United Neighborhood Houses of New York70 West 36th Street, 5th Floor ■ New York, NY 10018Phone: 212-967-0322 ■ Fax: 212-967-0792Visit our Website: www.unhny.org

AGING IN THE SHADOWS:Social Isolation

Among Seniors

in New York City

United Neighborhood Houses of New York

Spring 2005

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United Neighborhood Houses is the membership organization of New York Citysettlement houses and community centers. Founded in 1919, UNH’s membershipcomprises one of the largest human service systems in New York City, with 36agencies working at more than 300 sites to provide high quality services andactivities to more than a half million New Yorkers each year. For over 85 years,UNH has worked with its members to strengthen families and improve neigh-borhoods throughout the City. UNH supports the work of its members throughadvocacy and public policy research and analysis, technical assistance and fundingand by promoting program replication and collaboration among its members.

UNH BOARD OF DIRECTORS

Sidney Lapidus

President

Patricia M. Carey, Ph.D.

Vice President

Roger Juan Maldonado, Esq.

Vice President

Lewis Kramer

Treasurer

Thomas M. Cerabino, Esq.

Secretary and Counsel

Eric C. Andrus

Paul F. Balser

James W. Barge

Robin Bernstein

Tony H. Bonaparte, Ph.D.

Mark Hershey

Alain Kodsi

Jack Krauskopf

David W. Kubie

Anne C. Kubisch

Susheel Kurien

Harold O. Levy

Ann L. Marcus

Ilene Margolin

Janice McGuire

Edward Misrahi

Alex R. Picou

J. Donald Rice, Jr.

Eric R. Roper, Esq.

Stephan Russo

M. Bryna Sanger, Ph.D.

Charles Shayne

Andrew J. Silver

Arthur J. Stainman

Mario J. Suarez, Esq.

Mary Elizabeth Taylor

Judith Zangwill

Lewis Zuchman

Barbara B. Blum

Chair Emeritus

Anthony D. Knerr

President Emeritus

Richard Abrons

Director Emeritus

George H.P. Dwight, Esq.

Director Emeritus

Julius C.C. Edelstein

Director Emeritus

UNH EXECUTIVE DIRECTOR

Nancy Wackstein

UNH MEMBERS

◆ Boys and Girls Harbor◆ CAMBA◆ Center for Family Life in Sunset Park◆ Chinese-American Planning Council◆ Citizens Advice Bureau◆ Claremont Neighborhood Centers◆ Cypress Hills Local Development

Corporation◆ East Side House Settlement◆ Educational Alliance◆ Forest Hills Community House◆ Goddard Riverside Community

Center◆ Grand Street Settlement◆ Greenwich House◆ Hamilton-Madison House◆ Hartley House◆ Henry Street Settlement◆ Hudson Guild◆ Jacob A. Riis Neighborhood

Settlement House◆ Kingsbridge Heights Community

Center◆ Lenox Hill Neighborhood House

◆ Lincoln Square Neighborhood Center◆ Mosholu Montefiore Community

Center◆ Riverdale Neighborhood House◆ SCAN New York – LaGuardia

Memorial House◆ School Settlement Association◆ Seneca Center◆ Shorefront YM-YWHA of Brighton-

Manhattan Beach◆ Southeast Bronx Neighborhood

Centers◆ St. Matthew’s and St. Timothy’s

Neighborhood Center◆ St. Nicholas Neighborhood

Preservation Corporation◆ Stanley M. Isaacs Neighborhood

Center◆ Sunnyside Community Services◆ Third Street Music School

Settlement◆ Union Settlement Association◆ United Community Centers◆ University Settlement Society

AAggiinngg iinn tthhee SShhaaddoowwss:: Social Isolation Among Seniors in New York City

Table of Contents

Foreword

Executive Summary

I. Introduction

II. The Problem of Social Isolation Among Seniors

III. New York City’s Formula for Disaster

IV. Program Models Working to Combat Senior Isolation

V. Recommendations for Change

Appendix A: Program Model Examples

Appendix B: Interviews

Appendix C: Endnotes

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Authors Jessica Walker is a Policy Analyst in UNH’s Policy and Advocacy Department. She covers a range of issues relating to seniors, housing, homelessness, welfare, health, and mental health, especially as they pertain to settlement houses and the communities they serve. Cara Herbitter recently completed a yearlong AVODAH fellowship, which allowed her to serve as Project Coordinator in UNH’s Policy and Advocacy Department. She is now a research assistant in the Office of Policy and Planning at the New York City Department of Health and Mental Hygiene.

Acknowledgements We wish to express our deep appreciation to the many people who contributed to this report. First, we must acknowledge Dr. Eric Klinenberg whose award-winning book, Heat Wave, served as both the catalyst and framework for this work. Thank you to Rose Dobrof, Lewis Harris, Gerri Matusewitch, Nora O’Brien, and Erika Teutsch for their invaluable comments on an early draft of this report. We want to extend gratitude for the unending support we received within UNH for this endeavor, most especially from Nancy Wackstein, Susan Stamler, Anne Shkuda, Tim Mercure, Linda Lawson, and UNH Board Member Eric Andrus. We also thank all of the brilliant and talented individuals who sat down with us to share their expertise and discuss the important issue of senior isolation. Finally, we wish to recognize the generosity of The New York Community Trust, without whose support this effort would not have been possible.

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Foreword The term “community” has been muddled and overused in recent years. For some, the meaning is very basic: people who live within a particular place or region. United Neighborhood Houses and its member agencies see it more broadly. For us, community has more to do with the relationships within an area than with simple geography. Community is that place where people are inextricably linked with a common fate. It hopefully leads them to help one another work together toward a more promising future. It is a fact that some communities in New York City are stronger than others. The reality that many of our city’s older adults have little or no social support within their neighborhoods is disheartening and is the sign of a community in need of help. Some seniors have been loners all of their lives while others have experienced recent losses that have left them all alone. The thought that someone could be alone and unable to receive the help they need in a city of eight million people is troubling, especially since we do know how to find and help such isolated seniors. New York City’s network of settlement houses and community centers makes it their mission to provide social support to such individuals. We work to strengthen communities and the relationships within them. This can be in the form of instrumental support (any form of direct assistance or practical care such as transportation or Meals on Wheels service), informational support (the provision of or access to facts, advice, and referrals), affiliative support (companionship or fellowship), or emotional support (communication that a person is understood, valued for his or her own worth, and accepted despite any difficulties or shortcomings). That is why we often proclaim that we are working “for a city of neighbors.” Many seniors who might otherwise be socially isolated have been helped significantly by settlement houses, community centers, and other locally-based organizations. Our member agencies act as surrogate families for many seniors who no longer have their own. However, in light of the imminent demographic surge in the elderly population, there is still much work to be done. This report intends to initiate a larger conversation on the important issue of social isolation among New York City’s senior population. We hope that this contribution will shed some much-needed light on those seniors aging all alone in the shadows.

Nancy Wackstein Executive Director

United Neighborhood Houses of New York

March 2005

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Executive Summary As the senior population of the United States swells, and as the movement to assist elderly people to “age in place” gathers momentum, the issue of senior isolation becomes increasingly important. In advancing the laudable objective of helping seniors grow old in their own homes and communities, many experts and advocates stress how important it is for seniors to remain “living independently” and “able to determine their own fate.” At the same time, however, the importance of living interdependently as we age must also be acknowledged. If seniors are to avoid institutionalization and premature hospitalization, they require the social, physical, and emotional support of others. Seniors who are most at risk during emergencies are those who are socially isolated and have nowhere to turn for help. Yet the problems that many seniors experience during emergencies are often the result of factors that were already present, such as physical frailty or lack of a social network. They are living an “emergency in slow motion” every day of their lives, but because it is progressing slowly, no one is coming to their aid. UNH believes we have a shared responsibility for the way our society cares for the elderly, both in and out of emergency situations. Social isolation among seniors is a social problem and requires nothing less than a social solution. This report poses two questions: What is the role of our society in producing senior isolation, and what can we do as a society to combat it? To answer these questions, we rely on research, interviews, and discussions with service providers, academics, and City government officials. In four parts, this report defines and describes the problem of social isolation among seniors, highlights the particular vulnerability of New York City seniors, gives examples of programs already in place working to combat this problem, and, offers recommendations for change. Senior Isolation in New York City Senior isolation results when the conditions necessary for maintaining a functional social network break down. Both individual and societal factors influence the degree to which seniors become isolated. Individual factors include living arrangements, health, socioeconomic status, ethnicity, mobility, gender, and sexual orientation; a host of subjective factors such as individual attitudes and expectations; and the degree to which seniors receive social support from family and friends, participate in activities, and have access to information. Societal factors include the health and cohesion of communities; prejudices such as ageism, racism, sexism, and homophobia; and American society’s emphasis on individual self-sufficiency and remaining independent at all costs. New York City’s 1.3 million seniors are particularly at risk for living and dying alone. In fact, a citywide formula for disaster is now brewing. Seniors in the City are more likely to be poor, disabled, and to live alone than their counterparts nationwide and many are not getting the help they need. The threat of senior isolation can be found in even the most densely populated areas of New York City; seniors in upper Manhattan, the South Bronx, central Brooklyn, and portions of lower Manhattan are

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at particular risk. The situation will likely be compounded by the coming demographic surge in the older population. Baby Boomers, who will compose the largest cohort group of seniors ever, are even more at risk for social isolation than their parents. Program Models Working to Combat Senior Isolation Settlement houses, community centers, and other locally-based service organizations are ideally suited to identify and then help isolated seniors. Their intimate knowledge of their communities, their participation in local networks and associations, and their web of contacts throughout their neighborhoods make them the optimal places to receive and act on information about seniors in distress. In addition, because these organizations offer a range of services in an integrated setting, they are able to address a multitude of causes of senior isolation. This report describes some model programs that are currently addressing the needs of seniors. Additional support for these varied responses will be necessary to keep up with the population growth. Examples include:

• Integrated program settings, such as those found in most settlement houses and community centers. These organizations address the social and environmental factors affecting seniors as well as their individual problems. They often facilitate the social networking and community activities that can address neighborhood problems and keep communities strong.

• Programs that use seniors as resources serving in meaningful roles such as tutors and mentors for children and youth and volunteer companions for other seniors. This ensures that seniors maintain a sense of purpose after retirement while making a real contribution to their communities.

• Programs that bring seniors together, including traditional senior centers as well as alternative senior centers that target specific needs. The success of these programs often depends on the availability of transportation.

• Programs serving seniors where they live, such as Meals on Wheels, home visits, and supportive service programs (SSPs) within naturally occurring retirement communities (NORCs).

• Programs to keep seniors connected to others and to social services via technology, including conference calls, telephone reassurance, computerized automatic well-checks, and computer labs with Internet access.

• Case management and geriatric mental health services that are tailored for those seniors with complex and intensive needs who are most at risk of being prematurely institutionalized.

• Social adult day care and elder abuse prevention and support programs, which also target those seniors most at risk.

• Caregiver support, which ensures that existing relationships between seniors and their family caregivers (which is often the first line of defense against isolation) remain intact and beneficial.

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Recommendations for Change This report recommends steps New York City government, along with the nonprofit and private sectors, can take to combat senior isolation:

• To learn more about seniors at risk for social isolation, the City should expand its data collection efforts to better gauge the severity of the problem. A citywide assessment of elderly needs should also be conducted and a voluntary “check-in registry” to track the well-being of seniors should be developed and maintained.

• To strengthen and build on our “sense of community,” the City needs to take the lead in refusing to tolerate ageism and other forms of discrimination toward the elderly. A citywide public education and anti-discrimination campaign might be one way to initiate this effort. The City should also establish a clearly-written, widely-publicized protocol for individuals to follow when they become concerned about the welfare of a senior in their neighborhood. In addition, a citywide alliance should be assembled to promote and support the development of “elder-friendly” communities.

