The New York State Master Plan for Aging: What may come? (2024)

Forgive Bill Hammond, a veteran New York State government watchdog, for a healthy dose of skepticism as the state works to complete its first Master Plan for Aging.

Hammond, a senior fellow for health policy at the Empire Center for Public Policy, said he worries the plan could become “kind of a shopping list,” or “a way for various constituencies to advance their agendas.”

Hospitals, for instance, which tout the most powerful health care lobby in Albany, could see outsized wins as New York lawmakers use the plan to change the state health care system, Hammond said.

“When the pie gets cut up, it doesn’t necessarily go to the places where there’s the most urgent need,” he said. “It doesn’t necessarily go to the facilities that are struggling to find help, to the mental health side of things. It goes to the people who have the biggest stick, and I think that’s just a political, structural issue that Albany hasn’t yet figured out how to deal with.

“This master plan commission could be a way to push back against that,” he said. “It could be a way to say, ‘Look, we’re not talking about health care, we’re talking about aging, which includes some health care, but includes other stuff, too.”

That’s the idea those involved in the effort have embraced in a process that started in late 2022 and is expected to result in a raft of recommendations by early next year.

New York’s Master Plan for Aging will provide a framework for how to build and strengthen communities by focusing on healthy living and access to care.

The impact of 76 million American baby boomers born between 1946 and 1964, who began reaching retirement age in 2011, prompted the plan, one of two dozen taking shape across the United States.

Representatives from 22 state agencies and offices make up the Master Plan Council. Its key advisers have included 29 leaders from the private sector, nonprofits, healthy aging advocacy organizations and research institutions.

Eight subcommittees and 34 work groups emerged as the planning process churned through 22 public town hall meetings across the state, as well a series of online brainstorming sessions with key players in the health, disability and aging fields.

Dr. Eugene Heslin, first deputy commissioner and chief medical officer of the state Department of Health, is overseeing its work on the master plan for aging. He said the work groups are distilling thousands of ideas into about 90 proposals that will make up the final plan. Each will include a series of related recommendations.

The proposals will focus on social drivers of health, including housing, technology, education and literacy, health equity, and access to safe, walkable neighborhoods, affordable transportation and other means of healthy daily living.

Proposals also will cover disease prevention, prescription drugs and insurance, the future state of health care delivery, and meeting workforce needs.

All will embrace the belief that “aging doesn’t start when you’re old,” Heslin said. “Aging starts when you’re born.”

Improving prospects

The Department of State has joined the health department and Office for the Aging in leading the master plan effort, as a way to help all state agencies sharpen the proposals to meet legal and regulatory muster, assuring greater chances of success.

“When you’re looking at 90 or 80 or 100 different proposals, which all have subproposals in them, not everybody was speaking the same language, because the language is based upon your perspective,” said Heslin, a family physician.

The master plan is likely to advocate for more community housing, as well as the Complete Streets transportation model, embraced by the City of Buffalo, that takes steps during street construction and maintenance to calm motorized traffic and create safer spaces for walking and bicycling, said Greg Olsen, director for the state Office for the Aging.

John and Ginny Oehler, retired professionals who live in Amherst, see potential for savings and improvements based on their life experiences.

Ginny Oehler, 82, was director of Our Lady of Victory Infant Home in Lackawanna during the 1980s and, during the decade afterward, led United Cerebral Palsy, now called Aspire.

She retired in the late 1990s and runs A Mindful Edge, a small meditation and executive coaching business. She has spent most of the last two decades as a consultant on leadership with the Health Foundation for Western and Central New York, which provides grants for youth development, healthy aging and equity in health care. The foundation was an early advocate of the state master plan.

Her husband, 79, is a mostly retired accountant, who works two days a week.

The couple would like to see more internships and continuing education training in home health care – and nursing homes – as well as livable wages. They would also like more financial accountability for those who provide such services using taxpayer money.

They see a huge gap in the ability of the state to connect people with free and low-cost services and resources already available – a challenge health care providers say mostly affects those with new medical needs and lower incomes.

The Oehlers also said poor health care discharge planning and follow-up can be particularly troubling, because it sets the stage for noncompliance with treatment and unnecessary re-hospitalizations.

