared to two-thirds of their White and Black counterparts.
With respect to specific health indicators, less than half of older New Yorkers participate in the recommended amount of physical activity, and more than 60% are overweight or obese. More than a quarter have diabetes and more than two thirds have hypertension, both of which are preventable conditions that are significantly more prevalent among Black, Latinx, and Asian older New Yorkers and those who live below the federal poverty level and often face barriers to accessing health-promoting resources and care. Half of older New Yorkers have arthritis and 10% report having experienced a heart attack.
Older people are particularly vulnerable to communicable diseases due to increased prevalence of underlying health problems and are overrepresented in the number of COVID-19 cases, hospitalizations, and deaths. Additionally, physical distancing restrictions have resulted in increased food insecurity, social isolation, and the delay of preventive health care services that can facilitate early detection and treatment of serious conditions.
We are committing to the following policies and programs:
Embed health and age in all policies within city government
Throughout our lives, an estimated 80% of our health is determined by social and economic factors, and as a result, policies to impact health must go beyond the provision of health care. We believe that healthy aging is also a function of the person-environment relationship. Our policies to promote healthy aging will address the social, physical, and economic environments older people inhabit, and work to rectify decades of exposure to structural inequities experienced by underserved communities. A Donovan administration will elevate the issue of aging, make improvements to publicly controlled services, and help galvanize private sector investment and innovation.
Health in All Policies (HiAP) is an evidence-based model that has been increasingly embraced by states and municipalities to leverage policies across sectors to improve population health and advance health equity. New York State’s approach is unique in that it emphasizes both health and age. In 2018, Governor Cuomo passed Executive Order 190, which requires all state entities to consider health and age in all planning, policymaking, regulation, and procurement activities. Though still early in its implementation, this initiative has already increased the number of age-friendly communities in New York State and has resulted in more efficient use of public funding streams. For example, the Request for Applications (RFA) for Downtown Revitalization Initiative grants now requires applicants to articulate how their projects will improve health and promote healthy aging and has correspondingly weighted scoring for awards totaling $100 million annually.
We are committed to pursuing a similar strategy to facilitate the spread, scale, and sustainability of the Age-Friendly NYC initiative, and to ensure aging does not continue to be exclusively relegated to the Department for the Aging (DFTA), an agency that serves a small fraction of the older population. To achieve these goals, we will:
- Appoint a person in the Mayor’s Office to oversee the implementation of Age-friendly NYC;
- Pass an Executive Order requiring all city entities to consider health and aging in their planning, policymaking and regulation, and procurement activities;
- Require all city agencies to conduct an annual self-assessment of how their initiatives are improving health and wellbeing and promoting healthy aging;
- Instruct the DOHMH to develop metrics to track progress on priority areas and report on those metrics annually in the Mayor’s Management Report; and
- Provide seed funding to groups of older people and community-based organizations working to drive local age-friendly neighborhood initiatives.
Regularly collect and report on data related to older people
Older people are often excluded from data collection and reporting, which both reflects and reinforces their exclusion in society. Accurate and nuanced data are required to identify and address inequities and optimize our health and wellbeing as we age. While data on younger people are traditionally disaggregated into five or 10-year cohorts, data on older adults are often reported for all people over age 65.
We must ensure that data collection and reporting on older people reflects their diversity in age, race, ethnicity, gender, functional ability, socio-economic status, and other factors that influence health across the lifespan. For example, the City’s COVID-19 surveillance data is currently available by age (65-74 and 75+), sex, or race/ethnicity, but the data have not been cross-tabulated to highlight the interplay between these variables.
In addition, because older people are significantly influenced by neighborhood characteristics that can facilitate or limit health-promoting behaviors, we will prioritize aggregating data, where feasible and valid, to the Department of City Planning’s Neighborhood Tabulation Areas rather than Boroughs, Community Districts, Council Districts, or census tracts.
In the interest of improving data collection on older adults in New York City, we will:
- Promote the disaggregation of data by age into 5 and 10-year cohorts;
- Promote the disaggregation of data by Neighborhood Tabulation Area; and
- Publish an annual report on the health status of older people by neighborhood leveraging quantitative data and soliciting feedback directly from older people about their quality of life.
About 80% of heart disease and stroke, 90% of type 2 diabetes, and 40% of cancer incidents are preventable. Healthy eating, smoking cessation, and physical activity can lead to reductions in morbidity and mortality and can generate cost savings to health care and social insurance programs. For older people, studies have also indicated that physical activity is correlated with increased longevity, prevention of certain chronic diseases, reduced risk of functional limitations, and greater opportunities for social connection. We must make it easier for our older residents to access opportunities for physical activity.