• To address current service gaps, the City should adequately fund and expand those services that already exist and help nonprofit organizations develop new service models to address emerging needs. The City should also conduct extensive outreach to ensure that seniors are aware of the services available to them.

• To tailor services to the senior population’s unique and changing needs, nonprofit providers need to constantly re-evaluate their approach and consider new, more inclusive methods of outreach and service delivery. The City should be a supportive and flexible partner in this strategic planning process. In particular, plans should be developed to engage seniors in the social service system as early as possible, before a crisis situation occurs or isolation develops.

• To preserve community-based knowledge and relationships between local providers and seniors, the City should continue partnering with nonprofit providers to deliver programming at the neighborhood level.

By addressing the serious concerns outlined in this report, we can take a giant step toward improving life for thousands of New York City seniors who otherwise might be lost in the shadows of a large, impersonal, and complicated city.

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Seniors are increasingly selecting alternatives to nursing homes that allow them to remain in their own homes and receive services there.

I. Introduction The impending demographic surge among our nation’s elderly population is staggering. In 2011, the large “Baby Boom” generation will begin to turn 65; by 2030, projections indicate that one in five people will be age 65 or older. In addition, the size of the older population is projected to double over the next 25 years, growing to over 70 million.1 This change will affect every aspect of our society, presenting challenges as well as opportunities to policymakers, families, businesses, and health care providers. Among the elderly population, the fastest growing segment is among those 85 years and older. In 2000, an estimated 2 percent of the total U.S. population was age 85 and older; by 2050, the percentage is projected to increase to almost 5 percent. This statistic is especially significant in terms of its impact on our health care system because these individuals tend to be in poorer health and require more services than the younger old. There is a growing recognition in our country of the importance of allowing seniors to “age in place.” According to the Journal of Housing for the Elderly, “aging in place means not having to move from one's present residence in order to secure necessary support services in response to changing needs as we age.”2 While several service models have long served seniors in their individual communities, the push to help seniors “age in place” gained momentum with the 1999 Supreme Court case Olmstead v L.C. and E.W.3 This ruling affirmed the rights of individuals with disabilities, many of whom are seniors, to live and receive services in their own communities as opposed to being prematurely and/or unnecessarily hospitalized or institutionalized. Seniors are increasingly selecting alternatives to nursing homes that allow them to remain in their own homes and receive services there. In 2000, 4.5 percent of Americans 65 years and older lived in nursing homes, a decline from 5.1 percent in 1990.4 During this same period in New York City, the percentage of institutionalized seniors fell by 12.7%.5 According to a 2003 study by AARP, the overwhelming majority of seniors surveyed said they want and plan to remain living in their own homes as they age. In fact, persons between ages 65 and 85 are the least likely to move of any age group.6 Since the 1999 court ruling, government has been working to ensure that services can be provided in “the most integrated setting appropriate.”7 In advancing the laudable objective of helping seniors grow old in their homes and communities, many experts and advocates stress how important it is for seniors to remain “living independently” and “able to determine their own fate.” At the same time, however, the importance of interdependency as we age must also be acknowledged.

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The problems that many seniors experience during emergencies are often the result of factors that were present prior to the incident, such as physical frailty or lack of a social network. They are living an “emergency in slow motion” every day of their lives.

According to a new study published by the Journal of Gerontology,8 more than three million people in the United States need help from another person in order to remain living “independently” in their own homes. Without this help, many of these elderly and disabled individuals face going hungry, falling, or experiencing other problems that could increase the risk of institutionalization and death. They receive assistance from another person in the activities of daily living that are essential for survival, such as bathing, dressing, and eating. Unfortunately, some older adults are not getting all the help they need. Countless others are currently healthy enough to do many of these tasks on their own, but are without the social supports necessary to help them if and when they no longer can. The consequences of this can be devastating. According to sociologist Eric Klinenberg, author of the award-winning book Heat Wave: A Social Autopsy of Disaster in Chicago, which examines the 1995 heat wave in Chicago, Illinois during which a majority of the 739 heat-related deaths were among older adults:

The prevalence and danger of living alone without social contacts were apparent in the heat wave mortality patterns…‘anything that facilitated social contact, even membership in a social club or owning a pet, was associated with a decreased risk of death’; living alone ‘was associated with a doubling of the risk of death’; and ‘those who did not leave the home each day’ were even more likely to die.9

Frequently, as was the case in Chicago, seniors who are most at risk during emergencies are those who are socially isolated and have nowhere to turn for help. Yet the problems that many seniors experience during emergencies are often the result of factors that were present prior to the incident, such as physical frailty or lack of a social network. They are living an “emergency in slow motion” every day of their lives.10

As advocates continue to call for measures that will allow seniors to grow old in their communities and remain as independent as possible, it is also necessary to ensure that these seniors do not become socially isolated and unable to obtain the help and support they need. (Note: In this report, the terms “social isolation among seniors” and “senior isolation” are used interchangeably, each signifying the state of an older person with limited social ties.) As Klinenberg explains, when seniors die all alone in their homes “unprotected by friends and family and unassisted by the state, it is a sign of social breakdown” in which we are all implicated.11 We have a shared responsibility for the way our society cares for the

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Settlement houses and community centers have a long tradition of fostering relationships among neighbors, of being an “extended living room” for community residents seeking companionship and mutual support.

elderly, both in and out of emergency situations. Isolation among seniors is a social problem and therefore requires nothing less than a social solution. Settlement houses and community centers have a long tradition of fostering relationships among neighbors, of being an “extended living room” for community residents seeking companionship and mutual support. From the settlement’s perspective, these relationships constitute the primary vehicle through which residents can address the problems facing them, their families, and the communities in which they live. As such, this report takes a sociological approach when examining the problem of senior isolation in New York City. We ask, ‘What is the role of our society in promulgating senior isolation and what can we do as a society to combat it?’ In addition to secondary research, our information-gathering has included interviews with over a dozen professionals within the settlement house network, meetings with leading researchers in the field, and discussions with City government officials. This report will:

• explain the dangers of social isolation; • highlight the magnitude of social isolation among seniors in New York City; • present program models that are working to combat the problem of social

isolation; and, • identify current obstacles to further reducing senior isolation while

recommending ways to neutralize these problems.

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During their “golden years,” many seniors undergo difficult transitions in their lives—such as retirement, declining health, and the death of spouses, partners, and friends—that can strain their social network.

II. The Problem of Social Isolation Among Seniors

During their “golden years,” many seniors undergo difficult transitions in their lives—such as retirement, declining health, and the death of spouses, partners, and friends—that can strain their social network.12 This strain is particularly worrisome because it occurs at a time when seniors most need social support—to help them recognize emerging problems, provide immediate care, and/or facilitate help from

outside sources. Seniors who receive social support from family, friends, and neighbors benefit in terms of their psychological well-being, life satisfaction, and physical health.13 Yet having social support is less about the quantity of social ties than it is about the quality and durability of them: seniors must be able to both form and sustain strong interpersonal relationships. This often becomes more difficult with age and puts the elderly at particular risk of becoming socially isolated. In order to ensure that seniors continue to flourish, it is important to identify and combat the unique characteristics that result in social isolation.

A.) DEFINING SENIOR ISOLATION Defining senior isolation is a difficult task. The factors that cause senior isolation vary from person to person, as does its manifestation. Just because a senior is living alone does not necessarily mean that he or she is lonely or without social supports. As sociologist Eric Klinenberg writes:

It is important to make distinctions among living alone, being isolated, being reclusive, and being lonely. I define living alone as residing without other people in a household; being isolated as having limited social ties; being reclusive as largely confining oneself to the household; and being lonely as the subjective state of feeling alone.14

While they are not inherently problematic, the act of living alone and/or being reclusive are particular risk factors for social isolation. Such seniors may not be getting the help they need to live optimally in their day-to-day lives—and could be at elevated risk for experiencing dire outcomes in emergencies—because they have few places to turn for help. Although the causes of senior isolation vary, the underlying dynamic appears to be the same. Recently, researchers developed a theoretical model to explain its etiology.15

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“Of all seniors living alone and below the poverty line, one out of three sees neither friends nor neighbors for as much as two weeks at a time, and one out of five has no phone conservations with friends.”

Figure 1. Model of the process necessary to maintain an adequate social network. The model above depicts the fragile balancing act necessary to maintain a vibrant social network. Social integration refers to the integration into the web of roles and relationships we refer to as “society” (therefore, social isolation is its inverse). Functional support refers to the benefits individuals experience that accompany social integration. Finally, threats and disruptions are those events and characteristics that can hinder social benefits from materializing and may lead to social isolation. As the creators of the model explain, “gains in one level of the network may compensate or substitute for losses in the other.” For example, an abundance of friends can help ensure that one does not become socially isolated after the death of a spouse or partner. Social isolation can result, however, when the threats and disruptions become overwhelming. An example of this is a senior who loses sustained contact with the outside world because of a health problem that leaves her homebound. The depth of social isolation in the elderly population is staggering. As Dr. Klinenberg writes:

One of the most striking findings in the studies of seniors and isolation concern the extent to which some of the elderly have lost contact with their friends and families. Of all seniors living alone and below the poverty line, one out of three sees neither friends nor neighbors for as much as two weeks at a time, and one out of five has no phone conservations with friends.16

Finally, because social isolation so often becomes a vicious cycle, it is very difficult to reverse once put into motion (i.e., mild social isolation leads to depression which then leads to deeper isolation).

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B.) FACTORS INFLUENCING SOCIAL ISOLATION AMONG SENIORS Below is a partial listing of the most common factors that can influence one’s capacity to form and sustain a social network, which can originate at either the individual or societal level.17

Individual factors influencing social isolation • Living arrangement Older people who live alone are at a severe disadvantage because they do not have constant social support available to them inside their household. As such, they are more likely than others to be isolated, depressed, living in poverty, fearful of crime, and to have more dire outcomes in crises. • Support of family and loved ones Close family relationships provide a senior with emotional and instrumental support. Marriage and long-term partnerships have been shown to be beneficial to health and well-being while divorce has the opposite effect.18 Seniors without children are more likely to be socially isolated than those who have living children. Proximity also matters; no matter how loving adult children may be, those who live a distance from their elderly parents cannot offer the same level of social support as those living nearby.

• Meaningful social participation The degree to which one feels useful in society is an important factor in social isolation. Retired seniors who either volunteer their time or work in community or religious organizations often feel a deeper sense of purpose and have stronger social bonds than those without such connections.

• Health status and mobility

Physical or psychological impairments can be especially debilitating for the elderly. As seniors age, they can naturally become frailer or experience impairments which can severely limit their mobility, interaction with others, and ability to work or volunteer.

• Socioeconomic status

Seniors who are poor are more likely than those with higher incomes to live alone, suffer from poor health, have health-related limitations in performing daily tasks, and experience depression. Seniors with a higher socioeconomic status have more opportunity to nurture their social relationships. They have more freedom to entertain in their homes, take classes, travel and visit others, and use the telephone freely.19 In addition, they can pay for the specialized supportive services that they may need as they age.

COMMON FACTORS INFLUENCING

SENIOR ISOLATION

Individual factors Living arrangement Support of family/loved ones Meaningful social participation Health status and mobility Socioeconomic status Gender Sexual orientation Access to information Ethnicity Subjective attitudes

Societal factors

Social environment Ageism, racism, sexism, homophobia Social capital

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Seniors who are receptive to help, do not harbor excessive fear about crime in their communities, have a positive outlook about life, and do not see a huge disparity between their expectations and reality are less likely to become isolated.

• Gender Men tend to have fewer friends and receive less social support than do women. Part of this is explained by contemporary models of masculinity, which often preclude men from exploring the emotional intimacy on which meaningful relationships are based. Older women, who are generally better at bonding and maintaining close emotional ties, are at risk because they are more likely to be widowed, live alone, and be unable to drive.

