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West Side Inter-Agency
Council for the Aging
  August 10, 2020
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West Side Interagency Council on Aging
Minutes of General Meeting, October 18, 2018


West Side Interagency Council on Aging
Minutes of General Meeting, Thursday April 19, 2018

Board member Jim Palmer opened the meeting with a call for membership. He then outlined the subject of the panel discussion and introduced each speaker.

Sally Kaplan of What Matters began by describing the intiative in the Jewish Community to actively engage in advance planning for end of life. Their vision statement is value driven and the goal is to ensure their clients wishes will be honored. Why? 90% say it is important but only 27% have done the paperwork. Why now? There has been a flood of literature, e.g. Atul Gwande, and it’s having an impact on the industry. Baby boomers are starting to think about themselves, The program is person centered, value based. It asks “What are your beliefs?, what matters most?”…

They provide trained facilitators to help people get organized about it. 5 Ds: diagnosis, death, divorce, decade or decline are all reasons to pursue this. Living will is not a legal document in NYS but is helpful. The program works through community organizations and synagogues. Wendy at Dorot is one contact point.

Tony Susa of Calvary Hospice opened by saying he tries to keep everyone out of the hospital. “Today is a good day – the Mets won!” He then referenced Barbara Bush who had just died cited the media’s reporting that she had decided to forego medical care. He countered that she decided to CHANGE medical care. Comfort care IS medical care.

Life is a journey and continues until the very last breath. Palliative care addresses health issues – pain etc. but not necessarily end of life. Hospice is specific to end of life. In NYS 12 months (formerly 6 months). Their goal is to deal each and every day whether in hospital or home setting. They provide trained physicians to oversee medical issues and provide appropriate intervention (nurses, social workers, chaplains/rabbis/Buddhists/humanists), PT home health aides. They have volunteer programs that can provide respite to caregivers/family. They help prepare family for death to normalize it. Knowing the process can be comforting to the family and empowering. They will track the family for 13 months following a death, assessing what degree of help they can provide. They have bereavement counselors. He stressed the program is focused on both the patient and family.

Amy Levine and Juliet Sternberg of the Doula program began by pointing out that the dying are individuals – people see a 90 year old but not WHO they are. Who are we? They showed a 10 minute video about the program. People are isolated and lonely when facing final illness especially if they have no close family. Doulas provide companionship.

The Doula program trains volunteers to visit on a regular basis with people in their final chapter regardless of where they are – home facility, hospital. They establish relationships with the dying and often become great friends. They provide accessibility and service to the dying to prevent isolation and loneliness. You can request a doula from their website.

After a bit of Q&A (some areas covered were about legal documents, e.g. competence in cases of Alzheimers or dementia. It was pointed out that NYS has a low bar – there are no requirements for psychiatric evaluations.) Jim closed the meeting, thanking the panel and announcing the next meeting on May 17th.

West Side Interagency Council on Aging
Minutes of General Meeting, Thursday March 15, 2018

Rebecca Rosenzweig welcomed everyone and thanked our new host, The Riverside Premier Rehabilitation and Healing Center. She then introduced Nettie Harper of Inspired Memory Care.

Nettie began by stressing the importance of being present. Turn off the radio, TV, cellphones(!), hold all calls. When you are with a client, just be there.

Observation: language matters! You might ask if he/she wants to freshen up, rather than go to toilet.

Be aware of temperature. Does it need to be warmer? It’s easy to miss something you’re not looking for.

Respect personal space. Approach where you can be seen. If there is a weak side move to the strong.

Avoid telling when you can instead show.

Communication is both verbal and non-verbal. Allow for pauses – 20-30 seconds. You can echo the last statement to prompt memory. If you finish sentences and don’t allow for pauses there is learned helplessness. You can rephrase. Active listening is important. Maintain eye contact. Then ask open ended questions, e.g. “Tell me more about that”, “What’s the best part”, “What’s the worst part”…

Remember your client is not stupid. In memory loss emotions last longest.

Validation is empathetic. It is not fixing, therapizing or judgmental. Identify, watch tone, orienting information (physical space).

Words that stop connection: how to shift NO to YES – NO – call by name
CAN’T – Let’s…/May we…
WHY -- Tell me about…
STOP THAT – Handshake

Ask questions that solicit opinions and wisdom. Offer choices (controlled supports/action). In later stages ask yes/no question. Avoid fact-based questions.

Create a connections log so visits are noted. Make it a place for creative expression. Allow client to branch out.

After a brief Q&A the meeting wrapped up. There was one CEU offered for this workshop for qualified social workers/case workers.

West Side Interagency Council on Aging
Minutes of General Meeting, February 15, 2018

2018 WSIACA Powerpoint

West Side Interagency Council on Aging
Minutes of General Meeting, Thursday January 18, 2018

Due to meeting's delayed start for more seating, the gathering skipped participant introductions. No major announcements were made other than encouraging people to sign in and to sign up for the Sept.-Aug. WSIACA membership.

Rebecca Rosenzweig introduced today's guest speaker Ginalisa Monterroso, founder and CEO of Medicare and Medicaid Advisory Group (hereafter, referred to as MMAG).

Monterroso described her career and family history prior to founding MMAG. She started off working at the Jewish Home in the finance department, where she acquired much of her knowledge of the Medicaid system. She then worked at Archcare for 5 years. With the birth of her daughter Tara, who has Down Syndrome, Monterroso was encouraged to put her daughter up for adoption. Instead, Monterroso decided to raise her daughter and to navigate the bureaucratic system to get her daughter needed services, which involved having to sue NYC for private education and speech therapy. Tara is now 22 years old and is thriving.

Monterroso founded MMAG as advocates for clients to maximize Medicare and Medicaid benefits. Much of this involves navigating the bureaucracies to get clients needed services. Monterroso described how private duty nursing is possible, for instance: "Even if they have managed longterm care (MLTC), you can request a private duty nurse. You have to get a rejection from the CHA, with a doctor's note, and you submit it. Private duty nursing will only last for 6 months, it's not long term, but the client is able to get services." Both clients and MLTCs may not realize that such arrangements are possible.

Similarly, with Medicare's "skilled care component": "The letter will say that you're only going to get 4 weeks of services, and it will be discontinued. You all know it's not true, right? It's unlimited. There is no such thing as a 4-6 week service; it can go longterm as long as a physician writes a notes saying client requires services, every 60 days." While a nurse may be producing the documentation and stating that services are only available for a specific duration, "The dr. is writing the order; the only other person that can overwrite is another dr." What's important is what appears in that order.

Monterroso took questions from the audience about different scenarios. She recounted how MMAG will push mltcs to get clients their needed care. For example, the mltc allocated 4 hours to a client who was paralyzed. When MMAG responded this wasn't enough, the mltc told the client to find another mltc. MMAG said no, and continued to push for more hours through an appeal, which requires clients to be members before they can appeal. Since MMAG's clients have resources for private care, this enables MMAG to work on securing care via Medicare and Medicaid.

MMAG will also pursue immediate needs, which is emergency Medicaid homecare for clients who require a mltc. This serves as "a little bridge" and takes between 17-20 business days. With immediate needs, when clients are about to convert to mltc, the mltc has to accept the hours, it's 90 days.