Our focus on prevention must also help to identify and address social isolation among older people, which has recently been found to be as dangerous to public health as smoking, obesity, and lack of exercise. It predicts morbidity and mortality from cancer and cardiovascular disease and is a risk factor for cognitive impairment, depression, elder abuse, and vulnerability during disasters. Older people in New York City may be at greater risk of isolation due to higher rates of living alone (32%), poverty (21%), mobility impairment (29%), and lack of English proficiency (34%). Physical distancing restrictions to curb the spread of COVID-19, while essential, have significantly increased social isolation among older people, particularly those who are not connected to the internet and live alone and those who are not connected to the internet and don’t speak English.
To prioritize prevention for older New Yorkers, a Donovan administration will:
- Appoint a DOHMH Commissioner who will implement Age-Friendly Public Health principles, promote person-centered Age-Friendly Primary Care, elevate physical activity and immunizations among older people, and track appropriate metrics in the Take Care NY plan;
- Fund and widely promote programming in multigenerational spaces such as parks, community and recreation centers, and libraries (Learn more about our libraries plan in our full Education Platform);
- Increase walkability and pedestrian safety, prioritizing neighborhoods with large concentrations of older people (Learn more in our full Transportation Platform); and
- Invest in connectivity (infrastructure and hardware), technology training, and technical support for older people to prevent and reduce social isolation.
Ensure equitable access to health care and social services by making health care settings more age-friendly using evidence, design, and training
Age discrimination is also a barrier to quality care, with systematic bias against older patients manifesting in such ways as a lack of training among health care professionals in geriatrics and older adults being less likely to receive preventive care or testing/screening for diseases and other health problems. Ageism, whether explicit or implicit, can also result in under- or over-treatment. Health care providers may mistakenly dismiss symptoms of disease as “just part of aging” and to avoid difficult conversations around substance abuse and safe sex, even though sexually transmitted infections are increasing, and older people represented nearly 30% of opioid deaths in New York City 2018. Consequently, older people are often unaware of and do not receive reimbursable preventive services including vaccinations, cognitive screening, depression screening, and end-of-life planning. In 2016, only 20% of Medicare beneficiaries received their Annual Wellness Visit with a primary care doctor to develop a personalized prevention plan.
Moreover, many older adults have complex medical needs—due to multiple chronic conditions and the multiple medications they may take—that may compromise their valued independence and autonomy if not treated properly. They are at particular risk of complications during and after hospitalization, leading to high rates of hospital readmission.
The Donovan administration is committed to ensuring that, when older adults require care, it is provided without discrimination, concordant with their goals, promotes their physical function, involves the appropriate prescription of medication, addresses common syndromes like falls and delirium, recognizes the needs of family caregivers, and provides seamless coordination between settings and providers.
We can deliver this kind of care in inpatient and outpatient health settings by adopting the 4Ms Framework, an initiative of the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI). The 4Ms Framework is a set of evidence-based practices that addresses what “Matters” to patients, their “Medications,” their “Mentation” (or cognitive and mental health), and their “Mobility.” Health systems that assess older adults based on these four areas of concern and develop corresponding individualized care plans can work towards becoming officially designated “Age-Friendly.”
It is also important that we help hospitals make specific changes to their emergency department (ED) procedures, staffing, transitions, and physical environment to improve health outcomes for older adults. Older adults are likelier to use EDs and are at greater risk for serious complications in that setting compared to younger people. The environment itself—characterized by bright lights, fast pace of activity, and loud noise—can be disorienting to older adults and potentially interfere with the effectiveness of care. EDs that qualify for certification under the American College of Emergency Physicians’ Geriatric ED program offer the staffing, training, policies, quality improvement and evaluation procedures, equipment, and physical environment that meet older adults’ unique needs. Specific criteria for the highest level of accreditation includes having an Emergency Medicine Boarded physician champion provide training on subjects like transition of care, processes like screening patients for delirium, and access to mobility aids and free food and drink around the clock. While the scientific evidence of program effectiveness is limited so far, a 2018 prospective observational cohort study suggests that targeted evaluation by geriatric ED transitions of care staff may reduce inpatient admissions. There are currently at least four accredited geriatric EDs in New York City, including one at Mount Sinai and three at Northwell hospitals in Manhattan and Staten Island.
We will partner with hospitals to make a more concerted effort to screen for elder abuse, which can manifest in physical, sexual, emotional, and financial forms, and impacts approximately 1 in 10 Americans ages 60 and older. This can be achieved by creating multi-disciplinary response teams (MDTs) to help older adults in crisis; MDTs focus on complex cases that require coordination among different systems and professionals and involve more than one kind of abuse.
To make health care settings more age-friendly, Shaun will nominate a candidate for appointment as president and CEO of NYC Health + Hospitals (H+H) who is committed to steering the nation’s largest public health care delivery system toward:
- Joining the New York State Action Community supporting hospitals and health systems across the state as they work to implement the 4Ms;
- Directing NYC H+H acute care hospitals to apply to the Geriatric Emergency Department Accreditation Program and work toward improving their ED services for older adults;
- Training ED staff to identify and respond to signs of elder abuse;
- Hiring and training staff who specialize in geriatrics, including doctors, nurses and social workers; and
- Replicating the NYC Elder Abuse Center and Weinberg Center multidisciplinary team model to identify and address elder abuse in H+H hospitals.