• Sexual orientation LGBT seniors (those who are lesbian, gay, bisexual, or transgender) are much more likely than the general senior population to live alone, have no children, and age without a life partner or significant other. They are also less likely to access the senior programs and services they need, putting them at special risk for isolation.20

• Access to information

Seniors who cannot gain access to information and services because of illiteracy, language barriers, lack of technological knowledge, or a general lack of awareness about the help that is available are at a severe disadvantage when trying to connect with others.

• Ethnicity

In limited instances, certain cultural traits are thought to affect senior isolation. Some ethnic groups can have stronger multigenerational family networks, such as groups within the Hispanic and African American communities, for example, which help shield their elderly from becoming isolated. However, this benefit may be offset by the fact that more Hispanic and African American elders live alone and have lower incomes than other ethnic groups.

• Subjective factors The attitudes and expectations that seniors entertain about themselves, others, and their world have a great impact on whether or not they are socially isolated. Some seniors have chosen to be reclusive and socially isolated their entire lives. Seniors who are receptive to help, do not harbor excessive fear about crime in their communities, have a positive outlook about life, and do not see a huge disparity between their expectations and reality are less likely to become isolated.

Societal factors influencing social isolation

• Social environment

Communities are the foundation for social life. They are, Klinenberg writes, “the soil out of which social networks grow and develop or, alternatively,

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The phenomenon of being isolated is very idiosyncratic. What affects one senior may have little or no effect on another.

wither and devolve.” As such, a community has the potential to promote or combat senior isolation among its residents. The physical characteristics of the community, such as deteriorated sidewalks, lack of public space and parks, high levels of crime, inadequate public transportation, and insufficient community-based programs and services can limit the degree to which individuals interact, thus promoting social isolation.

• Ageism, racism, sexism, homophobia Prejudice, discrimination, and stereotyping—whether overt or systematic—only serve to separate and alienate individuals of all ages. These issues affect the lives of seniors in terms of where they can live, who they feel comfortable interacting with, and how they are treated when trying to access senior services.

• Social capital

Many analysts argue that the cult of individualism is eroding social trust. People are increasingly self-interested at the expense of community. This

has implications for seniors who are expected to “remain independent” and not “burden others” with their problems. While the above factors can influence the onset of social isolation, the phenomenon of being isolated is very idiosyncratic. What affects one senior may have little or no effect on another. This makes it especially hard to screen seniors for social isolation. When asked if she has close friends and family nearby, a senior could conceivably

answer “yes,” yet still be considered socially isolated and in need of additional help. With this dilemma in mind, the Cornell Gerontology Research Institute is now developing instruments to accurately assess social isolation in individuals across the senior population.21

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III. New York City’s Formula for Disaster While there is a growing concern for socially isolated seniors nationwide, the 1.3 million older adults living in New York City are at particular risk of living and dying alone. In fact, a citywide formula for disaster may now be brewing. The risk of senior isolation is expected to rise to unprecedented levels in the coming decades. If not addressed, the elderly in New York City will become increasingly vulnerable to this threat. The three major reasons include:

1.) SENIORS IN NEW YORK CITY ARE ALREADY AT SIGNIFICANT RISK. It is already true that the rate of poverty among elders in the City is much higher than in the United States as a whole. When compared to the entire nation, older adults in the City are also more likely to live alone, speak English less than “very well,” and be divorced, separated, widowed, or have never been married in the first place. In addition, older persons in New York City also have high rates of disabilities, but are more likely to remain living at home, usually alone.22

The City’s percentage of persons aged 85 and older—those most likely to be frail and have serious health concerns—has increased at a rapid rate since 1990 (up 19% in Manhattan alone). As such, the elderly in New York City are at great risk of becoming socially isolated, perhaps more so than many of their counterparts nationwide (see figure 2).

SEVERAL RISK FACTORS FOR SENIOR ISOLATION: NEW YORK CITY VERSUS THE ENTIRE NATION (2000)

Selected characteristics of persons age 65+

New York City Nationwide

Living alone, non-institutionalized 32% 28%

With disabilities 46% 42% Difficulty going outside the home because of disabilities 8% 5%

Below poverty level 18% 10%

Speak English less than “very well” 27% 7%

Never married 11% 4%

Divorced, separated, or widowed 51% 45%

Figure 2. Several risk factors compared. Source: U.S. Census 2000.

While it is difficult to locate socially isolated seniors, the map on page 10 pinpoints four areas that have some of the City’s highest percentages of seniors living alone plus a high level of need among their elderly residents.23 This hazardous combination indicates those communities with the highest risk for senior isolation.24 These areas include upper Manhattan, the South Bronx, central Brooklyn, and portions of lower Manhattan.

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Figure 3. Community Districts in New York City that are likely the most at risk for senior isolation based on the amount of seniors living alone and the level of need among the elderly residents. Sources: U.S. Census 2000; NYC Department of City Planning; NYC Department of Health and Mental Hygiene.

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Below is a chart outlining the twelve community districts identified as being most at risk (out of the 59 community districts that comprise New York City). Of course, senior isolation is a problem that can occur anywhere and should be addressed everywhere.

Overall Rank

(at risk for senior

isolation)

Community District Communities

Seniors Living Alone

(citywide avg.=32%)

Elderly Pop. in Need Score

(lower score= greater need)

Rank for Elderly Pop. in Need

(out of 59) 1 Manhattan CD 10 Central Harlem 49.7% 71 2

2 Manhattan CD 11 East Harlem 39.2% 57 1

3 (tie) Manhattan CD 5 Midtown, Times Square, Herald Square, Midtown

South 54.9% 140 19

3 (tie) Manhattan CD 9

West Harlem, Morningside Heights,

Manhattanville, Hamilton Heights,

37.2% 79 4

3 (tie) Bronx CD 1 Mott Haven, Melrose, Port Morris 39.7% 112 11

3 (tie) Bronx CD 6 East Tremont, Bathgate, Belmont, West Farms 41.4% 102 10

7 Brooklyn CD 16 Ocean Hill, Brownsville 39.1% 97 9

8 (tie) Bronx CD 4 Highbridge, Concourse 35.9% 81 5

8 (tie) Brooklyn CD 8 Crown Heights,

Prospect Heights, Weeksville

36.3% 95 7

10 (tie) Bronx CD 3 Melrose, Morrisania, Claremont, Crotona

Park East 38.8% 117 14

10 (tie) Brooklyn CD 3 Bedford Stuyvesant,

Tompkins Park North, Stuyvesant Heights

33.4% 75 3

12 Manhattan CD 3 Lower East Side, Chinatown, Little Italy 36.5% 117 14

Figure 4. Twelve NYC Community Districts most at risk for senior isolation.

2.) MANY OF THESE SENIORS ARE NOT GETTING THE HELP THEY NEED. A recent needs assessment of seniors living on Manhattan’s Upper West Side found that 49 percent of people age 65 and older who need assistance in basic daily living activities (such as help bathing or getting dressed) have one or more unmet need.25 Among the elderly population, social isolation and unmet needs are often interrelated.26 Having unmet needs likely increases an individual’s chances of being prematurely institutionalized or hospitalized, and reduces an individual’s participation in society. Many seniors in need are not taking advantage of the social services available to them, either because they are unaware of these programs or they choose to not participate. For instance, the Senior Citizen Rent Increase Exemption program (SCRIE), which provides rental assistance to

12

New York City must act now to ensure that its elderly population does not fall through the cracks.

seniors on fixed incomes, is still greatly underutilized; recent findings show that only 40% of all eligible households appear to be benefiting from it.27 Some of this unmet need stems from attitudes held by seniors themselves: many want to remain self-reliant at all costs, which is consistent with American society’s emphasis on individual self-sufficiency. Over the last 30 years, analysts have witnessed a steady climb in the “rugged individualism” found within our society. Many argue that this widespread civic disengagement will increase in the coming decades, causing Americans to become even more independent. This stance can inhibit seniors from obtaining the help they need while also hindering neighbors and friends from intervening when they perceive a senior is in need of help. In addition, while New York City’s crime rate has declined, there is still a strong perception that crime is prevalent. In 2002, for example, residents age 65 and older became, for the first time, the most likely of all Americans to own a gun.28 This fear can reinforce their distrust of others and increase the likelihood that they will become more reclusive and less likely to request assistance if and when the need arises. Even when seniors do manage to seek out help, they are not always getting their needs met adequately. Recently, Mount Sinai Visiting Doctors brought problems within the City’s Adult Protective Services (APS) unit to light, stating “APS is failing to deliver care to the City’s most vulnerable residents...Unless this agency is completely overhauled the City will continue to neglect to provide basic care to those in need.”29

3.) THE AGING BABY BOOM GENERATION IS AT UNPRECEDENTED RISK. While seniors in the City are already at significant risk for senior isolation, the trend is expected to worsen as the Baby Boomer generation begins to retire. Between 2000 and 2015, the number of older adults in New York State is

expected to increase by 19%.30 As a group, Baby Boomers harbor more risk factors for social isolation than their parents’ generation: they are more likely to be self-reliant. In fact, seven in ten Baby Boomers don’t want to depend on their children during retirement.31 They are also expected to have lower marriage rates, higher rates of divorce, fewer offspring, higher rates of poverty, and higher incidence of frailty.32

The threat of senior isolation among the City’s current generation of elders is alarming enough. In light of the imminent increase in the older population—a group that will be at unprecedented risk for senior isolation—New York City must act now to ensure that its elderly population does not fall through the cracks.

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Settlement houses, community centers, and other locally-based service organizations are ideally suited to identify and then help isolated seniors.

IV. Program Models Working to Combat Senior Isolation

Settlement houses, community centers, and other locally-based service organizations are ideally suited to identify and then help isolated seniors. Their intimate knowledge of their communities, their participation in local networks and associations, and their web of contacts throughout their neighborhoods make them the optimal places to receive and act on information about seniors in distress. In addition, because these organizations offer a range of services in an integrated setting, they are able to address a multitude of causes of senior isolation. This section outlines some of the many program models currently in place to alleviate senior isolation in New York City, though their scope is often limited by a lack of funding. Specific examples of these program models can be found in the appendix to this report.

1.) CREATING AN “ELDER-FRIENDLY” COMMUNITY Integrated program settings, such as those found in most settlement houses and community centers, look at a neighborhood and community as the unit of attention for enhancing quality of life for isolated seniors. While senior centers and individual programs can serve some of the individual needs of seniors, settlement houses and community centers attempt to address the total experience of seniors in need, including social and environmental factors. With a focus on building an elder-friendly community composed of welcoming community-based services, creating safe neighborhoods and strong social networks, and promoting access to medical care, settlement houses and community centers are working to improve the landscape of New York City’s neighborhoods while simultaneously addressing the needs of individuals.

a. Assessing Community Needs While social service programs can greatly help seniors, many issues fall

outside their purview: deteriorating sidewalks, for example, can keep frail seniors at home. To create an overview that takes all factors affecting seniors into account, a number of organizations have come together to undertake community needs assessment surveys. Although these are not focused specifically on social isolation among seniors, a needs assessment provides a powerful tool to determine the needs of isolated seniors within their neighborhoods, which can form the basis of a planning process to create a more elder-friendly community.

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Seniors, like all people,do best when they havemeaningful roles and feel a sense of purposein their lives.

b. Community Organizing Recognizing that seniors’ skills and experiences are often underutilized,

community organizing is a strategy that seeks to maximize the potential of community members. The goals of organizing can include both bringing people together to create community as well as working to address problems in the community through social or legislative change.

Community organizing does more than help to improve communities in the

macro sense; it also works to reduce social isolation by bringing people together and by increasing individuals’ sense of personal value to that community. This model is particularly helpful among LGBT seniors, among whom social isolation is often quite severe. In fact, it is often difficult for them to find community without making a concerted and organized effort.