MMAG will make sure that ppaperwork is in order - for example, Power of Attorney must have an additional gift rider. This is a change from prior years, so old POAs may no longer work without a gift rider. Have a notary witness the initialed document.
MMAG will ensure that assessments are made - for example, nurses may mistake independent facilities for assisted living facilities and refuse to do an assessment.
MMAG will help doctors with identifying the correct diagnosis that will enable care. MMAG will also push back on judges who may not be up to speed on Medicaid rules.
MMAG will negotiate with NY state about spousal refusal by phone. The state will accept one time payment that is less than what they original ask for.

Rosenzweig thanked speaker and stated that the next WSIACA meeting is Feb. 15, 3rd Thur. of month.

West Side Interagency Council on Aging
Minutes of General Meeting, November 16, 2017

Fact Sheet Immediate Need

West Side Interagency Council on Aging
Minutes of General Meeting, October 19, 2017

Rebecca Rosenzweig, chair, opened the meeting with introductions around the room. She was joined by Jim Palmer and together they presented the fourth annual Beatrice Goldberg Scholarship award and check to Kirandeep Kaur, master’s candidate at Fordham. Main presenter David Knapp of DFTA bill payer program was introduced and he began his presentation with an exercise, asking for an adjective to describe how you feel about monthly finances. Responses ranged from relief to anxiety.

Knapp spoke about the transfer of wealth – the average scam is $200k. We’re great at reacting, doing triage, but that is not good enough once a scam is initiated. For clients who get into serious trouble the city will help get them out of arrears but only one time. This however, doesn’t fix the root problem.

The DFTA bill payer program is small and hands on. The goal is to keep people aging in place. Nobody should lose their apartment because they can’t pay their bills. In Manhattan there are options for stipends.

History: AARP began a program for bill paying. NYC at one time had 20-30 programs and some of those neighborhood programs still exist. The DFTA program works primarily from referrals by professionals. They do bill payment only. Some traits of clients served may include anxiety, Parkinsons (no family support), cancer patients, early stage memory loss, chronic history of bad bill paying.

Basic requirements are: over age of 60, eligible for services, must accept referrals, able and willing to direct process. They used to have asset rules but dropped that because it was too hard to figure out. Instead raised max income requirement to $60k.

The program is an advisory one: they help with checking accounts, setting up accounts online. They work with the primary bills first: rent, utilities.

The program is staffed by volunteers. They train with clients in in-home assessments (referrals may come with no knowledge), they must exhibit financial acumen, have sources, know how to do it. The program gets very specific in matching volunteers to clients. Volunteers help with budgets. They investigate for social workers. Provide education with respect to credit cards; also pooled income trusts as a way of getting services.

Volunteers are not bonded. For the first couple of years they were fingerprinted but that was not workable. Now they have a three-month probation period. Thorough background checks are performed for financial and criminal activities nationwide. Volunteers typically spend 2-3 hours upfront with clients, then 2-4 hours monthly for maintenance.

Note: this program does not take MLTC clients.

Identity theft can happen even if you have a preventative program. Everyone should have a product that checks for ID theft in real time.

A brief Q&A session concluded the program. Rosenzweig thanks Mr. Knapp for a very informative session.

West Side Interagency Council on Aging
Minutes of General Meeting, February 16, 2017

2017 ESCOTA and WSIACA Powerpoint

West Side Interagency Council on Aging
Minutes of General Meeting, November 17, 2016

Valerie Bogart spoke about MLTC and FIDA with updates. See her complete presentation and access the appendix.

West Side Interagency Council on Aging
Minutes of General Meeting, October 20, 2016

Chairperson Rebecca Rosenzweig called the meeting to order and with fellow Board Member Jim Palmer presented the third annual Bea Goldberg Scholarship to Lingyue Lu citing her essay about having started by caring for family and her dedication to making elder care her focus as standing out in an exemplary group of candidates. A round of applause and then the main speaker, Jodie Berman, was introduced.

Ms. Berman began with a short cv and noted she will be presenting at the Expressive Summit in December should anyone care to learn more about innovative techniques in working with dementia clients. She then moved into three things you want your caregiver to know about you...amusing tidbits that personalize the relationship from the start, eg. "I like my coffee black", "I like to dance but not sing" etc. In a world that treats disease rather than the person, it is an important distinction in getting to know the person - not what they can't do, rather what they CAN. Pay attention to strengths and remaining abilities: intelligence, how to address the client, sense of humor, singing, dancing, empathy, resilience, outspokenness, makes a great cookie, verbal skill, spirituality and religion, stories. All are ways to connect.

Engagement in something of interest, eg. Baking (short video) - we need purpose in life. Why do we wake up? Eat? Take meds?

In early stages "I forget" - work with highlighter to mark schedules. Let the client select what to do. Late stages theystill can have a job - eg. Man who cleans placemats after mealtime gives him something of value to do and keeps him engaged. For families - arrange WITH your loved one rather than FOR him/her, eg. Flower arranging - if flowers are delivered to facility let the client arrange them.

Adapting the environment: turn off phones - too distracting and you need to focus on the client, not your cell. Turn off radio and TV, avoid noise like vacuums. Sit on dominant had side of person (to determine hand them a pen - they will almost always take it with the dominant hand).

Offer choice in as many ways possible, eg. What shirt would you like to wear today?, do you want your meds with juice or water? Do you want pet therapy or a stroll?, chicken or fish? Sing, dance or smile?

Talk less, demonstrate more. Keep it simple, move from simple to complex, mirror their movements, tone and speed. Validate! Eg. Shake hands, smile, "great job!", success - in a warm, not patronizing manner.

Don't tell, show. (Short exercise with audience member about eating soup - demonstrating showing how to do it.) Smiling is contagious - makes us feel good, releases serotonin and is a universal language, Use it!

Find their field of vision, get down to eye level rather than looming over the person and then engage. Ask them to show you - a very powerful tool. Handshakes are less invasive than hugs - it is a polite, respectful and warm gesture.

Old word New word
Client/patient friend/ their name
Take escort, accompany
You have to go Let's go together
I will do it May I assist you?

Watch tone and vocal inflection. "Are you ready?..."

Open ended questions vs. choice: Where do you come from vs. Are you from the east coast or west coast?; What is your profession? Vs. Were you a business man? What do you want to do? Vs. Would you like to visit a museum or park today?

Build on answers and follow up.

Another technique is to use visual cues - either words or pictures. Have them copy, compose, create. Remind a person to do something scheduled, can help a person to locate or find something, can provide instruction for other staff/family. If possible put signs up at eye level, use arrows.

Reading tests are important. Print rather than use cursive. Use markers not pencil - thicker lines work better. If using type, make the font big - 18 pt. minimum, sans serif face. Use high contrast. Hand person the paper and be sure they have glasses if they need them. Watch the eyes, reaction and listen. You will be surprised at what they can do.

Engagement examples: Make up a box with interesting stuff. Open and discuss the items. Polish silver.