Ensure equitable access to health care and social services—advertise and increase the utilization of preventive services that minimize older adults’ time in acute care settings
Older New Yorkers can avoid hospitalization altogether if they can access the services and resources they need in their own communities. These include regular primary care appointments, SNAP (Supplemental Nutrition Assistance Program), mental health counseling, and dental care.
Older Americans use preventive care services, which can help delay the onset or progression of disease, at half the recommended rate. The typical primary care office visit is too short to accommodate conversations about preventative care, so Medicare began annual wellness visits (AWV) as a preventative care service under the Affordable Care Act in 2011. The purpose of an AWV, which does not include a traditional physical exam, is to develop or update a “personalized prevention plan” for patients’ future medical issues based on their health and risk factors. AWVs collect information on a patient’s demographics and their assessment of their own health status. At an AWV, physicians also establish the patient’s medical and family history, a list of current providers, detect any cognitive impairment, review risk factors for depression, assess fall risk and hearing impairment, develop screening schedules, provide referrals to community-based lifestyle interventions, and, if the patient wishes, provide advance care planning services. A 2018 study of Medicare claims from 2009-2014 showed that patients participating in AWVs are more likely to seek preventative services within a year. Utilization rates are generally low, however, and they vary by race, income, and education, with utilization significantly lower among non-Hispanic, non-White Medicare beneficiaries. The City must encourage its older residents to participate in annual wellness visits and make these more accessible.
The Supplemental Nutrition Assistance Program (SNAP), which provides a median benefit of $101 in financial assistance for the purchase of groceries among one-person elderly households, is another federal program underutilized by older adults, who participate at about half the rates of all eligible populations. Underutilization may help explain why almost 11% of all older adults in New York City suffered from food insecurity in 2015-2017. Barriers to the program include low awareness, inability to navigate the application process, low benefit levels, and a sense of embarrassment about the need to rely on an assistance program. In places like California and New York City, high proportions of low-income older people who have limited English proficiency are particularly at risk. Outreach should be targeted to areas where SNAP is underutilized by older adults and where language barriers can pose additional challenges. Another potential solution to address food insecurity among these groups is to scale up and advertise programs like Fresh Food for Seniors, which allows older adults to buy fresh, regionally grown fruit and vegetables for just $8 a bag and pick it up from their local senior center.
Limited use of mental health services is a fourth concern impacting older New Yorkers. Out of the 85,000 older adults who would suffer from depression, only one percent are currently benefiting from an initiative to place clinicians at senior centers across the city. One barrier to access is that many older adults do not and/or cannot participate in senior center congregate meals or programming because they are homebound, speak limited English, or actively avoid age-segregated spaces. Today, only three programs citywide provide in-home psychotherapy services. City officials should explore opportunities to expand city mental health services into the home, actively recruit culturally and linguistically competent mental health providers, and facilitate access in other places where older adults congregate.
Additionally, many older adults also lack access to affordable dental care, the absence of which can lead to tooth decay, poor nutrition, and low self-esteem. Deterioration in oral health is also associated with premature mortality and cognitive impairment. Program models that offer some solutions include the NYU Dental Van Senior Citizen Initiative, which provides free screenings, emergency and comprehensive examinations with necessary X-rays, oral cancer exams, oral health education, oral hygiene instruction and nutritional counseling, cleanings, dental restorations, removable and complete dentures, simple tooth extractions, and simple denture repairs. Another model is ElderSmile, an oral health educational outreach initiative launched by the College of Dental Medicine at Columbia University in Northern Manhattan in 2006. ElderSmile similarly offers prevention, education, screening, treatment, and referral services for older adults in northern Manhattan through mobile van visits to senior centers. Ideally, a city-funded oral health program would generate referrals to federally qualified health centers (FQHCs) that provide dental care at a low cost. About 76% of federally qualified health centers provide such care, but less than four percent of the 65-and-older population in the U.S. used the safety net health care providers’ services in 2014.
Home-based long-term care services and supports (LTSS) provide people with physical and cognitive impairments with assistance in accomplishing activities of daily living (e.g., bathing, dressing, eating, toileting, and shopping) for an extended period of time. Of people turning age 65 now, 70% will need assistance with activities of daily living for an average of three years (3.7 for women and 2.2 for men) and 90% of people prefer to receive services at home. Chronic conditions and associated functional limitations increase with age, and as the demand for caregiving exceeds the supply of family caregivers, the need for paid direct care workers will increase.