2.) USING SENIORS AS RESOURCES Seniors, like all people, do best when they have meaningful roles and feel a sense of purpose in their lives. Retirement can threaten this feeling. As such, some programs provide a meaningful role for seniors while also garnering their

contributions to help others. Volunteer work allows able-bodied seniors to use their talents and skills in service to individuals and organizations that rely on unpaid workers. In fact, the 26.4 million seniors who regularly volunteer give approximately 5.6 billion hours of their time each year—a value of $77.2 billion to nonprofit organizations and other causes in this country.33 Such work can also be a tremendous source of joy, fulfillment, social stimulation, and satisfaction for the seniors themselves.

a. Intergenerational Programs

Intergenerational programs promote and encourage connections and interactions between the old and the young, with rich rewards for both. Seniors can teach children math or reading, or work with them doing activities like cooking, music, or art. For seniors, this regular interaction with younger individuals has the potential to help lessen depression, relieve boredom, and improve health. The excitement of seeing the world through younger eyes can be a potent medicine.

b. Friendly Visiting

Friendly Visiting is a program that allows senior volunteers to provide homebound older persons with regular socialization. The purpose of this program is to reduce loneliness and isolation, and to monitor the health and safety of homebound elderly persons. However, the senior volunteers gain something too. The one-on-one socialization provides both seniors with an outlet to relieve loneliness by reminiscing with them, reading, playing cards or games, going for a walk, shopping, or just having a conversation.

15

The fact that the overwhelming majority of senior center participants are frequent attendees testifies to the centrality of these centers in many seniors’ lives.

3.) BRINGING SENIORS TOGETHER For seniors able to travel, those programs and services that bring people together to socialize, support one another, and gain access to vital services are invaluable antidotes to social isolation. These include:

a. Traditional Senior Centers For seniors dealing with loneliness, a senior center is a

place to connect with others while engaging in meaningful activities. Senior centers host a variety of social programs such as congregate lunches, exercise classes, intergenerational programs, cultural programs, discussion groups, senior advisory councils and advocacy groups, and special holiday events. On the most basic level, these centers help seniors remain active, independent, healthy, and engaged with others—all of which help ensure seniors’ social integration. In addition, senior center staff members are often trained to link seniors to other social services that they may benefit from.

The City’s Department for the Aging (DFTA) provides funding for over 325

senior centers in the City. According to a 2001 report by DFTA on senior center utilization, over 51% of participants attend their center everyday while another 29% attend three to four times a week.34 The fact that the overwhelming majority of senior center participants are frequent attendees testifies to the centrality of these centers in many seniors’ lives.

While many participants rely on nutrition services provided at senior centers,

the opportunity to socialize with peers motivates them to engage in educational and recreational programs. As one senior at Sunnyside Senior Center in Queens said of the congregate lunch program, “The lunch isn’t the food, it’s the people you meet.”

b. Alternative Senior Center Models Some seniors avoid traditional centers because of disinterest in the daily

meal program. Their reasons vary but often involve self-image. Some are too proud to accept a “handout;” for others, accepting a meal implies relinquishing their middle-class status. Though they may need other services, they tend to stay away from centers, thus losing out on a vital conduit to social interaction or the help they need. Alternative centers have found ways to overcome these concerns by reaching out to the marginalized in unconventional ways. One such example is the senior center that does not serve meals at all and instead creates specialized programming for LGBT seniors.

The success of both types of senior centers depends on the availability of

transportation. As discussed earlier, one of the greatest indicators of isolation among seniors is limited mobility, which can result from health

16

A number of programs have come up with creative ways to make a difference in the livesof homebound seniors who might otherwise be completely isolated.

problems, frailty, or a lack of available transportation. These seniors need a variety of transportation options—shuttle buses or vans, escorts for walking or driving, reimbursement for taxis or car services—so they can tend to their daily needs, such as keeping doctor’s appointments, doing their grocery shopping, and attending senior centers.

4.) MEETING SENIORS WHERE THEY ARE A number of programs have come up with creative ways to make a difference in the lives of homebound seniors who might otherwise be completely isolated.35 Because these seniors cannot regularly participate in the activities at their local senior center, these programs come to them.

a. Supportive Service Programs (SSPs) in Naturally Occurring Retirement Communities (NORCs)

A partnership between several social service agencies, NORC-SSPs provide comprehensive services to the active and homebound senior population of a

particular housing development, with the goal of helping seniors age in place and avoid institutionalization. NORC-SSPs are unique because participants are able to obtain services very close to their homes; sometimes seniors need venture no further than their lobbies. By providing services to members of a specific housing development, NORC-SSPs not only meet the basic needs of their clients—many of whom may be frail and unable to access off-site services—but also combat isolation by building community among neighbors. Another benefit of the NORC-SSP model is that the inter-agency collaboration

promulgates change on a neighborhood level and creates a more elder-friendly community.

According to the United Hospital Fund, 28 government-funded NORC-SSPs

serve communities and housing developments in New York City as of June 2000; more than 46,000 seniors live in these communities.36 Currently, there are eight NORC-SSPs run by UNH member organizations (seven of which receive government funding).

b. Meals on Wheels One of the most well-known, vital services for the homebound is the

Meals on Wheels program that delivers a daily meal to homebound seniors unable to cook for themselves. The program has more than nutritional value; it also provides a regular check-in by food deliverers for those who are not likely to have many other visitors. On countless occasions, food deliverers have become literal lifesavers, arriving just in time to address a medical emergency. Currently, most senior programs that deliver meals in the City do so five days a week while a few also provide hot or frozen weekend meals.

17

Connecting seniors with the Internet, and helping them to maintain those connections, will become more important as the Baby Boomers begin to retire.

In October 2004, New York City implemented a pilot program in the Bronx that delivers frozen meals in bulk once or twice each week to eligible seniors. Ongoing monitoring will be necessary to ensure that the components of this program that can help prevent social isolation (i.e., the contact between food deliverers and the homebound seniors) are maintained and/or provided through other methods.

c. Friendly Visiting Most friendly visiting programs are staffed by volunteers who are trained and

supervised by a paid staff member, resulting in a low-cost program that not only benefits the homebound seniors but the volunteers as well. Many volunteers are retired seniors looking for a meaningful way to use their time and energy, while others are young people eager to find a mentor and develop intergenerational relationships.

Homebound seniors appreciate the connection to the outside world, and are thankful that their health and safety is of concern. The challenges to this program include finding volunteers and making an appropriate match. In addition, some seniors resist allowing a stranger into their homes, a feeling which is particularly strong among those seniors who are reclusive and socially isolated.

5.) KEEPING SENIORS CONNECTED VIA TECHNOLOGY Technology has vastly expanded in recent years. Many programs and services have found ways to harness this power to help isolated seniors remain socially connected.

a. Computer Labs with Internet Access Many organizations offer seniors access to the World Wide

Web. Using the Internet, seniors can stay in touch with friends and relatives and they can also research and study any topic they choose to learn about. Recently, a national survey of older Americans found that less than a third of seniors age sixty-five and older have gone online, compared to more than two-thirds of those between the ages of fifty and sixty-four.37 Connecting seniors with the Internet, and helping them to maintain those connections, will become more important as the Baby Boomers begin to retire.

b. Conference Calls and Telephone Reassurance Telephone reassurance programs, which can often be found at senior

centers, provide homebound seniors with daily, weekly, or occasional phone calls from staff or volunteers. While a phone call cannot replace face-to-face contact, it has many advantages: volunteers can virtually “visit” a dozen homebound seniors in one sitting, it does not invade the privacy of the person being called, and it only requires a telephone and a handful of volunteers.

18

“I want to thank all you people for keeping me alive. If you people didn’t call me I would not know that I have a telephone. At least someone knows I’m alive.”

For some seniors, these phone calls are the only daily contact they have with the outside world. As one senior who receives the calls expressed, “I want

to thank all you people for keeping me alive. If you people didn’t call me I would not know that I have a telephone. At least someone knows I’m alive.” In this way, the daily phone call provides a safety net for participating seniors. If a call goes unanswered, the protocol calls for the volunteer to contact family, neighbors, or a landlord to ascertain the senior’s well-being. Similarly, conference calls provide a rare opportunity for many homebound seniors to engage in a social group setting while remaining comfortably in their own homes. The program also benefits those devoted volunteers placing

the calls by affording them an opportunity to remain useful, make a difference in the lives of fellow seniors, and socialize with the other volunteers.

c. Automatic Well-Checks Using technology, some programs have implemented automatic check-ins or

emergency alert systems to help seniors age in place while making sure they receive assistance in the event of an emergency. One such example in Nassau County uses computers to automatically call participants at a preset time each day; if no one answers, the system calls back 15 minutes later. If there is still no response, the pre-designated contact person is phoned; if that person is unavailable, a police officer will be dispatched to the elderly person’s home and enter if necessary.38 Participants even receive a special call on their birthdays. While a computerized phone call cannot replace a personal one, this program has the potential to protect thousands of seniors.

6.) SERVING COMPLEX NEEDS Some seniors suffering from isolation require more intensive interventions than those offered by socialization and nutrition programs. This population—the most difficult to care for—are most likely to be prematurely institutionalized or hospitalized because of their high level of need. Understandably, many of these seniors’ caregivers frequently report high levels of stress, which if persistent and unrelieved, may lead them to abuse their charges, or to institutionalize them inappropriately. Social services that address these complex needs are highlighted below:

a. Case Management Case management programs assess the individual needs of a client, address

them through direct services or outside referrals, and then link seniors to appropriate services, such as counseling, other social work services (i.e. entitlement and benefits assistance, etc.), home care, shopping, Meals on Wheels, home visits, telephone reassurance, referrals, or financial management assistance.

19

Though they may live with caregivers and/or appear to have strong social networks, seniors who are victims of elder abuse suffer from an invisible, but no less dangerous, form of social isolation.

b. Geriatric Mental Health Services Seniors with untreated mental health problems often experience a unique

form of isolation from loved ones and neighbors as their disorder may serve as a barrier to socializing and accessing services successfully. To compound this, many seniors with mental health disorders, especially older seniors, are reluctant to seek help because of the stigma attached to mental health services. There are several program models—some of which are described in the appendix—that can help seniors overcome these obstacles.

c. Elder Abuse Prevention and Support Though they may live with caregivers and/or appear to

have strong social networks, seniors who are victims of elder abuse suffer from an invisible, but no less dangerous, form of social isolation. Elder abuse can take many forms, including emotional, physical and/or financial abuse. Often, it remains invisible to the outside world. Programs addressing this issue need to take into account the fact that often a victim’s abuser is also that person’s primary caregiver.

d. Social Adult Day Care and Respite Care Programs such as social adult day care (daily group

care out of the home) and respite care help frail seniors age in place and remain more socially connected while supporting their family caregivers. These programs are extremely important, as they are often able to serve seniors who might otherwise face institutionalization.

e. Caregiver Supports Strengthening the bond between seniors and their family caregivers is often

the first line of defense in deterring social isolation. Because caregivers are often under a great deal of stress, they need support to maintain their well-being so that they can continue to care for their loved ones. Caregiver support helps prevent cases of elder abuse and neglect by providing caregivers with a needed reprieve, outlets for their stress, as well as tools and training.

20

While there is widespread agreement that senior isolation is a major problem, we simply do not know enough about the magnitude and unique characteristics of senior isolation in New York City.

V. Recommendations for Change While much effective work is being done to confront senior isolation in New York City, barriers remain. This section outlines these major obstacles and presents several policy recommendations to help address them. Many of these recommendations speak directly to the role of local government which, in conjunction with community partners, is often best positioned to understand, serve, and protect the most vulnerable individuals. 1.) NOT ENOUGH IS KNOWN ABOUT SENIORS AT RISK FOR SOCIAL ISOLATION. While there is widespread agreement that senior isolation is a major problem, we

simply do not know enough about the magnitude and unique characteristics of senior isolation in New York City. The U.S. Census tracks how many of City seniors reside alone and other basic demographic information; the City’s Department for the Aging (DFTA) reports how many seniors participate in various programs and services. However, very little else is known or tracked, which limits our ability to locate and help seniors in need. As Eric Klinenberg writes, “In surveys and censuses isolates and recluses are among the social types most likely to be uncounted or undercounted because those with permanent housing often refuse to open their doors to strangers and are unlikely to participate in city or community programs in which they can be tracked.”39

RECOMMENDATIONS:

a. The City should expand its data collection efforts in order to gauge the severity of senior isolation.