Create invitations - who doesn't like to get those? It allows opportunity to accept or decline. Write reminders and make many copies to disperse. Eg. "Hi Dad - I will be there at 6. I love you, your daughter Jessica".

Key techniques: spontaneity and flexibility. Be in the moment. It's a process not a product. Enter into their reality (use mirroring) and always look at what they CAN do rather than what they CAN'T.

West Side Interagency Council on Aging
Minutes - General Meeting - April 21, 2016

Chair Rebecca Rosenzweig opened the meeting with introductions. First speaker, Rimas Jasin of PSS, introduced their new program initiative Circle of Care, a resource for caregivers and families of people with dementia. He reviewed the statistics on Alzheimers 6th leading cause of death, a person is diagnosed every 66 seconds. In NYC 13% of people 65 and older have some form of memory impairment that equals 140 thousand NYC residents. 1 in 19 New Yorkers are caregivers. There are over 425,000 caregivers dealing with Alzheimers or other forms of dementia.

PSS has operated various programs since 2003. They have packaged what they do best proactive and sustainable programs. The old transactional relationships no caregiver support, no independence, no community support -- is changed by this new program. Initial contact (new or follow up) leads to case assistance consultation, then additional consults leading to trainings. Key is collaborating with everyone.

Goal is to reach 2700 caregivers/year and provide a safety net of services and programs. The focus is on building relationships, capabilities to be better caregivers and be more accessible. They offer information/referrals; in-person assistance/counseling; lounges; telechats; workshops, e.g. Powerful Tools for the Caregiver; respite.

Circle of Care stations: there are 3-4 per borough in regularly scheduled private space with staff present part time (regular scheduled hours each week.) They are looking for additional host places. Hosts should be willing to help promote the program to their constituents, help staff reach broader community. They should plan to meet with staff at least 2 times in the first 4-5 weeks and would be providing a P/T office in a community organization.

Program highlights include experienced staff that is proactive, evolving to be transformational, comprehensive, evidence based, culturally sensitive and accessible.

For more info call 866-665-1713 or email careinfo@pss.org/caregivers.

Q&A Question about funding/cost. They get some funding from DOH and Alzheimers Association. There is no cost to client.

Then Rebecca Rosenzweig introduced our second program speakers from Inspired Memory Care, Kelly Gilligan and Nettie Harper. They began by speaking about perception bias competence vs. worth. Society can be punishing to older people if they are not sweet they can be considered problem. They mentioned Amy Cuddys research in how people live up to their expectations.

Their goal is to empower elders with memory issues. They arrange partnerships; offer classroom training and home/facility visits with caregivers and clients. They work side by side to coach and teach means of reaching clients.

Courses offered include: Getting to Know our Elders; Connecting with Elders for Inspiration (communicating validation therapy); Maximizing Elders Comfort During Care, Managing Everyday Living Together, Planning a Day Together, Having a Dining Experience.

Much of healthcare training is can I fix the problem. Sympathy is not empowering. I know how you feel is not useful. Must discover maximum strength possible. Managing behaviors is now perceived as unmet needs. One of the basic human needs is for space.

They then asked for a group of volunteers to demonstrate an exercise. They made a circle and had people look each other in the eye and go around simultaneously clapping this requires intense concentration it sounds easy, but is tricky. Once started there should be a rhythm. Question should there be a rhythm in working with elders? Interesting idea.

Another example of coursework in Managing Comfort During Care would be a shower scenario. What are the unmet needs? Privacy shower curtain; fear of falling seat/grab bars; independence give them a bar of soap, etc.

Power postures stand tall, shoulders back like a superhero it may feel silly but it actually helps in finding the power within. If you dont have a strong stance a tricky situation can escalate. Slow down and get centered.

Planning a day: some ideas are resident run programming. It is empowering. Inspirational sorts of activities might include movies, e.g. Singing in the Rain. Ask for opinions and dont worry if they are not fact based. Ask for advice this is wisdom sharing. Culinary inspirations you can show templates with text and pictures to break down the process and enable client to make a snack. Perhaps viewing art is a favorite pastime.

Inspired Memory offers to partner with agencies and directly with families.

See website for more information: http://www.inspiredmemorycare.com/

The meeting adjourned at 11:00 AM.

West Side Interagency Council on Aging
Minutes - General Meeting - March 17, 2016

Chair Rebecca Rosenzweig welcomed everyone on St. Patrick's Day and called for introductions/announcements. She then introduced the first speaker, Judith Dobrof from Mount Sinai.

Judy began by defining population management as a transformation in health care. With costs upward of 2.2 trillion dollars, uncoordinated care, inefficiencies and patient dissatisfaction all lead to poor outcomes. ACA passed in 2010 is the most significant piece of legislation since Medicare in the 60s. The goal is quality, accessibility and affordability of health care.

There is a triple aim: 1. Improve patient care experience. 2. Improve the health of the overall population. 3. Resulting reduction of avoidable expenditures from fewer emergency department visits/hospitalizations.

Moving from "fee" based to "value" based services. The Accountable Care Organization (ACO) is the first new model under the ACA. It rewards providers who must agree to participate and then share the savings achieved for medicare patients.

She showed an ad for Mount Sinai "If our beds are filled it means we've failed."

Mount Sinai Health Partners are solely focused on changing cultural practice. MSO (management services organization) provides back office support. Examples include physician engagement, quality, workflows. Care coordinators contracting with insurance companies. Currently there are 350,000 lives under contract. Low risk respond to education initiatives but they can move to high risk with age and must be monitored. High risk clients tend to require clinic or visiting doctors. Care Coordination is great for patients! They are paid to keep patients out of hospitals.

Triple aim applied to social services specifically: 1. Remove barriers to accessibility/health literacy for improved health. 2. Follow patients/families over time to improve outcomes and decrease costs. 3. Coordinate and navigate the system.

Mount Sinai has always had a strong history of social work and this is what they have always done. Now there is a biopsychosocial focus, a strength based perspective. They call patients to follow up. How do you motivate people? You develop a care plan - set goals. Communication/collaboration is a core part of social work and has a unique perspective.

Transitional Care - from hospital to home or other facility. PACT (Preventable Care Admissions Team). Follow for 30 days to prevent readmission.

Longitudinal Care - longer term over time. Mt. Sinai Health Home Program came out of NYS Dept of Health overhaul of Medicaid in 2011 It provides comprehensive coordination for both transitional and longitudinal social services. They intervene through home visits, community visits and these are reimbursable services! It is paid per member/month. Educational requirement to participate is MA level in social work with Bachelor level care coordination. There are currently 22 partners within the program.

Challenges - what did the group find the biggest challenges to be? - Communication, huge case loads, long assessment times - MLTC, CMS, client motivation.

Risk stratification - assess high vs. low. Then target patients - which ones to address first. Engage patients - engaged patients get better. Engage providers. Manage dosages. Positive reinforcement of "graduating patients" . Practice transformation.

Helena Ross of Mount Sinai Visiting Doctors program then addressed the group. Her program is a home based primary care providing a primary care physicians, nurse practitioners, social workers, Administration assistants and office based nurses (RNs).