Over the next decade, the New York City direct care industry (including home health aides, personal care attendants, and certified nursing assistants) will provide the most numerous job opportunities. However, these jobs are among the lowest paid and least respected. We must invest in these progressions to stave off an imminent shortage of home care workers which will threaten the health, safety, and wellbeing of older New Yorkers and their families and result in higher health care costs and lower quality of care.
While most direct care work is funded by Medicaid, a small but important segment of the direct care workforce is contracted by New York City through the Human Resources Administration (HRA) and the DFTA. HRA administers the Home Care Services Program (HCSP), a Medicaid-funded fee-for-service program to provide long-term care to people exempt from mandatory managed long-term care enrollment. HRA serves 5,050 people through 28 contracts. DFTA-funded providers serve 3,600 people who are ineligible for Medicaid through 28 contracts under the Expanded In-home Services for the Elderly Program (EISEP). We must look into leveraging these to improve job quality for direct care workers.
Under a Donovan administration, city agencies will work to:
- Create an outreach campaign to educate seniors and health care providers about the importance of annual wellness screenings (and how they differ from annual physical exams), using the existing network of senior-focused service providers;
- Increase SNAP utilization among eligible older people targeting outreach beyond senior centers in places where people naturally congregate such as libraries, recreation centers, grocery stores, and pharmacies;
- Scale up the Fresh Food for Seniors program as a citywide program in partnership with GrowNYC, rather than in local partnerships with individual council members;
- Launch in-home mental health services with culturally and linguistically competent clinicians;
- Create a resource for older adults identifying FQHCs providing dental care and scale the ElderSmile program across its network of senior centers; and
- Leverage contracts with employers of direct care workers to increase wages and improve job quality.
Help older adults plan to meet their end-of-life needs
Research shows that advance care planning (ACP)—the process of planning for future medical care under circumstances of impaired decisional capacity—is associated with improved quality of care at the end of life, including increased use of hospice and fewer in-hospital deaths. Early studies also show a decrease in inpatient hospital costs for patients who have ACPs. Yet, only one third of New York City senior center participants in a 2004 study had completed a health care proxy form. The low uptake of ACP across New York State is reflected in its extremely low hospice utilization rates—ranking 48th out of 50 in the US in 2015.
We will work with the NYC DOHMH and NYC H+H to launch an educational campaign on advance care planning to encourage New Yorkers and their health care providers to have conversations about end-of-life care preferences, which can now be billed for under Medicare, and to guide people on how to utilize advance care directives, such as Health Care Proxies, Living Wills, Do Not Resuscitate (DNR) orders, and Medical Orders for Life Sustaining Treatment (MOLST).
We are also committed to exploring the creation and evaluation of a citywide advanced care planning registry, which would interface with multiple electronic health records systems and increase the likelihood that individuals’ end-of-life wishes are respected under any medical circumstance. Such registries have been authorized by statute in a dozen states as of 2016 since Louisiana became the first to establish one in 1991. Studies of the population penetration and efficacy of ACP registries are non-existent, so a citywide evaluation of the program would benefit not only older New Yorkers, but older adults across the country.
In the interest of helping New Yorkers plan their end-of-life care, the Donovan administration will support DOHMH and NYC H+H in the launch an educational campaign on advance care planning and the pilot a citywide advanced care planning registry.
Cultivating and Retaining a Multigenerational Workforce
The aging workforce is a global phenomenon. As advancements in public health and medicine enable us to live longer, more active lives, the age of the workforce continues to trend upwards. Nationally, the number of workers aged 55+ is expected to grow from 35.7 million in 2016 to 42.1 million by 2026. Older workers secured 49% of all available jobs in 2018, with New York City mirroring this trend with over 700,000 older adult workers (17% of the workforce) identified in 2015. Older New Yorkers are choosing to remain in the workforce for two primary reasons: (1) financial necessity and (2) maintenance of purpose and identity through the social experience of employment.
Understanding the specific challenges that are faced by New York City’s older workers is critical to creating a landscape that promotes their continued engagement in the workforce. Older workers are uniquely positioned to play a key role in filling the burgeoning talent shortage that is unfolding across many sectors. Additionally, COVID-19 has led to an as-of-yet unmeasured exodus of younger New Yorkers, leaving an even greater need for skilled and unskilled labor. The immediacy of creating a multigenerational workforce requires short and long-term planning to address the challenges that are already present in our city and to prepare for the effects of an ever-growing older adult demographic.