Currently, the City’s Department of Health and Mental Hygiene (DOHMH)

collects and publicly releases comprehensive data on the City’s overall health and well-being. These “Vital Statistics” report on trends that offer insights into senior isolation, such as the leading causes of death by sex, age, and ethnic group; as well as the number of deaths in various locations (i.e., home, hospital, nursing home, etc.) The ailments from which seniors are dying, where they are dying, their level of independence, and the degree of neglect or caregiver support can then be inferred from these statistics.

However, the City could collect statistics that would provide an even better

view of the magnitude of senior isolation. Examples include statistics on the death rates of seniors whose bodies go unclaimed by family or friends (and must ultimately be buried by the City) and of those seniors who die alone in their apartments only to be discovered later on (even if their bodies are eventually claimed). This information could effectively be tracked using the City’s new electronic death registration system.

21

If the goal is to create communities where seniors can grow old with dignity in their own homes, then we must fully understand what is necessary to sustain “elder-friendly communities” and also see where we are presently falling short.

Collecting this kind of data would allow DOHMH to describe and track patterns of social isolation among seniors in New York City. It would also provide information to other City agencies, elected officials, hospitals, and community-based organizations to help them better understand and address senior isolation.40

b. A citywide needs assessment of all seniors should be conducted. If the goal is to create communities where seniors can grow old with dignity

in their own homes, then we must fully understand what is necessary to sustain “elder-friendly communities” and also see where we are presently falling short. Of course, factors that hinder a community from being “elder-friendly” highly correlate with those factors that perpetuate social isolation.

This citywide needs assessment should evaluate

each community’s ability to address seniors’ basic needs, optimize their physical and mental health and well-being, promote their social and civic engagement, and maximize independence among the frail and disabled. Having a clear sense of the common obstacles facing communities throughout the City would be invaluable to informing policy decisions.

c. The City should keep a voluntary “check-in registry” to track the

well-being of seniors. After the September 11th World Trade Center disaster, a recommendation

was made to develop City maps that highlight neighborhoods with high concentrations of older people, and to create a comprehensive database of frail older people in these neighborhoods who would be at special risk during an emergency.41 One such database was created for the frail elderly on Manhattan’s Upper East Side. Several service providers for the elderly, including two UNH member agencies, partnered to create the East Side Community Emergency Preparedness Project, which compiled a master list of their frail clients and rated their level of risk in the event of an emergency. Because confidentiality is an important element of such a system, this list was voluntary: seniors who signed up were guaranteed that their privacy would be maintained.

During New York City’s blackout in August 2003, this list proved invaluable

insofar as it allowed providers to easily contact their clients and then quickly send workers out to help those in need. A voluntary database like this is beneficial for more than just emergency preparedness; it can be used to alleviate the “everyday emergency” of social isolation.

The City should also develop and implement a voluntary “check-in registry” that is tailored to the unique needs of New York City seniors. Some

22

“We all aspire to live to be old, and consequently we all must work to create a society where old age is respected, if not honored, and where persons who have reached old age are not marginalized.”

communities outside the metropolitan area instituted voluntary automatic well-check phone calls for homebound seniors. One such example, which is discussed in this report’s appendix, is Nassau County’s RUOK (Are You OK?) program which, though currently underutilized, could be adapted for New York City so that seniors are not required to be home everyday. For example, many senior centers offer a special service for their “disassociated seniors” (those seniors who have not come in for services in some time) so that if they stop showing up, someone from the center checks in on them.

2.) COMMUNITY ASSETS AND SOCIAL CAPITAL ARE NOT BEING MAXIMIZED. In recent years, academics have argued that American society is undergoing a process of civic disengagement that is eroding our communal structures (i.e., volunteerism and civic associations). Social capital, such as neighborliness and harboring a “sense of community,” are reportedly declining as a result. Americans are thought to be growing more and more individualistic at the expense of “the glue

that holds us together.” The negative implications are clear: people in need are less willing to reach out for help, and those who do are less likely to find the community support they need. This loss of “generalized reciprocity” often stems from privacy concerns, fear of others, time constraints, declining health, and a lack of community facilities that promote social interaction.42 In this context, social isolation is an extension of changes occurring throughout our society.

Opportunities for social integration among older adults are further eroded by ageism, defined as "any attitude, action, or institutional structure which subordinates a person or group because of age or any assignment of roles in society purely on the basis of age."43 The elderly are frequently stereotyped and viewed—not as human beings—but as objects so that their rights and opportunities can be more easily denied. It is no wonder some seniors choose self-imposed isolation to avoid these ageist attitudes.44

RECOMMENDATIONS:

a. The City should take the lead in refusing to tolerate ageism.

While several trends indicate that ageism is slowly declining, the City should take the lead in hastening its demise.45 As Dr. Robert Butler, who first coined the term “ageism” explains, “We all aspire to live to be old, and consequently we all must work to create a society where old age is respected, if not honored, and where persons who have reached old age are not marginalized.”46

23

Without a protocol inhand, many neighborsshy away from helpingisolated seniors in thefirst place; even whenpeople do act, it canresult in squanderedopportunities becauseemergency respondersmay miss warningsigns of an “emergencyin slow motion.”

The City should organize an effective and ongoing campaign against ageism in collaboration with various partners. A recent report issued by the International Longevity Center-USA offered several possible examples, such as holding public meetings to inform and persuade people to oppose ageism, disseminating information about the true aging process, publishing advertisements and running commercials opposing ageism, lobbying for legislation to oppose ageism, organizing watchdog activities to ensure that businesses and the media do not discriminate against older people, and enlisting the cooperation of other organizations (i.e., churches and unions) to support campaigns against ageism.47

While the City’s Department for the Aging (DFTA) is

to be applauded for including the need to “confront ageism” as one of the strategic goals in their 2005-2006 Annual Plan, much more work needs to be done to formulate and enact a plan of action. A citywide public education and anti-discrimination campaign might be one way to initiate this effort.

b. The City should establish a clear and widely-publicized protocol for

those citizens who become concerned about the welfare of a senior.

Presently no standard citywide protocol exists for concerned neighbors who notice a senior’s mail has gone uncollected or a senior has not left his or her home in several days. The Adult Protective Services (APS) unit within the City’s Human Resources Administration has an intake referral hotline to accept and act on reports of seniors in need, but the unit is often understaffed and inadequately supported. In addition, this unit is usually more reactive than proactive, becoming involved only after a crisis erupts.

Although mail carriers, utility workers, and others who regularly come in

contact with the elderly have often been told to look out for signs of distress, neighbors remain an elderly person’s most important eyes and ears. Yet without a protocol in hand, many neighbors shy away from helping isolated seniors in the first place; even when people do act, it can result in squandered opportunities because emergency responders may miss warning signs of an “emergency in slow motion.”

Nassau County police officers conduct formal “well-checks” on seniors if a

neighbor calls to voice concern, making home visits, and referring those who could benefit from non-emergency assistance to their Department of Senior Citizens Affairs. In 2003, Nassau County police received 1,783 requests for “well checks.”

New York City should establish such a protocol, either through the 9-1-1

emergency number, the 3-1-1 informational number, or another mechanism to be determined. Once in place, the public needs to be educated about its existence and how to use it. This will help encourage New Yorkers to feel a

24

Funding for most programs under the City’s Department for the Aging (DFTA) has remained relatively flat for several years. New money to cover increasing costs, such as salaries, rents, and insurance premiums, has not been made available since 1999.

sense of responsibility for their elderly neighbors. In addition, substantial training will need to occur to ensure that first responders know how to interpret warning signs and refer seniors in various stages of distress to the proper services.

c. A citywide alliance should be assembled to promote and support

the development of “elder-friendly” communities.

Creating communities where seniors can age in place takes both planning and commitment. Government cannot be expected to accomplish this alone.

A citywide alliance should be assembled to conduct a needs assessment (as previously recommended) to tackle problems head-on, raise visibility about the need for “elder-friendly” communities, highlight current obstacles, create and fund new program models, and implement solutions to emerging problems. Recently, Dennis Kodner, Executive Director of The Brookdale Center on Aging, proposed developing such an alliance (“AgeWell New York”)— composed of research centers, City agencies (i.e., the Department for the Aging and the Department of Health and Mental Hygiene), health and social service providers, neighborhood and block associations, and foundations—to give all of the ‘major players,’ each with different expertise and resources, a seat at the

table.48 The group’s collective goal would be to analyze the problem of senior isolation and the obstacles to the formation of elder-friendly communities throughout the City, identify and/or create program models and other remedies to combat these problems, and work together to fund and replicate these effective strategies.

3.) SERVICE GAPS STILL EXIST. Despite the many exemplary service models currently in place, the City is ill-prepared for the coming surge in the elderly population. Although Governor George Pataki commissioned the “2015 report,” which studied the shifting elderly demographic in the state and instructed all State agencies to plan for the coming influx, current funding for senior services remained vulnerable to cuts in recent State budgets. To date, the City has done little to study or plan for the coming increase in its senior population and their changing needs. Funding for most programs under the City’s Department for the Aging (DFTA) has remained relatively flat for several years. New money to cover increasing costs, such as salaries, rents, and insurance premiums, has not been made available since 1999. Several programs and services have even been threatened for funding cuts since then. In a recent survey of many DFTA-funded service providers, over half stated that they have met these increasing costs by cutting funds from another part of their budget, such as staff and programs.49 Other programs have reached, or exceeded,

25

If every senior over the age of 60 used a local senior center, only six meals per person would be available each year. If all individuals over 65 years old living below the poverty level used senior centers, 46 meals per person would be available each year.

their allocated funding to serve clients and have stopped doing outreach to locate seniors in need. A recent report by City Public Advocate Betsy Gotbaum highlighted this issue of capacity limitations. The report found that New York City has just one senior center for every 3,638 seniors; and only one senior center for every 465 seniors over the age of 65 living in poverty. But if every senior over the age of 60 used a local senior center, only six meals per person would be available each year. If all individuals over 65 years old living below the poverty level used senior centers, 46 meals per person would be available each year. In addition, it is estimated that there are 93,687 seniors in high need of home-delivered meals, but the program can only serve 18% (17,164) of them.50 But even these statistics do not tell the whole story. Because some providers stop outreach efforts for programs already filled to capacity (usually because of funding constraints), it is hard to know how many seniors are actually in need. This can become a vicious cycle where programs are going underutilized even though there is actually a great need for them. Seniors need to be made aware of the services available to them. DFTA has made great strides in the past few years to improve outreach to seniors. The advent of 3-1-1 and effective usage of their website has been a major boon to the agency’s effectiveness. Their UNI-Form benefit assessment system also helps to screen seniors for various government benefits. In addition, DFTA has worked with UNH and the Council of Senior Centers and Services (CSCS) to increase awareness of the Senior Citizen Rent Increase Exemption (SCRIE). Yet there are still many seniors, perhaps those who most need them, who simply are not aware of programs and services that they could be benefiting from right now. To meet existing and future needs, the City must expand current programs, develop new service models, and then also ensure that seniors are adequately aware of the services available to them.

RECOMMENDATIONS:

a. The City should adequately fund and expand effective service models wherever possible.

Effective programs, some of which have been outlined as part of this report,

should be adequately funded. The City should work with its community partners to determine which models are worthwhile and where expansion is necessary. A senior center’s effectiveness should be measured by its overall impact and level of participation for all of its components, not simply by the number of meals that it serves to seniors. Programs that reach capacity should maintain wait lists to measure actual need. In addition, funding must

26

The next wave of seniors is expected tobe even more socially isolated than the current generation. This requires not merely an expansion of services but a new, more inclusive approach, tailored to the unique characteristics of the Baby Boomers.

be available to cover operating expenses that naturally increase over time such as salaries, rents, food costs, and insurance premiums.

b. The City should develop new service models to address emerging

needs, specifically in the areas of geriatric mental health and caregiver support, which are especially important to the Baby Boomer generation.