Every patient gets an initial intake to assess risk. They meet in teams to discuss patient. End of life care is an expensive model - it doesn't really pay for itself. Only one program is currently funded by the hospital - they need additional funding.

There are 2 special programs internal to Mt Sinai: Mobile Acute Care Team (MACT) which runs 3-4 days and provides hospital level care at home (used for pneumonia, wound care etc.) Sub-acute care - 20 days - is just now being piloted. Community Para Medicine (CPM) provides an EMS professional for an emergency department-like visit at home. This is not covered under medicare.

Under the ACA innovations the goal is independence in home, reimbursement to MDs for home visits - largely out of John Hopkins currently. MDs act as medical case managers.

The handout follows with web addresses to providers.

West Side Interagency Council on Aging
Minutes - General Meeting - February 18, 2016

Arleen Stern opened the meeting welcoming all newcomers and reminding everyone to consider membership. She then introduced our speaker, Paula Arboleda from the Evelyn Frank Legal Resources Program. Ms Arboleda dove right into continuing what Valerie Bogart began in November on updates to MLTC and FIDA. To see the proposed changes in the NYS Budget for Medicaid, click here. To see the powerpoint presentation click here.

West Side Interagency Council on Aging
Minutes - General Meeting - November 19, 2015

Rebecca Rosenzweig opened the meeting and invited Jim Palmer to join her in presenting the 2nd annual Beatrice M. Goldberg Scholarship to America Ortega, MSW candidate at Fordham University. Jim introduced Ami to the group saying, America's current advanced field placement is as an academic housing social work intern at the Project FIND Hargrave Housing Facility in NYC. In addition, America works as a community social worker at the Project FIND Hamilton Senior Center, a NYC Innovative Senior Center. In her scholarship essay, America wrote, "as a daughter of a disabled parent, I have a unique perspective of being a care giver and observing the decline that the impoverished aging population experiences. This perspective has helped me to understand the challenge of being a homebound older adult client, as well as helping me to become an empathetic social worker. My goal is to work with underserved, overlooked, and high risk older adults". In keeping with the vision of both Beatrice Goldberg and WSIACA, America further offers, "I am also dedicated to advocating for increased programming and funding to programs that serve older adults and to speak up for those who lack the ability to voice their needs. In doing so, I hope to improve the lives of my clients and offer them the support and knowledge they require in order to age comfortably in place".

Also on hand to celebrate was Thomas Duffy, our first scholarship winner now working full time at Dorot. The certificate was presented to enthusiastic applause, and we moved on to our featured speaker, Valerie Bogart.

Ms. Bogart has spoken with our group regularly on updates to MLTC and as always came with a lot of material to review. To see her entire power point presentation, click here. To download directly her very helpful appendices click here.

West Side Interagency Council on Aging
Minutes - General Meeting - October 15, 2015

Adrian Walter-Ginzburg, PhD, on Hoarding

Rebecca Rosenzweig, chair, opened the meeting with a reminder that the membership year began in September and shared with the group how easy it is to use PayPal on the site to join. If you haven't done so, please consider membership in WSIACA. She then introduced the featured presenter, Adrian Walter-Ginzburg.

Following a brief biographical introduction and outline of her company's services, Ms. Walter-Ginzburg recounted the story of the Collyer Brothers who filled a 5th Avenue mansion with refuse, junk and human waste. It was filled with booby traps and Langley got caught in one and died. His brother then died of starvation. To this day "Collyer" is code employed by the fire department signifying a hoarder house.

Hoarding disorder was accorded its own designation in 2013 - it used to be a subcategory of OCD but is more like ADD. There are 6 criteria that must be met:

  1. Persistent trouble discarding possessions regardless of value.
  2. Distress discarding due to urge to save/store.
  3. Decluttering requires 3rd person.
  4. Symptoms cause distress/impairment and/or an unsafe environment.
  5. Not medical in origin and
  6. Not be a symptom of other mental issues.

Hoarding definition -

  1. Conscious urge to accumulate possessions
  2. Corresponding distress at getting rid of things
  3. Most have no real world value
  4. Clutter prevents use of space - hazardous conditions lead to fire, fall hazard, vermin, mold, mildew
  5. And there must be a disruption in life as a direct result

Behaviors are acquiring, difficulty in discarding, and difficulty in organizing. Collecting is NOT hoarding. A collector is proud to display objects. A hoarder is not, is more likely to be embarrassed, depressed and does not share.

Reasons for hoarding: believe items are of greater value than they are; security; perfectionism (I may need this down the road); to obtain love (50% hoarders have never married); fear of discarding personal information; physical limitations and frailty; inability to organize; self neglect; stressful life events may trigger this behavior.

Distress is seen in anxiety about others touching possessions; conflict with spouse over clutter; illness related; inability to complete ADLs or IADLs; shame at chaos, distress about improper home environment; embarrassment/withdrawal from society (can't have anyone over syndrome); inability to work.

Older adults more likely to have time to acquire, have diminished capacity, suffer more losses and require support and are at increased risk of injury. Consequences include family/relationship issues, financial (cost of cleanup averages $20k - in NYC that is closer to $50k), legal, lack of functional space, loss of health.

Decluttering: golden rule - OHIO (only handle it once)

Forced: place is condemned, tenant facing eviction (#2 cause in NY), family intervention, medical discharge from hospital or rehab facility requires it.

Voluntary: is ready/want to change

Undecided: wants to but still can't let go.

There are five levels of hoarding. (Level 4/5 ex. Grey Gardens.) Also animals and pets.

Plan of action:

  • Evaluate level - informs level of equipment needed
  • Categorize saving
  • Create plan
  • Encourage cognitive modification
  • Declutter


  • Respect the client's attachment
  • Evaluate for safety
  • Don't be critical of environment
  • Refer to medical or mental health professional if necessary
  • Go slowly
  • Involve clients
  • Work with other agencies

Encourage client. Praise them. Break tasks into smaller parts.

Saving categories:

  • Sentimental
  • Functional
  • Aesthetic
  • Esteem


  • Strategy meeting
  • Schedule
  • Set goals
  • Target specific areas
  • List pros and cons
  • Comfort, safety

Long term strategies:

  • One in, one out
  • Ongoing organizing

West Side Interagency Council on Aging
Minutes General Meeting - September 17, 2015

Chair Rebecca Rosenzweig welcomed all to a new season of WSIACA general meetings and made a pitch for membership pointing out it is very easy to pay online at our website. Jim Palmer spoke briefly about the newly named Beatrice Goldberg scholarship and said the second annual scholarship recipient will be announced at the next meeting (October 15th). First time attendees introduced themselves and then Jim introduced our speaker, Chodo Campbell from the Zen Center for Contemplative Care.

Chodo began with a short meditation just asking everyone to sit quietly and focus on breathing and being in the moment. He then dove in with an overview of how the center came to be and discussed his background in hospice care, particularly at Beth Israel in the AIDS center as the first chaplain on through ordainment and now having trained 300 students across the country in the practice of contemplative care.

The center offers several training programs: a 9 month program in foundations of contemplative care is geared to social workers, medical personnel, caregivers who wish to learn the practice. There are more advanced options you can read about on the site at zencare.org.