We are committing to the following policies and programs:
Capitalize on the experience, institutional knowledge, and dedication of older adult workers
Engaging the older adult workforce has documented positive effects on both individual health and business performance and is rich with social and economic potential. Maintaining a multigenerational workforce creates opportunities for “reverse mentoring”, scenarios where different generations learn from each other and share varied perspectives on problems that arise on the job. This diversity of views and experience allows for older workers to share their valued institutional knowledge with younger workers and helps companies to secure the intellectual capital that typically leaves with retiring workers. Furthermore, from a productivity perspective, older workers tend to be more engaged, more motivated, and less likely to unexpectedly leave their positions. To build on this potential, the Donovan administration will:
- Demonstrate a commitment to these values by hiring older New Yorkers in city roles, making age-friendly adjustments to the built environment, publicizing these initiatives, and working to reduce the stigma of older workers staying in the workforce;
- Foster connections between New York City community-based nonprofits and national programs like Encore.org, ReServe, and Center for Workforce Inclusion that place older adult workers in part-time, flexible jobs or roles that contribute to social causes;
- Advocate for flexibility in working hours and phased half-retirement options for individuals looking to transition more slowly into full retirement; and
- Hire older mental health specialists to deliver mental health services through the Mental Health Corps—seventeen areas in NYC’s five boroughs qualify as “mental health provider shortage areas.”
Provide job training and increased access to employment and volunteer opportunities for older New Yorkers
Contemporary career recruitment strategies reflect the technological developments of our time (web-based, social media, etc.). Increasingly, older workers are left out of these processes. Access to a quality internet connection, the complexities of modern technology, and the need for high-tech devices have stranded many older adults that are seeking work. We understand that it is in our city’s best interest to break down these barriers to gainful employment and provide a portfolio of support for those interested in attaining employment. Existing city-based programmatic support for older adult job seekers does not go far enough in preparing interested workers for a modern employment landscape. Under a Donovan administration, the City will implement and improve upon a variety of programs to better the prospects for these workers by:
- Enhancing DFTA’s Senior Employment Services (SESU) program by integrating “skills based” job placement and post-placement mentoring to ensure that older adults obtain and retain employment;
- Providing socioemotional support for older adults navigating the challenges of the job search, and creating opportunities for peer-to-peer networking;
- Promoting CSSNY’s Retired and Senior Volunteer Program (RSVP) in libraries, senior centers, transit, etc. to continue growing community service-oriented volunteerism (Learn more about our libraries plan in our full Education Platform);
- Increasing the number of potential employers participating in the annual DFTA job fair to 50 from <30
- Partnering with Older Adults Technology Services (OATS) to design accessible and affordable technology training to better prepare older workers for an increasingly tech-based work environment; and
- Expanding the NYC Tech Talent Pipeline’s “Bridge-To-Tech” program from exclusively 18-24 to include the 55+ members of our community.
Continue developing access points for financial planning education, savings opportunities, and protections from fraud and abuse
Nearly one-third (29%) of 55+ U.S. households lack any form of retirement savings or pension plan. Many factors have led to this situation, among them the 2008 Great Recession, escalating costs of health care, stagnated wages, older adults saddled with student loan debt (their own or as cosigner for children/grandchildren), and the unprecedented financial strains associated with having had to care for one’s parents and one’s children simultaneously. Building retirement savings is a critical public policy concern as its effects are felt within various parts of our society, from the allocation of city funds to address financial insecurity, down to the lived experience of struggling older adults. To prepare for and manage these present and future challenges, we will implement a mandatory, default opt-in Retirement Savings Program for private sector employees to encourage prioritization of long-term savings, and continue developing partnerships with libraries, CUNY branches, senior centers, etc. to provide accessible financial planning support and scam/fraud awareness to interested older adults (Learn more about our libraries plan in our full Education Platform).
Elevate awareness of ageism in the workplace and educate on methods of addressing these biases in public and private sectors
As the share of older adults in the workforce continues growing, so too does the incidence of ageism on the job. Age discrimination is present throughout the arc of employment from the hiring process to decisions made about termination. Among workers aged 45-73, two out of three have reported experiencing some form of discrimination in their workplace. Workplace ageism can take many forms, from overt disparaging remarks about age to more subtle forms, such as being passed over for promotions. Despite its pervasiveness, only 3% of older workers have filed formal complaints of their experiences. To address these issues, a Donovan administration will:
- Engage the New York City Commission on Human Rights (NYCCHR) in developing training/educational materials on identifying and preventing ageism in the workplace;
- Institute a work group populated by ageism experts, private sector employers, and older adult workers to better understand the incidence and effects of workplace ageism in New York City; and
- Educate the city population through PSAs explaining the nature of ageism in the workplace and steps to formally address instances of ageism.
Providing Older People with Affordable, Safe, and Accessible Housing with Services
Nearly 1.2 million older adults live in New York City. They are geographically dispersed, with the largest concentrations in Brooklyn and Queens. The vast majority (96%) are growing older at home—also known as aging-in-place—and they are more likely to rent (56%) than own (44%). Older renters typically have lower incomes than older owners, and as a result, the majority of older renters rely on subsidies to afford their housing. Conditions are more difficult for the many older New Yorkers who live alone.
As of 2016, 60% of senior renter households in New York City were rent burdened, and the following year, it was reported that those who were trying to move into affordable senior housing had to wait an average of 7 years. On top of that, older New Yorkers face a range of challenges to receiving equitable and fair consideration when looking for housing. For example, one in eight older LGBTQ New Yorkers report facing discrimination in housing, with many hiding their identities for fear of prejudice.
