The push to help New Yorkers age in place

Even before the COVID-19 pandemic began, how older New Yorkers were being cared for was a growing concern.  

Those anxieties were exacerbated by the public health crisis, as months of isolation and shortages in senior services heightened the need for services that empower older New Yorkers to live on their own. 

As of September, 186,000 people in nursing homes, assisted living and other long-term care facilities across the U.S. had succumbed to COVID-19, according to research conducted by the Kaiser Family Foundation. The shortcomings of long-term care facilities failing to contain COVID-19 infections and the reduced demand for assisted living centers has increased the search for housing alternatives for older New Yorkers who need care but desire to live outside of a long-term facility. 

“We learned that older adults in nursing homes were more vulnerable than all other older adults because they were confined to one location,” Lorraine Cortés-Vázquez, commissioner of the city’s Department for the Aging, told City & State. “The way the pandemic spread made those environments more susceptible to contagion. Thus, reinforcing why people should have options to live in the community.”

A 2018 study, conducted by the AARP, found that 3 out of 4 older adults aged 50 and older want to stay in their homes and communities as they age. The same study revealed that communities have become a source of support and engagement for residents for older adults who have an even stronger desire to age in place. The city currently has 27 naturally occurring retirement communities, which provide services to older adults that allow them to maintain independence and prevent them from being placed in nursing homes. But the city is hoping to expand them, as well as its number of senior centers.

The Department for the Aging funds several senior centers across the city, which include Heights Neighborhood Senior Center and BronxWorks Innovative Senior Center, and has been committed to increasing its number of senior centers since the onset of the pandemic. The city also offers its aging residents a variety of programs and services that cater to older residents aimed at helping them age within the walls of their own homes, such as meal delivery services and help with personal care, such as bathing and housekeeping. 

In April, Mayor Bill de Blasio announced the five-year Community Care Plan to expand aging support services for older New Yorkers, particularly in underserved communities, to enable them to age in place and foster an even more age-inclusive city. The $58 million investment includes creating more older adult centers or naturally occurring retirement communities in communities with large aging populations that are underserved. It will also provide additional program staff, transportation services and outreach to expand services to older residents, which are to be allocated within the first year. The plan is expected to increase the already existing services that have allowed older adults to remain in their homes. 

“The (plan’s) first year is the building of community support and the expansion of community support,” Cortés-Vázquez said. “What’s the goal of this? To prevent institutionalization because the more support I get in my community, the less I fear about being in a nursing home because someone will help me maintain some level of independence.” 

The city is also expected to jump from 28 naturally occurring retirement community buildings or neighborhoods, which were not built for seniors but include a high percentage of older adults, to 36 within the first year of the plan’s launch. Older adult centers are also anticipated to jump from 249 to 272 within the first year. 

"New York City's budget is a reflection of its priorities and values. For New York City to truly be the fairest big city, that fairness must extend across the lifespan,” Allison Nickerson, executive director of aging advocacy group LiveOn NY, said in a statement. 

Elana Kieffer, acting director of the Center for Healthy Aging at the New York Academy of Medicine, rallied behind the significance of the naturally occurring retirement community model and pushed to develop them across the five boroughs.

“This is a very smart model because it will provide in place-based services that people don’t have to travel to get to those services … the more we continue to promote that, where it makes sense in different buildings in New York City, the better,” Kieffer told City & State. 

The city’s Community Care Plan is also expected to support the projected increase of older adults, the majority of whom come from communities of color. By 2040, older adults are projected to make up 20.6% of the city’s population. Between 2000 and 2018, the city’s older white population decreased by 3.2%, while other ethnic and racial populations grew rapidly. Within those same years, the city’s older Black population increased by 58.8%, Hispanics saw a 98.3% increase and Asian-Pacific Islanders saw a 180.4% increase, according to data compiled by the U.S. Census. 

Cortés-Vázquez emphasized the importance of making sure that the city is prepared to address the differences in needs within the racially diverse older adult population and plans to address the historical inequities within communities of color. 

“This action will not only target the needs of the increasingly growing older adult population but the growing diverse population as well,” Cortés-Vázquez said. “The systems that we have in place had not been ready, they have tried their best, but are not ready to address that older population growth and more importantly that distinct cultural competency that’s going to be required. A lot of them are newcomers, who have not had the experience of these supports and services in their countries of origin. So we have to think about all of those things as we move forward.”

In the city, older communities of color were more heavily impacted by the virus than their white counterparts. New York nursing homes with at least a quarter of African American or Latino residents were twice as likely to be hit by COVID-19 than those with less than 5% of African American and Latino residents, the AARP reported. 

More senior centers and groups are expected to cater to communities of color in the future. “I’m proud to say that a lot of the ethnic groups that were funded by the city council discretionary are now going to be fully operating older adult centers,” said Cortés-Vázquez. 

While the plan’s first year will be centered around fostering stronger community relationships and expanding services for older adults, the following year will be all about in-home services. “It is not home attendance with a nurse but in-home, home care services that will enable older adults to continue to be independent and live in the community,” Cortés-Vázquez said. 

As for the remaining three years of the plan, the Department for the Aging is tasked with keeping pace with the needs of all the city’s older adult communities as its population is expected to increase. “Given the population growth that we anticipate, in the next 20 years almost every neighborhood in New York will be eligible to be a neighborhood NORC,” Cortés-Vázquez said.