They teach a more thoughtful approach, focused on taking care of yourself to be more fully present and thereby able to care for others in a more meaningful way.

There are three principles they teach:

  • 1. Not knowing this means walking into a room without an agenda, without having your thoughts colored by whatever staff may have told you about this patient/client. This allows you to ask Whats going on with you today The meta story is what is important rather than the daily gripes etc. Spirituality has little to do with religion, but rather with focus and presence being with a person 100%. To illustrate Chodo had everyone pair off and face each other. He asked everyone to look into their partners face, eyes for about 2 minutes and really look at them. He pointed out that we did not know what kind of morning anyone had, that all of us will die but we dont know when, it could be today. After he asked how many were uncomfortable with this exercise about 1/3 of the group raised hands. Then how many thought it worthwhile about felt it was useful. Chodo concluded this point by asking what if we really looked and saw the people we interact with eg his Starbucks barista, who now knows just what he likes and has it ready when he walks in the door simply because he took the time to connect with that individual.
  • 2. Bearing Witness What is happening around the client/patient family, kids, spouse. Are these people connected to what is happening? Can you help promote that connection. Example given of a man in a hospital bed surrounded by family who are all up against the walls. The patient is mumbling. Chodo leans in to hear that the man just wants to be held. He has the family all hold hands and surround the man in a circle of understanding. Bearing witness can be as simple as that.
  • 3. Compassionate/loving Action Sometimes doing nothing is the right thing to do. Bearing witness, noticing what is going on in me. Notice, sit with it, then acting.

He opened to questions. First about family it seems a dying person is often serene but the family around that person is not. Chodo replies that often this is about being frightened, thinking of mortality. He suggests addressing the family asking how are YOU doing? Whats this like for you? How can we be more present?

The Center offers three distinct paths. Meditation there are many sessions weekly with different approaches for different reasons. Education, and Direct Care where a chaplain would do home visits or hospice/hospital visits.

He spoke of MBSR (mindfulness based stress reduction) as being widely taught. The original book by John Zinn was edited heavily to remove all references to Buddhism to make it more secular (and more universal) but it is part of the Buddhist tradition. The challenge: without a grounding in ethics (which Buddhism brings), it loses something. It becomes a job rather than practice.

Asked if he sees things changing in our practice of helping the aging he points out that institutions are beginning to see the importance of spiritual care and alternate modalities. None of which is new, many have been practiced for millennia. People are starting to talk about death death cafes in England have been copied here where people talk about how they want to die and learn about advance directives and the importance of health proxies. Being Mortal by Atul Gwanda is a beautiful book about dying.

To close Chodo did another short meditation and ended by saying May the oceans of the world have enough water to wash out your ears in other words, dont believe a thing I said. Experience it yourselves.

Thursday, February 19th, 2015.

Big Changes Coming for Medicare and Medicaid 2015:
New FIDA Demonstration Program and Other Updates to MLTC
A continuation of the November presentation with more information and latest updates

Presented by:
Valerie J Bogart, JD
Director, Evelyn Frank Legal Resources Program
New York Legal Assistance Group

Documents for the meeting:
MLTC & FIDA Update 2015-01-12
NYLAG Caregivers fact sheet FIDA
Troubleshooting Medicaid Coding

Links for the meeting:
info about Govs proposed elimination of spousal refusal
KNOW YOUR RIGHTS: Managed Long Term Care and FIDA - Fact Sheets and Recorded Webinars has the caregiver fact sheet attached here in English and Spanish, plus some online webinar links

Online webinar free training by David Silva July 16, 2013 - NYLAG Webinar on Pooled Trusts - How to Use Trusts to Reduce Spend-down .(not directly about MLTC but important tool for those who have a spend-down)
Upcoming live training at CSS
View the Winter 2015 Training Schedule cost is only $50
MAR 18th a training on pooled trusts by NYLAG staff attorney Marie Vaz
Visit our Health Advocacy Website

About our Speaker

Valerie Bogart has been Director of the Evelyn Frank Legal Resources Program (EFLRP) since June 2002. EFLRP was originally founded in the 1990's by Selfhelp Community Services, Inc., in memory of the daughter of the late Hans Frank, a Holocaust survivor and a board member of Selfhelp. Evelyn Frank was a passionate legal services attorney in California who specialized in Medicaid. In April 2013, the entire Evelyn Frank Legal Resources Program moved to the New York Legal Assistance Group (NYLAG), where Valerie continues to serve as Director of the program.

EFLRP is a comprehensive legal services program that advocates for access to long-term care and other health care services for seniors and people with disabilities through a combination of direct representation, policy advocacy, professional legal education, and online resources through the website NYHealthAccess.org. Earlier, Valerie was a litigator and trainer on Medicaid long term care for the Legal Aid Society Brooklyn Office for the Aging and Legal Services for the Elderly in Manhattan (part of Legal Services-NYC) and was a Reginald Heber Smith Fellow at the Legal Aid Society in Minneapolis. She lectures and writes extensively for bar and social services organizations, has taught adjunct courses at CUNY and Fordham law schools, and has received numerous awards, including the Lawyers who Lead by Example Award from the New York Law Journal (2012), the Felix A. Fishman Award for Extraordinary Advocacy from New York Lawyers for the Public Interest (2011), the President's Award from the National Academy of Elder Law Attorneys (2010) and the Access to Justice Award of Project FAIR (2010). She is Co-Chair of the Medicaid Committee of the New York State Bar Association Elder Law Section, and served on the Board of Neighbors Together in Brooklyn. She received her law degree from the New York University School of Law.

West Side Interagency Council on Aging
Minutes of General Meeting Held on January 16, 2014

Co-Chair Rebecca Rosenzweig opened the meeting with a brief welcome and a reminder to "like" us on Facebook at West Side Inter-Agency Council for the Aging. She introduced featured speaker Valerie Bogart who jumped right in by stating that the Evelyn Frank Legal Resources Program has moved from Self Help to NYLAG with the mission to help people navigate Medicare/Medicaid.

Last year Ms. Bogart offered a preview of MLTC - now a year later we are into it and there is an expansion happening. She reviewed some of the basics: the differences between Medicare and Medicaid; dual eligible; Medicare does not cover long term care which is why you need Medicaid. We're at ground zero in NYC for testing MLTC programs that are now rolling out statewide. Recent changes include requiring nursing homes to join a MLTC program (this is not yet approved by the Feds).

To continue reading, copies of her complete presentation and important appendices (thorough breakdown of plans available) are available for download. Click here for presentation. Click here for appendices.

West Side Interagency Council on Aging
Minutes of General Meeting Held on October 17, 2013

Co-Chair Jim Palmer opened the meeting with greetings and asked how many were first time attendees. Everyone introduced himself or herself and then Jim asked if there were any announcements (see end for announcements.) He then introduced the main speaker, Ben Cirlin.