According to the newly-established Geriatric Mental Health Alliance, “the failure to address mental health problems adequately now, and the failure to plan for the elder boom, reflect dreadful policy failures and that the time to address them is now.” In addition, the alliance stressed the need to support family caregivers by providing help during crises and financial assistance.51

c. The City should do more and better outreach for its senior supports

and services.

There are a variety of reasons why seniors do not utilize programs and services from which they could greatly benefit. There are some seniors who

are aware of these programs, but choose not to participate; others simply do not know that help is available. The City must work with providers to continue outreach efforts about available senior services. Informational campaigns, conducted by the City and community groups, about specific benefits—such as SCRIE, blood pressure screening, tax assistance, and flu vaccines—can help seniors find the services they need. The City knows how to construct effective public awareness campaigns, which often include advertising on City buses and subways. Recent examples include the Department of Consumer Affairs’ campaign to increase the number of eligible New Yorkers claiming the Earned Income Tax Credit (EITC) on their tax returns; and the Department of Health and Mental Hygiene’s “Take Care New York” campaign, which offers tips for maintaining good health.

4.) NOT ENOUGH HAS BEEN DONE TO TAILOR SERVICE APPROACHES TO THE

CHANGING ELDERLY DEMOGRAPHIC. As we have seen, the next wave of seniors is expected to be even more socially isolated than the current generation. This requires not merely an expansion of services but a new, more inclusive approach, tailored to the unique characteristics of the Baby Boomers. Some of the current approaches to service delivery can be alienating for seniors who are made to feel like outsiders or “needy clients” when partaking in programs. Programs must meet the needs of a racially and ethnically diverse senior population. LGBT seniors who do not feel welcome at a program, for example, are less likely to seek out and/or continue benefiting from services.

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Nearly two-thirds of recently-interviewed senior center participants in New York City indicated that they used education and recreation services most often; only 12 percent said “socialization.”

In addition, many seniors do not feel as though they should seek services in the first place because they do not see themselves as “seniors,” or at least the type of people they believe would use “senior services.” This phenomenon is expected to worsen as Baby Boomers age. According to Dr. Roy Aday, director of Aging Studies at Middle Tennessee State University in Murfreesboro, “Baby Boomers equate senior centers with nursing homes and see them as a place for low-cost meals in an institutional setting. No question, we’ve got some misperceptions and stereotypes to overcome.”52 Much of the current programming and marketing of senior services was not designed to reach the next wave of individuals approaching retirement age. Currently, the City’s average age of senior center participants is 77. Many traditional centers may have trouble attracting Baby Boomers who will begin retiring in the next few years.53

RECOMMENDATIONS:

a. Providers should constantly evaluate their approach and be open to trying new and more inclusive methods of service.

The best program models prevent their clients from feeling marginalized, excluded, or alienated. For seniors to truly benefit from a service, they must feel welcomed, accepted, and included. Not only should staff be trained to accommodate and integrate various groups of people in the same setting, they should also embrace new methods of service delivery that best accomplish this goal. In short, providers and their funders must be open to change as the world around them changes.

b. Providers should make a concerted effort to engage seniors early.

For obvious reasons, it is best to have contact with and offer support to seniors well before any crisis develops. Engaging seniors around the time they retire is optimal. Retirement is a stressful time for many seniors: they worry about their finances, their social lives, and self-esteem. To appeal to these “younger seniors,” many senior centers and services will have to reinvent themselves. For starters, they may consider taking the word “senior” out of their names insofar as it can have a negative connotation. Some senior center planners think names like “Center for Healthy Aging” or “The Wisdom Center” might have more appeal.54 Updating programming and facilities can also help attract new seniors. Nearly two-thirds of recently-interviewed senior center participants in New York City indicated that they used education and recreation services most often; only 12 percent said “socialization.” Examples of services or programs that might appeal to “younger seniors” include fitness classes, wellness workshops, seminars on financial management, book clubs, and cultural activities.

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“The social distance between city administrators and the disadvantaged people they serve is increasing. As governments operate more like professional firms, commissioners become CEOs, agencies subcontract more services out to private companies…”

As they retire, younger seniors can also benefit vastly from serving as volunteers for various senior services. A recent survey found that about 20% of retirees describe themselves as bored, and about 25% see themselves as unproductive, both of which can lead to depression, social withdrawal, and isolation. Yet those seniors who are volunteering report higher self-esteem,

greater life satisfaction, and more energy.55 In addition, those young seniors who volunteer will find their own transition to ‘older’ senior that much easier. Volunteering is an especially useful way to engage seniors who are economically secure and may not see themselves as the “type” of senior in need of such services. As several researchers explain, “Our society typically prepares individuals for moving into new roles, whether it is kindergarten or employment, but we do not prepare individuals for role disengagement, such as leaving the world of work.”56 Providers seeking out ways to create volunteer opportunities for younger seniors will themselves benefit from the unique contributions of these individuals.

5.) THE CITY IS MOVING TOWARD A BUSINESS MODEL OF PROVIDING PROGRAMS AND SERVICES FOR THE ELDERLY.

Generally speaking, government is increasingly moving toward a market-based model of service delivery. As Eric Klinenberg writes:

The social distance between city administrators and the disadvantaged people they serve is increasing. As governments operate more like professional firms, commissioners become CEOs, agencies subcontract more services out to private companies,…political organizations risk losing contact with citizens.57

In New York City, several public agencies have already altered their methods of service delivery in an attempt to achieve cost-savings. Recently, the City sought to “streamline” services for the elderly by moving from a community-based infrastructure to a larger, regional scale of service (only 21 regions citywide for home-delivered meals); and by moving away from nonprofit contractors toward private, for-profit ones. While these changes might save money in the short-run, they could result in the further isolation of some seniors. Relying on for-profit, private contractors in the human services sector could result in service disruptions if those services are not deemed profitable.58 A second problem, according to Eric Klinenberg,

…is the expectation that city residents, including the elderly and frail, will be active consumers of public

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Nonprofit organizations that offer compassionate services tailored to a specific community are the most appropriate providers for isolated seniors, and the most likely to successfully locate and engage them.

goods, smart shoppers of services made available in the market rather than ‘citizens’ entitled to social protection. This market model of governance creates a systematic mismatch, whereby people with the weakest capabilities and greatest needs are the least likely to get them.59

This phenomenon is troubling because it disregards the needs of isolated seniors and implies that people who need help are either already receiving it or do not want it.

RECOMMENDATION:

a. For the delivery of human services, the City should continue to partner with nonprofit providers at the community level.

While services for the aging, like all government

services, should be efficient and cost-effective, streamlining must not adversely affect the quality of service or alienate program participants. Nonprofit organizations that offer compassionate services tailored to a specific community are the most appropriate providers for isolated seniors, and the most likely to successfully locate and engage them.

As authors David Osbourne and Ted Gaebler explain when comparing the business and nonprofit sectors:

The [nonprofit] sector tends to be best at performing tasks that generate little or no profit, demand compassion and commitment to individuals, require extensive trust on the part of customers or clients, need hands-on, personal attention…, and involve the enforcement of moral codes and individual responsibility for behavior.60

As such, the City should try to maintain and expand its partnerships with these vibrant community-based organizations.

By addressing the serious concerns outlined in this report, we can take a giant step toward improving life for thousands of New York City seniors who otherwise might be lost in the shadows of a large, impersonal, and complicated city.

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Appendix A: Program Model Examples

Assessing Community Needs • The Community Health Organization for the Elderly of East Harlem was created in 1998 as the culmination

of a joint research project undertaken by Union Settlement, Mount Sinai Medical Center, and the Center for Human Environments. Notably, the project considered the effect of social networks on seniors’ health, as “social isolation has clear and demonstrative negative effects on health and quality of life.”61 Researchers felt that it was important to take social networks and social isolation into account when designing services so as to better “integrate formal and informal supports.”62

• As a pilot of the AdvantAge Initiative,63 the Lincoln Square Neighborhood Center’s NORC completed a needs assessment survey of the over 600 adults who are 65 and older and living in their housing development to determine the elder-friendliness of the community-based on 33 indicators in the following four areas: addressing basic needs, promoting social and civic engagement, optimizing physical and metal health and well-being, and maximizing independence for the frail and disabled. After analyzing the survey’s findings, Lincoln Square assembled the NORC Advisory Council, a coalition composed those with a stake in creating a more elder-friendly community: seniors, nonprofits, local businesses, legislators, the police, government agencies, funders, and hospitals. The council is now addressing the three most prominent issues identified in the survey – safety and quality of life, hunger, and health. As a first step, representatives from the police department attend the NORC Advisory Council meetings, provide crime reports, and are available to speak to the seniors directly about their safety concerns. In addition, the West Side Crime Prevention Program assures seniors that they can report crime to the police anonymously. Many seniors did not previously report crime because they feared retribution.

Community Organizing • Goddard Riverside Community Center holds monthly Family Council meetings, primarily attended by

seniors, to educate participants about issues that affect their lives. Participants can then take action by writing letters or making phone calls to elected officials, attending relevant hearings at City Hall, or organizing demonstrations.

• At SAGE (Senior Action in a Gay Environment), a senior initiated a project called SAGE Neighbors on the Upper West Side by bringing seniors together in each others’ living rooms to share their experiences, needs, and hopes for the future. This small gathering soon blossomed into a group of 200-300 LGBT seniors from various neighborhoods who meet together to socialize, visit homebound LGBT seniors, and work on projects such as producing a newsletter and compiling a resource directory for LGBT seniors on the Upper West Side. Thanks to this directory, two LGBT seniors who had been living in the same building for several years met for the first time at a SAGE Neighbors gathering and became important social supports for one other. As society moves beyond traditional family networks, this concept of constructing families out of friends, lovers, and neighbors, which is based on community organization, will become even more important.

Intergenerational Programs • Experience Corps utilizes volunteers, ages 55 and over, to improve the literacy skills of elementary school

students at risk for academic failure. Experience Corps literacy volunteers, working in teams of 10-12 per school, provide one-on-one individualized tutoring to K-5 students who are reading significantly below grade level and are in danger of failing. Each week, volunteers provide one-on-one literacy instruction using the Book Buddies tutorial program. In addition, volunteers provide overall classroom assistance by conducting small reading groups and working with individual children.

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Alternative Senior Centers • Forest Hills Community House in Queens has addressed this issue through a program funded by the Queens

Borough President, which does not provide meals but rather social programming alone. Sporting the non-stigmatizing name, “Kew Gardens Community Center,” it has been highly successful in attracting seniors who feel out of place at traditional seniors centers but are in great need of social contact. Also, these seniors can access social services should the need arise. Forest Hills also has a second offsite program that specifically serves LGBT seniors, who may feel marginalized at traditional senior centers. This unique program provides an opportunity for LGBT seniors to come together in a setting where they feel safe, appreciated, and supported by friends.

Naturally Occurring Retirement Communities (NORC-SSPs) • Founded in 1994, Co-op Village Senior Care (CVSC) serves seniors in a twelve-building development on

the Lower East Side. With The Educational Alliance serving as the lead agency, CVSC is a partnership with Cooperative Village (East River, Hillman), Seward Park, Amalgamated Dwellings, United Jewish Council of the East Side, Beth Israel Medical Center, Visiting Nurse Service of New York, NY Service Program for Older People (SPOP), UJA-Federation of New York, State Office for the Aging (SOFA), and NYC Department for the Aging (DFTA). Like most senior centers, CVSC provides case management; nursing and transportation services; and group social, educational, and health-related activities.