“Let’s say you are in the hospital and your kids are living all over the place,” Ginny Oehler said. “Giving someone a list who’s just had serious surgery or a setback or a stroke is not going to do it.”

The health care system also needs to better communicate with those who speak little English, the couple said.

Covid-19 showed that municipal, state and national health systems are “too siloed,” said Dr. Ashwin Vasan, commissioner of the New York City Department of Health & Mental Hygiene, during a talk in June at the latest annual Association of Health Care Journalists conference, in Manhattan.

Vasan offered potential solutions that included data sharing that ensures greater privacy, generative AI to improve best practices, more workplace wellness, a pay equity model and greater disability awareness.

Cost drivers

Master plan advocates also say duplicating creative and proven ways to keep older people and those with disabilities in the least restrictive environment for their needs is key – and can help control costs.

The typical “customer” in Office for the Aging in-home programs is an 83-year-old widow with a modest income who lives alone, has at least four chronic health conditions and limited mobility, Olsen said.

Those programs can help with bathing, dressing, eating, going to the bathroom, cleaning a house, shopping and meal preparation.

“We are able to serve them in their homes for six years at less than $10,000 a year,” Olsen said.

Nursing home care in New York costs on average $95,265 a year, while home care for someone who gets 40 hours each week costs $66,560 a year, or 30% less, according to the Association of Aging in New York.

Adults who need help 20 hours a week would pay 65% less, the association said last year in a report that also concluded the state could save $500 million a year if the 6% of “low care” nursing home patients were served by an expanded home care system.

“People don’t want to lose their independence, they don’t want to lose their autonomy and they don’t want to go to a facility,” Olsen said, “so, can we serve frail people at home by supporting them and working with families that are functional to be able to do that? The answer is absolutely, yes.”

Right now, gaps exist in the care provided to older adults and people with disabilities in the United States, according to AARP’s Long-Term Services and Supports State Scorecard, in which New York finished sixth overall.

Despite more progress than the last update in 2020, every state had areas for improvement, especially related to the long-term care workforce, equity in nursing homes, support for family caregivers and emergency preparedness.

The frailty dilemma

“Our system of health benefits for the elderly is very generous, maybe to a fault,” Hammond said. “We have a very high level of employment and spending on home care because we’ve decided as a state that we’re going to provide home care to a broader swath of the population.”

In spite of that, he said, “we’re not getting the result in terms of keeping people out of nursing homes that you would expect. It would be very fruitful for the master plan commission to understand why.”

Another dynamic across the country – wealthier families shielding assets as older loved ones near their elder years – further strains taxpayers and state budgets, Hammond said.

“Medicaid was meant to be a safety net health plan,” he said. “It was meant to help people who didn’t have any way of helping themselves financially or otherwise, and yet we have a situation where people from all walks of life, when the time comes for them to go into a nursing home, chances are before long, they’re going to end up on Medicaid.

“It’s a tough problem,” he said. “Something that would be fruitful for the commission to tackle is how do you develop a market for insurance, or some other way of financing nursing homes, that doesn’t involve relying on a safety net program that pays rock-bottom reimbursem*nt rates?”

A more comprehensive approach will help, Olsen predicted.

“If we start to change our model to really focus on keeping people as healthy as they can be – keeping them working, keeping them engaged, combat isolation, intervening early with coordinated community services so that Medicaid and emergency rooms and nursing home placements are the last resort – then the answer is yes, we absolutely can save money,” he said.

An urgency

The Oehlers understand the challenges. One of their five children and five of their 14 grandchildren live in the Buffalo Niagara region. The others live out of state.

They are grateful they can still visit them occasionally, and that their good health continues.

John Oehler credits some of that to workouts three days a week. Ginny Oehler said her small coaching business helps.

They aren’t looking forward to health challenges to come – but have prepared as best they can.

“We don’t want to leave anything messy for our kids,” Ginny Oehler said. “We want to get it done so that it’ll be as easy for them as possible.”

It’s why the Oehlers go about these days relieved they have prepared for what they can control.

“The peace of mind,” they said together, “is just great.”

“We love retirement,” John Oehler said. “I never knew that being in my 70s would be some of the most satisfying and happiest days of my life.”