Ben elaborated on the introduction, citing his many years involvement with grieving people and posited the world is shrinking in grief - elderly people have really narrowed lives, but change is possible. In the past 25 years there have been a lot of changes in how we view grief. Cultural challenges are big. We live in an assumptive world - we make assumptions all the time, e.g.: in the Garden of Eden (used as a powerful myth about the experience of being human rather than a literal reading) the principals are attached to their bodies, surroundings and assume that the rest of life will be the same. Then the apple forces them to move east of Eden - they experience loss and shock.

Question: how do we live "east of Eden"? It's a difficult transition. In our culture we typically view only one way, but there are many paths. Mr. Cirlin told of a client named Sally who had a perfect life - kids gone, plenty of money, lots of plans with husband. She awoke one morning to find him dead of a sudden heart attack. Eight months later she spoke of a chair dance as a form of personal therapy (Ben played video.) It is a profound look at "How do I let go? How do I hold him in my heart?"

Freud's Grief Work Hypothesis was promulgated 100 years ago and most western thinking follows this: must emotionally confront loss - remember, review then detach for recreation of the unattached individual as the only way to grieve. Then Kubler-Ross in Phases of Grief cites denial, anger on through acceptance. (Short video of Homer Simpson to illustrate.) The idea is to achieve closure - to get to a point where it is not messy anymore. Our society pushes this concept - think about tragedies as they play out on TV - within days they ask about closure. (News video of child killed by hit and run framed as parents looking for driver to achieve closure.) Two weeks? You don't even understand what your world will be.

Bereavement models-linear. Loss - shock - yearning - disorder and despair - adaptation. Two editions of "Myths about Grieving":

  • 1. Depression and distress are inevitable - their absence is problematic
  • 2. Positive emotions are implicitly assumed to be absent during bereavement
  • 3. Survivors must work through loss
  • 4. It is important to break down attachment to deceased
  • 5. Survivors an expect to recover from loss and reach a state of resolution

Research meanwhile has shown that:

  • 1. Depression/distress are NOT inevitable for every individual. 45% of the population experience mild disruption and this is normal.
  • 2. There is little empirical support for the presence of distinct psychological states in sequence
  • 3. Positive emotions are surprisingly present during bereavement
  • 4. Very little to support that working through is necessary. Grief appears to be a phantom concept.
  • 5. Need to detach is false. It is normal to maintain bond with deceased loved one - phenomenon of continuing bonds.
  • 6. Stage theories posit an end point of acceptance or recovery that may not exist.

Imagine a house with 6 rooms - at first all the rooms are filled with grief. As you work through them the rooms change, but there can be one room that will always contain the grief - it's there but not the whole house. Grief is complicated, there are a variety of trajectories and complexities are good.

Styles of grief: Ken Doka and Terry Martin "Men Don't Cry, Women Do: Transcending Gender Stereotypes in Grief". Two types are emotive/poetic vs. action/engineer. Gender influences style is not determinative.

Intuitive Grief: feeling intensely, crying, lament - expressive of inner experience. Successful strategies facilitate experience and expression of feeling

Instrumental Griever: thinking is predominant to feeling as experience. Reluctant to talk about feelings. Primary adaptive strategies: action, movement, exercise, and sports. Problem solving. May have brief periods of cognitive dysfunction.

Dissonant Grief: Instrumental but wanting to be intuitive.

Most people are a mix but favor one style. How to help: Begin with yourself. Identify your own personal style. Validate the griever's style. Help educate about styles. A female instrumental griever may be the most disenfranchised. One may be instrumental early in the process and intuitive later. It's normal and okay.

For intuitive grievers traditional approaches work well - groups often work. Individual work focuses on expressing emotions. For dissonant grievers you want to assess the pattern carefully and explore reasons for the dissonance. For instrumental grievers you might employ logical analysis - breaking it down to manageable units. Problem solving. Use of therapeutic metaphors such as "carry a heavy load". Diversion and distraction as well as humor may work. Reframe strengths. Rituals, e.g. lighting candles in church or building a coffin for a deceased cat to help a child.

Dual process model: Loss oriented -- Restoration model, where the loss model works emotional and reactive processing of loss while the Restoration deals with changes and new roles brought about by death.

Another view: linear model picture a circle with a large circle inside it where the inner circle represents grief and the outer circle the whole life. The inner circle shrinks over time in the progression of grief. Another way to approach this is to make the outer circle expand - the inner circle of grief remains the same size but when the outer circle increases the proportion changes.

Dignity therapy focuses on questions about the most important events in your life. When did you feel most alive? What would you want someone to know about you? The most important roles in your life? Why? What are your accomplishments? What are you proud of? Is there anything you need to say to loved ones? Hopes and dreams.what have you learned? Etc.

".loss by itself does not cause psychopathology. Grief hurts but does not make us ill. We forget that it is the inconstant people who drive us mad, not the ones who die. We forget that it is the failure to internalize those whom we have loved, and not their loss, that impedes development." George Valliant, MD

Finally - grief offers opportunities for growth - in our own perception of us and connection to others.in our jobs and our lives as a whole.

The meeting wrapped up at about 10:50.

Next general meeting is November 21st.

West Side Interagency Council on Aging
Minutes of General Meeting Held on September 12, 2013

Co-chairs Jim Palmer and Rebecca Rosenzweig opened the meeting at 9:30 with greetings and introductions. A couple of announcements about upcoming events: Love An Elder Day was approved by the state legislature and will be celebrated on October 1st. Ron Bruno announced a 4 week interactive workshop for anyone 50+ to help envision the next phase in life. See end of minutes for more details.

Jim then introduced the featured speaker, Ann Wyatt. She began the story of how she came to the Alzheimer's Association three years ago with a mission to better support nursing homes with dementia care. Her initial issue was communication - information doesn't always get to the nursing home staff. Solution was to start a newsletter - short, action focused, easy to subscribe to online. Published every 2-3 months, it now has over 500 subscriptions with some in Canada. This led to creation of a newsletter for families of those with dementia.

The primary challenge was/is how do you change the care environment? Her research took her first to Chicago, and then to Phoenix. The Beatitudes Program in Phoenix has it figured out. They take the tough cases - ones that have been asked to leave other facilities for obstreperous behavior. The atmosphere there is calm and serene. It is easy to spend time there.

The NY Alzheimer's Assoc. then asked for volunteers for a 30 month project and three replied - Cobble Hill, Isabella and Jewish Home. There are also three hospices that are very much a part of this pilot program. The idea is that after the first year, the program will expand through these facilities.

How to do it? This is important. The Phoenix program has 100 beds vs. Isabella with 750. It requires organizational support to make these changes. And so key people were taken to Phoenix for a visit to see what can be done. And the Phoenix staff came here and provided training. A key element is the mandatory weekly staff meeting at each unit, which Ann attends. This is a time to share successes as well as challenges, eg: front line staff get hit/spit on every day and just assume it's how it works in a dementia unit. At the meetings they learn that it doesn't have to be that way.

Evaluation component is really critical. There are five pieces: 1. Artifacts of dementia care, eg. Phx does an assessment in Sept. and again in December. 2. Questions to people suffering dementia. 3. Cost study, eg. Phx eliminated supplements through better food and saved $30k annually. 4. Cost of meds, eg. a shift from antipsychotics to pain/antidepressants. 5. Minimum data set - using it for quality improvement is a challenge.