Accessibility within buildings also continues to be a significant challenge, with 45% of all rental units found in buildings that do not have an elevator and only 49% of buildings with elevators that are fully accessible. Once inside these units, older adults may find physical challenges such as bathtubs or poor lighting.
We are committing to the following policies and programs:
Grow and improve existing programs that ensure that housing is financially affordable
New York City has a number of programs that make housing more affordable for older adults, and yet, they are sorely underutilized. Nearly 323,000 households are owned by adults aged 65+, and the Senior Citizen Homeowners’ Exemption (SCHE) and the Disabled Homeowners Exemption (DHE) provide tax breaks to homeowners with a combined annual income of $58,399 or less. Yet, in 2017, only 57,000 New Yorkers were enrolled in both programs. The Senior Citizen Rent Increase Exemption (SCRIE) and the Disability Rent Increase Exemption (DRIE) programs, also known as the New York Rent Freeze program, freezes rents for adults aged 62+ and people with disabilities who live in rent-regulated apartments. Yet only 43% eligible older adults are enrolled in the program and 4 out of 10 older New Yorkers report not even knowing about the program. Furthermore, SCRIE freezes the rent at the price at the time of enrollment, which does not account for any future income changes. In turn, nearly one-third of SCRIE participants are now paying over 70% of their income on rent. A Donovan administration is committed to reforming city programs to make them more accessible and affordable for our older residents.
Two existing place-based programs offer innovative models of providing affordable housing and intergenerational connections. The Home Sharing program run by the New York Foundation for Senior Citizens (NYFSC) matches “hosts” age 60+ who have extra private space in their homes with “guests” to share their space and pay a portion of the rent. And in July 2020, Governor Cuomo unveiled plans for a 291-unit affordable and supportive housing site called Clarkson Estates in Flatbush, Brooklyn. This site will have specified units for families, formerly incarcerated individuals, youth aging out of the foster care system, and formerly homeless young adults. The site will also be home to a multi-service, multigenerational “HUB” that will be available for residents and the public.
There is an opportunity to partner with developers to ensure that our city’s affordable housing has space for residents of all ages.
By growing these programs or replicating them throughout the city, housing can become affordable for New Yorkers of all ages and all incomes. In order to do this, we are committed to the following:
- Establishing SCRIE/DRIE as an opt-out program rather than an opt-in program for all eligible renters who live in rent-regulated units;
- Capping rents for SCRIE/DRIE beneficiaries at 33% of their income;
- Expanding SCRIE/DRIE eligibility requirements to include income-qualified renters in market-rate housing;
- Incentivizing developers to create multigenerational affordable housing sites; and
- Increasing the amount of aid for summer utility bills.
Partner with local developers, contractors, property managers, and allied health care professionals to make new and existing buildings easy to access and navigate
As people age, they become predisposed to chronic physical and cognitive conditions that can diminish functional capacity. In order for older New Yorkers to age in place, their homes must be able to accommodate their occupants’ current level of ability. First and foremost, we must ensure that older adults are able to enter and exit their homes safely. Many rental units are in buildings that do not have an elevator, and many buildings with elevators not are fully accessible. We must also make the necessary investments within units to ensure that potential hazards, including kitchen items placed in high cupboards and missing grab bars in bathrooms, do not lead to serious falls and worse.
Falls are the leading cause of injuries among older adults in NYC. In 2016, over 47,000 falls led to ER visits, hospitalizations, or deaths. Furthermore, hospitalizations from these falls cost approximately $722 million per year, or $40,600 per fall-related hospitalization, in New York City alone.
Many studies have shown that relatively simple and low-cost home assessments and modifications can greatly reduce falls. One successful model is DC Safe at Home, where an occupational therapist (OT) performs a home safety assessment. The OT then orders the necessary equipment and works with a local contractor to make home modifications such as grab bars, tub cuts, and ramps. In NYC, this program can be funded through grants, tax credits, and/or a revolving loan fund. A Donovan administration will incorporate universal design principles that go beyond the Americans with Disabilities Act in new senior housing construction and conduct occupational therapist assessments and low-cost home modifications to low and middle-income households to reduce in-home falls.
Provide place-based services and programs in new and existing housing sites
New York City has been the site for multiple pilot programs that link housing sites with health care and support services. One successful model is the NORC (naturally occurring retirement community), which is one or more apartment buildings with a large number of older tenants. There are currently 35 NORCs in NYC, and a majority of them have on-site supportive services to help older New Yorkers age in place. We must identify and expand models like the NORC using a data-driven approach.