• Baruch Elder Services Team (B.E.S.T.)—a partnership between Grand Street Settlement and Cabrini Medical Center with support from several foundations, New York City Housing Authority, and New York State Department of Health—provides bilingual services similar to those provided by CVSC to the primarily Latino/a elder residents of NYCHA Baruch Houses. Because B.E.S.T. is a relatively new program, its outreach efforts have been very creative: the free blood pressure screenings B.E.S.T. sponsored in the lobby of each building attracted many seniors who were then given information about the organization’s programs and services. It has also relied upon its senior volunteers to do outreach. These efforts range from door-to-door visits to group “visibility walks” during which a large group of volunteers walk through the housing development wearing B.E.S.T. t-shirts and distribute pamphlets. Outreach that relies on personal connections not only helps to build community, but also is more likely to reach seniors who might not otherwise be reached.

Conference Calls and Telephone Reassurance • Stanley Isaacs Neighborhood Center in Manhattan began its now famed conference call program over

fifteen years ago and currently hosts about 3-5 conference calls each weekday. The conference calls bring together homebound seniors, volunteers, and staff for activities that include guided “sittercise” (seated exercise) classes, writers’ workshops, group sing-alongs, book readings, bingo, political and film discussion groups, and support groups.

• At Riverdale Neighborhood House, which has been running a telephone reassurance program for over thirty years, a group of ten senior volunteers makes daily phone calls to approximately 50 homebound seniors.

Automatic Well-Checks • For seniors who do not want a daily call, the Emergency Alarm Response Systems (EARS) program, run by

CVSC, provides frail, elderly clients with a mechanical device that activates an alarm in case of medical or safety emergency. Clients are also provided with ongoing assessments and case management. While the program is not foolproof—seniors don’t always activate the alarm in time—it can prove lifesaving for those seniors who may not have telephones or are unable to dial a phone in an emergency.

Case Management • Mosholu Montefiore Community Center in the Bronx operates an Expanded In-Home Services for the

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Elderly Program64 (EISEP) serving approximately 900 seniors each year (they have a contract to serve 500 at a time). Because of contract requirements with the DFTA, the average caseload per social worker is between 60-70 clients; those seniors in need of more intensive case management must be referred out to other counseling and case management services.

• One of the few places to provide this type of comprehensive case management is Hartley House’s Project HOPE in Manhattan, which serves homebound clients in West Midtown who are often severely isolated, living in poverty, and in dire need of services and social interaction. Currently the staff, which is composed of one full-time social worker, one part-time Spanish-speaking social worker, and one social work intern, has 42 active cases. Since many of their clients are at risk for being referred to protective services, Project HOPE’s goal is to help homebound seniors remain at home by assessing their complex needs and developing appropriate care-plans.

• A different model is Assertive Community Treatment (ACT), which is currently funded by the New York State Office of Mental Health (OMH). Instead of having a case manager coordinate services, an ACT multi-disciplinary team provides comprehensive, flexible and specifically tailored services, including treatment, support, and rehabilitation directly to individuals in their own homes. An ACT team, such as the one run by Goddard Riverside Community Center, typically includes psychiatrists, nurses, psychologists, social workers, and substance abuse and vocational rehabilitation specialists. Team members collaborate to deliver integrated services, monitor progress towards goals, and adjust services over time to meet the recipient’s changing needs. The staff-to-recipient ratio is small (one clinician for every ten recipients as opposed to one clinician for every 30 recipients in traditional case management), and services are provided 24-hours a day, seven days a week, for as long as they are needed. Clients who are homeless or who live in SROs are also served; these interventions are carried out at the locations where problems occur and support is needed rather than in hospitals or clinics. ACT teams share responsibility for the people they serve and use assertive engagement techniques to proactively engage individuals in treatment.65

Geriatric Mental Health Services • Greenwich House’s Senior Citizens Health and Consultation Center in Manhattan aims to address this need

by working to reduce stigma and create a comfortable environment for seniors. With a staff of psychiatrists, internists, MSW and CSW social workers, and home health aides, the Center provides assessment and treatment planning, psychiatric rehabilitative readiness determination and referral, individual and group verbal therapies, medication therapy, medication education, case management, clinical support services, discharge planning, and home health aide services in conjunction with psychotherapy. The staff also visits homebound clients who are unable to make it to the Center. The Center protects the privacy of its clients in several ways. The very name of the program gives no indication that it is a mental health clinic. Also, because the program is housed within a settlement house that also runs a senior center and other services, clients who come in for appointments are not obviously identified as mental health consumers. In addition, the senior center is part of an informal dual referral system: senior center staff sometimes identifies clients in need of mental health services and refers them to the Center downstairs, and clients of the mental health program are often encouraged to visit the senior center upstairs for lunch or to participate in a program before or after their appointments. This informal relationship benefits seniors with mental disorders who might otherwise not seek out services while also providing those already seeking out mental health services with a safe environment in which they can socialize.

Elder Abuse Prevention and Support • Citizens Advice Bureau (CAB) in the Bronx has an Elder Abuse Program that provides support to victims of

elder abuse while helping them obtain orders of protection from their abusers and gain access to necessary medical care and legal services. The program also helps seniors who are being abused by their caregivers to find other means of being cared for and become financially independent. CAB’s Elder Abuse Program has done a significant amount of outreach. This outreach includes to the NYC Housing Authority (NYCHA), the police department, hospitals, landlords, senior centers, and others who touch the lives of isolated seniors.

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Social Adult Day Care • Lenox Hill Neighborhood House runs two social adult day care programs—Health Enhancement Care

(HEP), a five-day-a-week program for physically frail seniors, and the Center for Alzheimer’s care for the Elderly (CARE), a four-day-a-week program for the mentally frail including those with Alzheimer’s. Both programs enhance the lives of frail seniors through a range of group and individual activities shared in a warm environment. The programs also provide respite to caregivers who need to work and lead their own independent lives.

• Other social adult day care programs can be provided at home. The Educational Alliance, for example, runs a program in which a social worker makes home visits to clients and shows caregivers how to engage seniors in constructive activities similar to those held at the center.

Caregiver Support • Lenox Hill’s Project STAR (Support, Training, Advocacy and Respite) provides this type of caregiver

support including individual and group counseling, respite care, training on advocacy and entitlements, special programs, and access to the fitness center. In recognition of the importance of caregiver support, Mayor Bloomberg and the City’s Department for the Aging (DFTA) recently launched a new website for caregivers (www.nyccaregiver.org) which should serve as an excellent resource for caregivers and their families as they seek out programs and services available to them.

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Appendix B: Interviews Michael Gusmano Associate Director of the World Cities Project co-convened with the International Longevity Center; Assistant Professor of Health Policy and Management, Mailman School of Public Health at Columbia University Amber Hollibaugh Former Director of Education, Advocacy and Community Building at Services and Advocacy for GLBT Elders (SAGE) – New York City Mark Lachs Associate Professor of Medicine and Co-Chief of the Division of Geriatrics and Gerontology at Weill Medical College; Director of Cornell's Center for Aging Research and Clinical Care and Director of Geriatrics for the New York-Presbyterian Health System Eric Klinenberg Assistant Professor of Sociology at New York University; Author of Heat Wave: A Social Autopsy of Disaster in Chicago

Dennis Kodner Professor of Urban Public Health at Hunter College; The Rose Dobrof Executive Director, Brookdale Center on Aging of Hunter College

Jack Kupferman Director of Administrative Appeals for the Senior Citizen Rent Increase Exemption Program of the New York City Department for the Aging

Nora O’Brien Former Director of Partnerships and Special Projects, International Longevity Center–USA (during time of interview); Currently the Director of Aging Programs and New Initiatives at the Brookdale Foundation

Karl Pillemer Professor in the Department of Human Development at Cornell University; Co-Director of the Cornell Gerontology Research Institute

Sally Renfrow Deputy Commissioner at the New York City Department for the Aging

Caryn Resnick Deputy Commissioner at the New York City Department for the Aging Sonia Rodriguez Assistant Commissioner at the New York City Department for the Aging Victor Rodwin Professor of Health Policy and Management at New York University; Co-Director of the World Cities Project co-convened with the International Longevity Center

Dr. Martha Sullivan Executive Vice President of the Lower Eastside Service Center; Former Deputy Commissioner at the New York City Department of Health and Mental Hygiene

Linda Whitaker Assistant Commissioner at the New York City Department for the Aging

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Visits with UNH Member Organizations Citizens Advice Bureau Julia Belizare-Spitzer, Elder Abuse Program The Educational Alliance Sheryl Fuller, Director of Older Adult Services Forest Hills Community House Kenneth Lauritzen, Associate Executive Director Goddard Riverside Community Center Erika Teutsch, Director of Older Adult Services Grand Street Settlement Miriam Colon, Baruch Elder Services Team Greenwich House, Inc. Judy Jones, Director of the Senior Health and Consultation Center Hartley House Amanda Leis, Project H.O.P.E. Lenox Hill Neighborhood House Dr. Rebecca Mushkin, Director of Older Adult Services Lincoln Square Neighborhood Center Joanne Ricco, Director of Older Adult Services Moshulu Montefiore Community Center Bob Altman, Associate Director Riverdale Neighborhood House, Inc. Ester L. Bar-Shai, Associate Executive Director Stanley M. Isaacs Neighborhood Center, Inc. Wanda Wooten, Executive Director Sunnyside Community Services Diana Cruz, Senior Center University Settlement Society Robert Tobing, Associate Executive Director

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Appendix C: Endnotes 1 Federal Agency Forum on Aging-Related Statistics. “Older Americans 2004: Key Indicators of Well-Being.” Washington, DC: U.S. Government Printing Office. November 2004. 2 Schwarz, Benjamin, PhD, Editor. “Aging in Place.” Journal of Housing for the Elderly. December 2004. <http://www.seniorresource.com/ageinpl.htm> 3 In July 1999, the Supreme Court issued the Olmstead v. L.C. and E.W. decision, which clearly challenges federal, state, and local governments to develop more opportunities for individuals with disabilities through more accessible systems of cost-effective community-based services. The Olmstead decision interpreted Title II of the Americans with Disabilities Act (ADA) and its implementing regulation, requiring States to administer their services, programs, and activities "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." 4 Public Broadcasting Station (PBS) Online NewsHour. “Health Spotlight: Today’s Nursing Hour.” December 2004. <http://www.pbs.org/newshour/health/nursinghomes/facts.html> 5 NYC Department for the Aging. “Quick Facts.” July 2003. Information is based on Census data about living arrangements of persons 65+, 2000 and 1990. 6 AARP. “These Four Walls…: Americans 45+ Talk About Home and Community.” May 2003. 7 The Center for an Accessible Society. “Supreme Court Upholds ADA ‘Integration Mandate’ in Olmstead decision.” Press release, June 22, 1999. <http://www.accessiblesociety.org/topics/ada/olmsteadoverview.htm> 8 The Gerontological Society of America. “Disability Researchers Identify Barriers to Independent Living.” Press release, March 15, 2004. <http://www.geron.org/press/unmetneed.htm> 9 Klinenberg, Eric. Heat Wave: A Social Autopsy of Disaster in Chicago. The University of Chicago Press: Chicago and London, 2002. 10 The University of Chicago Press. “Dying Alone: An Interview with Eric Klinenberg, author of Heat Wave: A Social Autopsy of Disaster in Chicago.” 2002. <http://www.press.uchicago.edu/Misc/Chicago/443213in.html> In this interview, Klinenberg says, “It is a city of great opulence and of boundless optimism, but—as William Julius Wilson says—Chicago also suffers from an everyday "emergency in slow motion" that its leaders refuse to acknowledge. The heat wave was a particle accelerator for the city: It sped up and made visible the hazardous social conditions that are always present but difficult to perceive.” 11 Klinenberg. Pg. 32. 12 Ibid. Pg. 3-5. 13 Pillemer, Karl et al. (editors). Social Integration in the Second Half of Life. The Johns Hopkins University Press: Baltimore & London, 2000. 14 Klinenberg. Pg. 44-45. 15 Pillemer et al. Pg. 51. The figure: “Theoretical Scheme for Dynamic Relationships among Social Integration, Functional Social Support, and Threats/Disruptions to Social Support.” 16 Klinenberg. Pg. 50. 17 This entire section (on the factors influencing social isolation) relies heavily on the following works:

---Klinenberg. ---Pillemer et al. ---Queensland Government. “Factors influencing social isolation of older people (55 years plus),” Cross

Government Project to Reduce Social Isolation of Older People. January 22, 2004. <http://www.communities.qld.gov.au/seniors/isolation/factors.html>

18 Pillemer et al. Pg. 30. 19 Ibid. Pg. 34. 20 Hollibaugh, Amber. “Aging in the Lesbian, Gay, Bisexual & Transgender Communities.” Presentation on behalf of SAGE, presented to the Administration on Aging at the ASA/NCOA 2003 Conference in Chicago, Illinois, March 15, 2003. 21 Cornell Applied Gerontology Research Institute. “Development of Instruments to Assess Social Integration and Isolation; Elaine Wethington, Principal Investigator.” December 2004. <http://www.blcc.cornell.edu/cagri/proj3.html> 22 Gusmano, Michael K., Ph.D.; Margaret Guk Hodgson, M.P.A.; and Emanuel Tobier, Ph.D. “Old and Poor in New York City.” International Longevity Center-USA. Issue brief, September-October 2002. 23 New York City Department of Health and Mental Hygiene (DOHMH). “New York City Community District Profiles With New York City Elderly Services Need Analysis Weighted For Population, Ethnicity, Poverty, and Health.” 2004. The New York City Elderly Services Need Analysis was created for the purpose of providing a reliable and objective means of determining which communities, within New York City, are in the greatest and most immediate need of expanded public health, behavioral health, and social services for the elderly. The analysis ranges from those communities most in

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need of services (lowest score=1), to those least in need (highest score 54). The “elderly” are defined as those persons residing in the City who are age 65 and above. This analysis relies on several sets of publicly available health and demographic data. Variables assessed for each community district in this analysis include poverty rates among the elderly, percentage of ethnic seniors, availability of community resources for the elderly, and the incidence of heart disease, cancer, diabetes, stroke, and mental illness. This analysis is not intended as an official neighborhood ranking of NYC communities by DOHMH. 25 Lincoln Square Neighborhood Center, in collaboration with the Center for Home Care Policy and Research, Visiting Nurse Service of New York. Lincoln-Square Neighborhood Center findings from the AdvantAgeInitiative, Figure 10.6. March 2004. <http://www.vnsny.org/advantage/> 26 The Center for an Accessible Society. “Independent living for a million adults jeopardized by a shortfall of a few hours of help.” March 16, 2004. <http://www.accessiblesociety.org/topics/persasst/laplantestudy0304.html> 27 Independent Budget Office, stated in a personal letter from IBO to UNH. August 7, 2003. “Comparing the numbers of participants as reported by the Department of Finance with the number eligible according to the 2002 HVS, we found the participation rate to be 40.2 percent. (This is up from 33 percent based on the 1999 HVS.)” 28 Vanderpool, Tim. “Why more senior citizens are carrying guns.” The Christian Science Monitor. January 6, 2004. 29 Public Advocate for the City of New York; Betsy Gotbaum, Public Advocate. “City Fails to Care for Mentally and Physically Impaired Adults, Elderly Public Advocate Gotbaum and Mount Sinai Visiting Doctors Call for Overhaul of Adult Protective Services.” Press release, Jan. 25, 2005. 30 New York State Office of Mental Health. 2005-2009 Statewide Comprehensive Plan for Mental Health Services. January 2005. <http://www.omh.state.ny.us/omhweb/statewideplan/2005/> 31 AARP. “Baby Boomers Envision Their Retirement: An AARP Segmentation Analysis.” February 1999. <http://research.aarp.org/econ/boomer_seg_prn.html> 32 Pillemer et al. Pg. 40 33 Independent Sector. “America’s Senior Volunteers.” June 2000. <http://www.independentsector.org/pdfs/SeniorVolun.pdf> 34 Office of Management and Policy of the New York City Department for the Aging. “Senior Center Utilization Study.” Spring 2001. Pg. 22. 35 U.S. Dept. of Health and Human Services. Medicare Glossary. June 2004. <http://www.medicare.gov/Glossary/search.asp?SelectAlphabet=H&Language=English> Medicare defines a homebound person as one who is “normally unable to leave home” and for whom “leaving home takes considerable and taxing effort” (certain exceptions are made for leaving the house to attend medical and non-medical appointments, as well as social adult day care). 36 United Hospital Fund. “A Good Place to Grow Old: New York’s Model for NORC Supportive Service Programs.” 2004. Fredda Vladeck, principal author. 37 The Foundation Center. “Internet an Important Health Tool, But Not for Seniors, Study Finds.” Philanthropy News Digest. January 14, 2005. 38 Nancy A. Fischer, “Few Elderly, Disabled Using Free Service that Checks on Them,” The Buffalo News, Niagara Edition. June 1, 2003. 39 Klinenberg. Pg. 45. 40 NYC Department of Health and Mental Hygiene (DOHMH). “Assault Injuries & Death in NYC, 2001,” Bureau of Injury Epidemiology, 2001. Summary of Vital Statistics 2002, The City of New York, Bureau of Vital Statistics. December 2003. 41 O’Brien, Nora, M.A. “Emergency Preparedness for Older People, An Issue Brief.” The International Longevity Center – USA. 2003. 42 Pillemer et al. Pg. 191. 43 Traxler, A. J. Let's get gerontologized: Developing a sensitivity to aging. the multi-purpose senior center concept: A training manual for practitioners working with the aging. Springfield, IL: Illinois Department of Aging. 1980. 44Robinson, Barrie, MSW. Ageism. University of California at Berkeley, School of Social Work, 1994. 45 New York City Department for the Aging. “Annual Plan Summary, April 1, 2005 – March 31, 2006.” Issued September 2004. 46 Butler, Robert N., M.D. “The Future of Ageism, Issue Brief.” Preface. International Longevity Center-USA. March/April 2004. 47 Palmore, Erdman B., Ph.D. “The Future of Ageism, Issue Brief.” International Longevity Center-USA. March/April 2004. 48 Kodner, Dennis L., Ph.D., “The Urban Neighborhood—A Laboratory for Successful Aging.” Presentation delivered at the Hunter School of Social Work in New York City, November 11, 2003. 49 Council of Senior Centers and Services. “More with Less is Impossible.” January 14, 2005.

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50 Public Advocate for the City of New York; Betsy Gotbaum, Public Advocate. “Just Getting By: New York City Nutrition Services for Seniors.” October 2, 2002. 51 Friedman, Michael B., and Kimberly A Steinhagen. “Issues in Geriatric Mental Health Policy: A Report of the Observations of Advocates, Providers, Researchers, Academics, Government Officials, and Older Adults.” Community Mental Health Report. May/June 2004, Vol. 4, No. 4. Pg. 49-64. 52 Vann, Korky. “Senior centers thinking younger.” The Hartford Courant. August 26, 2003. 53 Office of Management and Policy of the New York City Department for the Aging. 54 Vann. 55 Ibid. Pg. 91. 56 Pillemer et al. Pg. 253. 57 Klinenberg. Pg. 233 58 Nightingale, Demetra Smith, and Nancy M. Pindus. “Privatization of Public Social Services: A Background Paper.” Urban Institute. October 15, 1997. 59 Klinenberg. Pg. 232-233. 60 Osbourne, David, and Ted Gaebler. Reinventing Government: How the Entrepreneurial Spirit is Transforming the Public Sector. Reading, MA: Addison-Wesley Publishing Co., Inc., 1992. 61 Clarke, Helene et al. “Health and Service Needs of East Harlem’s Elderly.” New York: 1998. Pg. 13. 62 Ibid. Pg. 13. 63 The AdvantAge Initiative is being piloted in ten counties, cities, and towns all over the country to help them create more elder-friendly communities in preparation for the growing surge of seniors “aging in place.” 64 EISEP was designed for seniors who require non-medical homecare including housekeeping and personal care. 65 New York State Office of Mental Health. “Assertive Community Treatment.” December 2004. <http://www.omh.state.ny.us/omhweb/ebp/adult_act.htm>

United Neighborhood Houses is the membership organization of New York Citysettlement houses and community centers. Founded in 1919, UNH’s membershipcomprises one of the largest human service systems in New York City, with 36agencies working at more than 300 sites to provide high quality services andactivities to more than a half million New Yorkers each year. For over 85 years,UNH has worked with its members to strengthen families and improve neigh-borhoods throughout the City. UNH supports the work of its members throughadvocacy and public policy research and analysis, technical assistance and fundingand by promoting program replication and collaboration among its members.

UNH BOARD OF DIRECTORS

Sidney Lapidus

President

Patricia M. Carey, Ph.D.

Vice President

Roger Juan Maldonado, Esq.

Vice President

Lewis Kramer

Treasurer

Thomas M. Cerabino, Esq.

Secretary and Counsel

Eric C. Andrus

Paul F. Balser

James W. Barge

Robin Bernstein

Tony H. Bonaparte, Ph.D.

Mark Hershey

Alain Kodsi

Jack Krauskopf

David W. Kubie

Anne C. Kubisch

Susheel Kurien

Harold O. Levy

Ann L. Marcus

Ilene Margolin

Janice McGuire

Edward Misrahi

Alex R. Picou

J. Donald Rice, Jr.

Eric R. Roper, Esq.

Stephan Russo

M. Bryna Sanger, Ph.D.

Charles Shayne

Andrew J. Silver

Arthur J. Stainman

Mario J. Suarez, Esq.

Mary Elizabeth Taylor

Judith Zangwill

Lewis Zuchman

Barbara B. Blum

Chair Emeritus

Anthony D. Knerr

President Emeritus

Richard Abrons

Director Emeritus

George H.P. Dwight, Esq.

Director Emeritus

Julius C.C. Edelstein

Director Emeritus

UNH EXECUTIVE DIRECTOR

Nancy Wackstein

UNH MEMBERS

◆ Boys and Girls Harbor◆ CAMBA◆ Center for Family Life in Sunset Park◆ Chinese-American Planning Council◆ Citizens Advice Bureau◆ Claremont Neighborhood Centers◆ Cypress Hills Local Development

Corporation◆ East Side House Settlement◆ Educational Alliance◆ Forest Hills Community House◆ Goddard Riverside Community

Center◆ Grand Street Settlement◆ Greenwich House◆ Hamilton-Madison House◆ Hartley House◆ Henry Street Settlement◆ Hudson Guild◆ Jacob A. Riis Neighborhood

Settlement House◆ Kingsbridge Heights Community

Center◆ Lenox Hill Neighborhood House

◆ Lincoln Square Neighborhood Center◆ Mosholu Montefiore Community

Center◆ Riverdale Neighborhood House◆ SCAN New York – LaGuardia

Memorial House◆ School Settlement Association◆ Seneca Center◆ Shorefront YM-YWHA of Brighton-

Manhattan Beach◆ Southeast Bronx Neighborhood

Centers◆ St. Matthew’s and St. Timothy’s

Neighborhood Center◆ St. Nicholas Neighborhood

Preservation Corporation◆ Stanley M. Isaacs Neighborhood

Center◆ Sunnyside Community Services◆ Third Street Music School

Settlement◆ Union Settlement Association◆ United Community Centers◆ University Settlement Society

United Neighborhood Houses of New York70 West 36th Street, 5th Floor ■ New York, NY 10018Phone: 212-967-0322 ■ Fax: 212-967-0792Visit our Website: www.unhny.org

AGING IN THE SHADOWS:Social Isolation

Among Seniors

in New York City

United Neighborhood Houses of New York

Spring 2005

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