Question: do you have the state or the facility manage this data set? Having the facility do it seems to be more successful. It allows comparisons with other facilities on key markers: a) resistance to care; b) verbally affecting others; c) physically affecting others; d) other behaviors not affecting others.

The Beatitudes program has eliminated "sundowning" (agitation at the end of the day.) They did this by observing/changing: a) TV was disturbing to many patients; b) shift changes were noisy and disturbing; c) large group activities were changed to more one on one for better result - they still have activities but not large groups; d) in advanced stages rest is important - let them sleep.

They also changed the foodservice by making food available 24/7. Every 45 minutes someone comes around with a tray of nibbles. Weight loss has been eliminated. The goal was to get rid of special diets - at this stage of life they are irrelevant. Let them eat what they like. People love peanut butter sandwiches and pound cake. Dementia patients will not eat if they don't like the food. Dieticians are very cooperative, but they have to know what to provide. They love chocolate and candy - so keep a bowl of Hershey kisses around.

It's not just about what you don't do at the end of life, but what you DO. If cookies provide joy - that's wonderful! Use lollipops - it can change an experience hugely. Side note: on one of our projects in NY the staff realized the cookies were too hard. They switched them for soft ones in the dementia unit and now the entire facility wants them.

As a result of these changes visits increase because the atmosphere is better. They also encourage shorter visits, but more frequent. This seems to be easier on the family as well as the patient.

A big issue for dementia patients is pain which is unidentified and undertreated frequently. Tools to help identify pain are a behavior based form: 1. If they tell you there is pain - believe it! 2. Check the form. Do not use PRN. Once pain has been identified, Tylenol is often enough to manage it, but it must be consistent. Morning care is very critical - often patients are in pain first thing and if that is managed properly, the whole day improves. Try other pain meds if Tylenol isn't effective. Pain treatment has proven more effective than antipsychotics.

Music & Memory - a program founded by Dan Cohen and funded by the Rubin Foundation - puts ipods into dementia care units and is proving a very effective way to generate memory and pleasure. There is a film "Alive Inside" - we saw a short clip of Henry with his music. There will be a screening on September 20th - see end of minutes for details. Find out more at the websites: http://www.ximotionmedia.com (film) and http://musicandmemory.org/ (program)

All three of our pilot programs are working with Dan. The key to making it effective is to select the music that the patient loves. It's not just about what agitates you, but what gives pleasure. Result is that in many cases they eliminate resistance to morning care with music. It can also change the whole experience for family members - to see loved ones not in torment is a blessing. Interestingly, with headsets on they find it doesn't isolate but rather engages the patients. All these practices also work for other types of patients without dementia, ie stroke or other trauma.

At Beatitudes the waiting list for staff jobs is long. Our three projects are coming along. Working through the organizational concepts takes time. Staff must get past the status quo.

The key is if you think you can eliminate the sundowning, calling out etc. you can! For example: we keep people in a day room to eliminate falls. This may in fact be counter intuitive as sitting still for so long tends to make their balance worse and stiffness sets in. Also - we alarm the beds which makes it difficult for them to get any rest. At Isabella they are tackling the noise problem. They discovered that the pill crusher was disturbing so they ordered a silent pill crusher.

Individualized care matters. And it isn't necessarily complicated - it's easier to give that peanut butter sandwich than to force something else on an unwilling patient.

Following a brief Q&A the meeting adjourned.

West Side Interagency Council on Aging
Minutes of General Meeting Held on March 21, 2013

Co-chair Jim Palmer welcomed everyone and went around the room for introductions. Noted next meeting dates are April 18th and May 23rd. He turned the floor over to Florence Lynch who introduced our featured speaker, Robert Tobing of SPOP who spoke about caring for older adults with mental health challenges.

Bob explained that SPOP is an offshoot of SelfHelp created in the '70s. Today it covers all of Manhattan, though practically it is still focused on 125 St. south. Services are available to any over the age of 55. There are several programs depending on the specific needs of the client.

Continuing daycare services provide ongoing support for adults with serious or persistent mental illness needing more than just a weekly clinic visit. The small program size allows for greater personalization and "perfect" continuity of care. It will be converting to a PROS (personalized recovery oriented services) program as funding has been dramatically reduced - 25% retroactive to last April. The PROS program is focused on getting clients back to work/school and is not typically geared to the older adult. It does offer a message of recovery and hope and SPOP is working within the program to make it more appropriate to the older client.

Bob Franco, director of Adult Day Services, spoke briefly about his program for adults with Alzheimer's, dementia or memory loss. CDTP funding ends in September with a move to PROS. SADC @$75/day and there are slots available. Transportation is available at approx $20-25/day though many clients are within walking distance. It is a very community centered program.

With LTMC issues coming to the fore, it is useful to note that many of them will pay for the services offered at SPOP. Two specific programs with contracts are Senior Health Partners and Centerlight.

For intake call (212) 787-7120 ext. 514. During the call the level of care required will be determined. Either client or referring agent can call. Within one week case is assigned to a clinician. In-person screening is set up. This can be done at home if necessary. (SPOP has just converted to HER electronic record keeping and all staff use tablets in the field.) The emphasis is on the client determining treatment and plan by identifying goals, determining modality and whether brief or long term therapy is required.

Program is not in a typical clinic setting, but located in a church. There is a nursery school in the basement making for a nice sense of mixed community. There are satellite centers in other senior facilities, ie: Carter Burden, Stanley Isaacs etc. All are designed to encourage confidentiality and minimize stigma.

The program has recently added a psychiatric nurse practitioner with a focus on wellness. Her office is front and center so she is always aware and she is a major addition to the program.

Challenges are mostly about funding. PROS; Health Homes were funded by Medicaid and now? MLTC has all senior centers looking to find ways to work within the new system.

Final takeaway - SPOP helps older adults maintain their health and independence.

Jim thanked the speakers and the meeting ended at 10:45.

West Side Interagency Council on Aging
Minutes of General Meeting Held on February 21, 2013

Co-Chair Jim Palmer opened the meeting and thanked Rachel Fredman and Jewish Home LifeCare for providing space and support for these meetings. Co-Chair Rebecca Rosenzweig greeted first time attendees who hailed from Harlem, Mt. Sinai, Hunter College, the Actors Fund, Project Open, St. Lukes to name just a few. Maxine Metersky of the membership committee invited all attendees to become members. Jim then introduced the speaker, Valerie Bogart, with a short bio and a big welcome.

It is an overwhelmingly confusing time Ms. Bogart began. She went on to state that words matter and in these changes to policy you must be vigilant about the terminology. Selfhelp has done great work in putting together a very useful website that has all the pertinent information you might need, and it is updated constantly. This should be a go-to resource: NY Health Access.

The move to Managed Long Term Care is complex and evolving, but changes are already happening. Some key things to watch out for include type of plan selected (the website has a grid you can download with details about every type of plan and each provider within those plan types); changes in the appeals/grievances process timing is critical. NYS requires a notice of appeal rights. If care decreases you can get a continuance if paperwork is filed on time but the process is a 2 step one now.