Early studies have shown promising results that place-based services reduce health issues and health care costs. On a national scale, the LeadingAge Center for Affordable Housing Plus Services studied health outcomes for older adults living in HUD-assisted properties that provided on-site services such as physical exercise, health education, primary care, behavioral health care, and medication management, as well as a Resident Services Coordinator who connected tenants with services. Compared with older adults living in HUD properties without services, residents had a lower likelihood of hospital admissions. These partnerships also benefit these service agencies because they now have a built-in clientele and can eliminate travel time when making home visits.
One encouraging model in NYC is SHASAM (Selfhelp Active Services for Aging Model), run by Selfhelp Community Services, Inc., which provides a comprehensive set of supports that address social determinants of health and is available to residents in affordable senior housing buildings throughout one’s tenancy. A recent study by Rutgers University found that residents from six Selfhelp buildings in Queens had a lower utilization rate of hospitals and emergency rooms, and a lower rate of spending from Medicare and Medicaid, than their counterparts in buildings without supportive services. Additional studies on similar models have shown that the provision of health care and services in housing sites has influenced the health outcomes of older people.
Place-based services can go beyond the basic physical, medical, and behavioral health needs of older adults. There is significant evidence that social connectedness is critical to one’s emotional and physical wellbeing in later life. Since 30% of New Yorkers age 65+ live alone, it is imperative to create social opportunities when possible, especially among older adults that lack relatives or spouses to provide care and look out for their interests. This is a particular issue among older LGBTQ New Yorkers who maintained strong networks of chosen family through life but may lack the same familial support networks that non-LGBT older adults may have.
One way to do this is to utilize housing sites for educational programs such as early childhood centers or after school high school programs. One example is HANAC Corona Senior Residence, a 68-unit affordable housing building for low-income older adults in Corona, Queens, with an early childhood education facility on the ground floor. We will work to:
- Utilize local data to determine where new NORCs will be created and fund supportive services;
- Significantly expand the availability of place-based services to meet the full range of older New Yorkers’ needs;
- Work with Resident Service Coordinators in affordable housing sites to use an existing online referral system to both make and track referrals for residents in need of services; and
- Create shared-space intergenerational sites in nontraditional locations for organizations and schools and create intergenerational social opportunities and connections for older adults.
Create a coordinated and age-specific network to address housing insecurity
While there are many ways to make homes safer, more accessible, more affordable, and more service-oriented, shelters in New York City see 2,000 older adults on an average night who don’t have a place to call home. In addition, 15% of all evictions are of low-income older tenants. With COVID-19 disproportionately impacting older adults, evictions and homelessness only compound the threat of infection and death.
We must ensure that older New Yorkers who require shelter and/or supportive housing have access to services that are age-specific and can address their basic housing needs as well as any chronic health conditions. We will emulate nonprofit organizations like Hearth, Inc., which provides supportive housing to homeless older adults and provides case management and homelessness prevention services to those who are at risk of becoming homeless.
Ideally, older New Yorkers under a Donovan administration will not have to go to any type of shelter if a social service network can prevent homelessness in the first place. New York City has seen successful models such as the Bronx Health and Housing Consortium, which utilizes a multisectoral alliance of 70 member organizations to provide research and advocacy, technical assistance, and training in the areas of eviction prevention, permanent supportive housing, and homeless services and referrals. This model, and others like it, shows that with data collection, planning, interagency collaboration, and robust referral networks, people of all ages can find housing or avoid homelessness in the first place. In order to implement this, we will:
- Prioritize rapid housing to older adults who are homeless;
- Initiate age-appropriate supportive housing services co-located in shelters, temporary housing, and single-room occupancy (SRO) sites; and
- Expand the Bronx FUSE (Frequent Users System Engagement) data sharing system, which identifies frequent users of jails, shelters, and hospitals and connects them with supportive housing and other services, to the other four boroughs.
Making Transit Work for Everyone
Transportation is essential to older adults’ quality of life, health, independence, social
interaction, and ability to contribute to their communities, including as consumers and workers in the local economy. Since one in three older New Yorkers are living with a disability, or three times as many as the general population, accessibility is paramount to ensuring that older adults are able to participate in public life.
But New York City’s transportation system woefully underserves its customers with limited mobility. The city has one of the lowest percentages of accessible subway stations of any major world city. As such, older people tend to rely on surface-level transportation.,
Transit access must be treated as a fundamental human right. New York City’s transit system must work for everyone, not just those with the privilege to adapt when faced with irregular routes, downed trains, or broken elevators.
We are committing to the following policies and programs:
Focus on surface-level transportation
For the many New Yorkers with ambulatory difficulty, improving the surface-level transportation experience is essential. Nearly half of all falls among older adults occur outdoors, and environmental factors—such as uneven surfaces and objects that can be tripped on—account for many of the falls among older people worldwide. We are committed to investing in well-maintained sidewalks, outdoor lighting, bus stops that include shelters and seating, and public benches that can significantly improve an older person’s ability to get around safely and comfortably.
