Releases & Statements

**FOR IMMEDIATE RELEASE**                                                                                      December 3, 2009

Contact: Matt Mittenthal  

212.669.4691; 917.597.4485

Gotbaum Report: Reorganization at Department for the Aging Caused Delays, Disruptions in Service Delivery to Seniors

Problems Persisted 15 Months Later as Case Management Agencies Reported Greater Caseloads for Social Workers, Insufficient Funding for Seniors

Read the Report

MANHATTAN—A 2008 redesign of case management services at the Department for the Aging (DFTA), launched to accommodate a growing and increasingly diverse older population, left many case management agencies with insufficient funding and large numbers of seniors without services. According to a survey released today by Public Advocate Betsy Gotbaum, many of these problems remained fifteen months later, as clients faced longer average wait times to receive services, and the average caseload for case managers was greater than it was before the reorganization.

Public Advocate Betsy Gotbaum said, “I’m glad that with new leadership at DFTA, there are concerted efforts to make sure seniors don’t have to wait any longer to get the services they need. And I applaud DFTA’s recent announcement that seniors will be able to receive home-delivered meals without having to first endure a drawn-out assessment from a case management agency.

“That said, our recent survey indicates there is still much work to do, and it may require additional funding. The fact that clients face longer wait times to receive services than before the redesign suggests that the city may need to rethink its strategy for meeting the needs of its growing and diversifying senior population.”

DFTA’s plan for reorganization was based on two primary changes: first, to encourage cost efficiencies, by reducing the number of contracts with case management agencies from 32 to 23; and second, to assign case management agencies sole responsibility for home-delivered meal services, previously under the jurisdiction of community senior centers.

However, during the plan’s implementation period – from April 1 to July 1, 2008 – it became clear that DFTA had underestimated the number of clients each agency would serve (as DFTA recently acknowledged in testimony before the City Council). This created a situation in which agencies were forced to increase caseloads for case managers and supervisors, wait-list clients, or both.

Gotbaum’s survey, released as part of today’s report, suggests that, fifteen months after the reorganization, case management agencies remained overwhelmed by caseloads, threatening the quality and timely delivery of services to New York’s senior citizens.

The report, “Unsolved Case: A Survey of New York City Department-for-the-Aging-Contracted Case Management Services Staff,” is based on a survey of case managers and case manager supervisors employed by DFTA-funded senior case management agencies. The survey, conducted between July 1, 2009 and August 9, 2009, was designed to examine the impact of the spring 2008 reorganization on the quality of DFTA-funded senior case management services and the capacity of DFTA-funded case management agencies. The Office of the Public Advocate received 103 completed surveys, a response rate of nearly 30 percent.

Findings of the survey include:

Caseloads

• Since the reorganization, the average caseload for case managers has increased from 66 to 69 cases, higher than DFTA’s target caseload of 65.
• Since the reorganization, the average caseload for supervisors has increased from 401 to 456 cases, far higher than DFTA’s target caseload of 325. Forty-six percent of current supervisors also directly manage clients in addition to their supervisor role.
• A majority of supervisors do not consider DFTA’s standard of 65 cases per case manager a manageable caseload. Nearly two-thirds do not consider DFTA’s standard of 325 cases per supervisor manageable.

Case Management Capacity

• Since the reorganization, the majority of supervisors report an increase in new requests for services.
• Since the reorganization, homebound seniors’ average wait time from service request to assessment has increased by one week to a total of five weeks. Seniors’ wait time for home-delivered meals, from request to start of service, currently averages 6.2 weeks for regular meals and 6.9 weeks for kosher meals.
• Since the reorganization, homebound seniors’ average wait time from initial assessment to receiving assistance with travel to medical appointments has more than doubled from nearly two and a half weeks to more than five weeks.
• Since the reorganization, case manager turnover has significantly increased.
• Since the reorganization, problems related to DFTA’s data processing system have continued despite frequent complaints to DFTA from case management staff.

Case Management Quality

• The majority of veteran case management staff does not believe that the reorganization has improved the quality of case management services.

• More than three quarters of current case managers are not able to reach out to seniors in the community to proactively identify seniors at risk of nursing home placement.
• Since the reorganization, the percentage of case managers who always or frequently have to reduce or delay client services and other responsibilities to cope with their workload has risen significantly.

The Public Advocate recommends that:

The New York State Office for the Aging Should:

Consider New Funding Sources Such as an Income Tax Check-Off for the Expanded In-home Services for the Elderly Program (EISEP).

The New York City Department for the Aging Should:

Reduce Caseloads by:

• Funding agencies to a level that ensures their ability to hire sufficient case managers and supervisors.
• Determining a lower standard caseload, including a case mix variable for clients requiring frequent visits or complex service arrangements.

Improve Case Management Capacity by:

• Transitioning the current Provider Data System (PDS) to a secure, web-based system that allows remote and user-friendly entry and exchange of client data.

Improve Case Management Quality by:

• Providing case managers with greater access to benefits and entitlement resources by expanding training opportunities and creating a case management resource website.
• Providing logistical support and incentives to increase outreach efforts to identify at-risk seniors.

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