There has been a concerted effort to improve pedestrian safety among older New Yorkers. The Department of Transportation’s Safe Streets for Seniors program has reduced senior pedestrian fatalities by 17% citywide by implementing pedestrian safety measures in areas with high rates of senior pedestrian crashes resulting in fatalities or serious injuries. Since launching the program, DOT has extended crossing times at crosswalks to accommodate slower walking speeds, constructed pedestrian safety islands, widened curbs and medians, narrowed roadways, and installed new stop controls and signals at 41 “Senior Pedestrian Focus Areas” (SPFAs) across the five boroughs. While this program should be expanded, it should alter its methodology to ensure new SPFAs are identified using a racial equity lens. Almost none of the current SPFAs are located in neighborhoods with high concentrations of Black residents, while neighborhoods with higher concentrations of White residents are more likely to have an SPFA.
A survey conducted by the New York Academy of Medicine in 2019 found that one of the most common complaints among older people referred to the city’s cyclists, often referencing fears or experiences of being hit by cyclists while walking. Street design, public information campaigns, and increased enforcement can help to alleviate these complaints. Steps that the Donovan administration will take include:
- Identifying priority areas for sidewalk repair and better lighting informed by age-friendly neighborhood consultations and socio-demographic data (e.g. large concentrations of older people, people with mobility impairment, and falls prevalence);
- Increasing public seating, including bus shelters with seating and prioritizing neighborhoods with large concentrations of people with ambulatory difficulty;
- Assessing disparities in implementation of Safe Streets for Seniors and expanding the number of Senior Pedestrian Focus Areas; and
- Resolving conflicts between pedestrians and cyclists through street design, public information campaigns regarding etiquette and laws, and increased enforcement, while recognizing equity implications of greater enforcement.
Invest in accessibility
New Yorkers are accustomed to a certain level of unpredictability when it comes to the city’s transportation system. But what is an inconvenience for some riders—like a downed elevator or escalator—has, over the years, left other riders totally stranded. The lack of accessibility throughout the system has put the MTA up against a series of lawsuits over the years.
While the MTA has pledged to improve accessibility through its MTA Fast Forward Plan, further investment is needed to make the system truly accessible. There are 124 stations in compliance with disability laws, with 24 being added in the last capital plan and 70 included in the current 2020-2024 budget, which would push the number of handicap-accessible stations closer to 50%. Current timelines that former New York City Transit Chief previously established aim to have the system fully accessible by 2035, a move which some transit accessibility advocates agree is a reasonable timeline. Yet none of this can move forward without funding.
The Mayor’s Office for People with Disabilities Commissioner Victor Calise and others have called for the federal government to protect the MTA’s 2020-2024 capital plan, which is currently in danger of being shelved due to revenue loss associated with COVID-19. Access-A-Ride, the city’s paratransit network, is often referred to as the main alternative to subway travel for riders in wheelchairs or those with limited mobility. Over 150,000 registrants use the service for an estimated 7.1 million rides per year, and 71% of riders of over age 65. In practice, however, this service fails to serve as a viable transit option for many users. For example, an audit conducted in 2017 by the Comptroller’s office found that 43% of Access-A-Ride complaints, from safety issues to lateness, remained unresolved past the MTA’s own deadlines. Another audit showed that an Access-A-Ride vehicle failed to arrive for a scheduled trip more than 31,000 times in a year-long time period. In recent years, New York City Transit (NYCT) has attempted to improve Access-A-Ride through piloting on-demand rides (previously rides needed to be booked 24 hours in advance) and introducing an app. A Donovan administration will expand and improve upon NYCT innovations, while continuing to improve its overall service delivery.
At the same time, we will partner with the private sector to provide an alternative for riders who use wheelchairs. The New York City Taxi and Limousine Commission (TLC) has been increasing the number of wheelchair accessible vehicles in its fleet, with a goal to reach 50% of accessible yellow taxis. To increase accessibility in the for-hire vehicle sector, the TLC recently enacted rules that require that companies dispatch a minimum percentage of their annual trips, increasing each year, to wheelchair accessible vehicles. As of 2019, there were 500 accessible for-hire vehicles in New York City. This number will be monitored and the minimum percentage of required accessible vehicles will be increased. A Donovan administration will:
- Fully fund capital improvements to bring MTA subway stations into Americans with Disabilities Act compliance, prioritizing neighborhoods with large concentrations of people with ambulatory difficulty;
- Improve accessibility by investing in braille signage, auto-gates (instead of heavy, hand-operated emergency exit gates), and tactile strips at platform edge, and by replacing faulty elevators;
- Increase required minimum percentage of accessible vehicles for on-demand ride hailing services;
- Create flexible transit services that can accommodate some mobility-impaired riders at less cost than paratransit (including “feeder” paratransit, on-demand services and route deviation); and
- Reform Access-a-Ride by expanding or improving on-demand pilot and introducing contract incentives for improved performance.