Please click here to access Ms. Bogarts entire presentation. The final page is a contact list with links to agencies with names and phone numbers, articles and tools that will be a great resource in the coming months.

Q&A session went past the allotted time, but it was a lot of material with an enthusiastic crowd. Rebecca thanked Ms Bogart and the meeting adjourned.

Announcements: Eldercare specialist seeking employment opportunities. Skills include interpersonal communication, supportive counseling, advocacy and case management. Contact: Joy at j7nyc@verizon.net.

West Side Interagency Council on Aging
Minutes of General Meeting Held on February 17, 2011

Arleen Stern, board member,opened the meeting at 9:30am and welcomed everyone. Helena Ross, Directory, let everyone know that our automated system for updating/adding directory listings will be available soon. Rebecca Rosenzweig, Membership, encouraged all present, to pay their dues to WSIACA. All present introduced themselves.


Helena Ross: The Mount Sinai Chelsea-Village House Call Program is now providing Team-Based Medical House Calls. Their Goal - to allow elders to remain in their own homes, to avoid unnecessary hospitalization, and nursing home placement through regular medical care and social support, primary care in the home.
Please call for further information or to make a referral. (212) 604-6534.

NYC DFTA HIICAP Program has trained volunteer counselors available to help people with Medicare and related insurance. We are looking for sites to place our counselors to offer one-to-one assistance.
Contact Eric Hausman, 212.422.0075 or ehausman@aging.nyc.gov.

Jim Palmer, Program, introduced our speaker Valerie Bograd, J.D. Director, Evelyn Frank Legal Resources Program, Selfhelp Community Services, Inc., New York since 2002. She has received many awards for her outstanding service to the aged. We were quite honored to have her speak to us.

Her topic was: Breaking News:The Latest in Budget Issues/Decisions & Medicaid Cuts Affecting Our Work With Seniors.

Please find her outline below:

New York State Budget 2011 -- Status as of 2/15/2011


EPIC would not longer cover anyone without Part D.

Of the current 302,000 enrollees, about 50,000 are not in Part D plans - because they are in Medicare Advantage, a retiree plan, or not eligible for Medicare (immigrants without green cards for 5 years).

EPIC would no longer cover drugs during the annual deductible period

EPIC would no longer pay or subsidizes the monthly Part D premium.

EPIC would continue to pay for drugs during doughnut hole of Part D -- in fact, this is all it would still do.

EPIC would no longer "wrap around" Part D to help reduce its costs. It would no longer:

Subsidize the Part D copayment. If the Part D copay is $60 for a brand name drug, now the consumer must pay it all. Before, EPIC would pay $40 and the member only pays a maximum of $20 per brand name drug.

Pay for a drug if the Part D plan refuses to cover a drug because it is not on its formulary. Now, EPIC will pay for it if the member's physician requests an exception to the formulary and files a second appeal.

Who will be most affected?

52,000 (out of 302,000 enrollees who are not on Medicare or who have Medicare but have been excused from enrolling in Part D because it would jeopardize their retiree coverage, etc.

Those not on the "Low Income Subsidy" for Part D. In the end of 2009, out of 254,000 EPIC members with Part D, about 78,000 had "Extra Help" or the Low Income Subsidy, or fewer than one-third of those who have Medicare.

About 58% of all EPIC members are singles or couples with incomes under $20,000 per year. But only some of these are on "Extra Help." (The income limit for Extra Help is 135% FPL for Full subsidy (under $15,000/year for ONE, $20,000 for TWO), or 150% for Partial ($16,300 for ONE).. The rest will have increased costs with premiums (Over $30/month), higher copayments, the annual deductible).


No specific proposals yet but the Medicaid Redesign Team is scoring 49 proposals on five indicators: quality, efficiency, overall impact, savings for year 1, and savings for years 2 and 3. The deadline for team members to complete the ratings is noon on Friday, February 18. Governor's budget calls for $2.8 billion in cuts to a $53 billion dollar program..

See http://www.health.ny.gov/health_care/medicaid/redesign/

Download PDF of all 49 cuts: http://www.health.ny.gov/health_care/medicaid/redesign/docs/proposals_being_rated.pdf


Elimination of Level I Personal Care Services (housekeeping)

Requirement that Personal Care Recipients be Eligible for Nursing Home level of care - reportedly 23% are not.

Provider-specific aggregate per patient spending limit for personal care services.

A home attendant vendor would receive a reduced aggregate amount to provide services for x number of clients. It would be less than the current amount. The vendor and HRA would have to figure out a way to provide the services, likely reducing hours per client.

We believe this would be illegal, depriving clients of hours they are entitled to by law -- but if the law changes, it is hard to know what they are entitled to.

Prospective payment system for CHHA services (capitated rates)

Move 7,000 more people to Managed Long Term Care. which has increased from 20,000 to 27,000 enrollees since 12/07.

ALL 49 Proposals

Proposal Description Proposal #
1.Increase the Health Facility Cash Assessment Rates 1
2.Reduce and Control Utilization of Personal Care Services (see detail above) 2
3.HCRA Streamlining 3
4.Eliminate 2011 Trend Factor (1.7%) 4
5.Reduce and Control Utilization of CHHA Services 5
6.Reduce MC / FHP Profit (from 3% to 1%) 6
7.Elimination of the Personal Care Benefit for Persons who are not NH Certifiable 7
8.Reduce MC / FHP / CHP trend factor (1.7%) 8
9.Eliminate All Targeted Case Management for Managed Care Enrollees 9
10.Eliminate Direct Marketing of Medicaid Recipients and Facilitated Enrollment activities by Medicaid Managed Care Plans. 10
11.Bundle Pharmacy into Medicaid managed care 11
12.Reduce/Redirect Indirect Medical Education (IME) Payments 12
13.Restructure Reimbursement for Proprietary Nursing Homes 14
14.Rebuild NY Preferred Drug List 15
15.Implement Pricing Reimbursement Methodology for NHs 16
16.Reduce fee-for-service dental payment on select procedures 17
17.Eliminate spousal refusal. 18
18.Eliminate D&TC Bad Debt and Charity Care 19
19.Establish New Ambulette Dialysis Transportation Fee (reduces it to same amount as for adult day health care) 22
20.Coverage for Dental Prosthetic Appliances - eliminate dentures for adults 23
21.Remove Physician component from Ambulatory Patient Group (APG) base rate 25
22.Utilization Controls on Behavioral Health Clinics 26
23.Prior Authorization for Exempt Drug Classes 32
24.Prescription Limitation to 5/month 35
25.Eliminate Part D Drug Wrap in Medicaid 43
26.Limit opioids to a four prescription fill limit every thirty days. 57
27.Home Care Worker Parity - CHHA / LTHHCP / MLTC 61
28.Revise Indigent Care Pool Distributions to align with Federal Reform 66
29.Assist Preservation of Essential Safety-Net Hospitals, Nursing Homes and D&TCs 67
30.Uniform Assessment Tool (UAT) for LTC 69
31.Expand current statewide Patient-Centered Medical Homes (PCMH) 70
32.Implement Episodic Pricing for Certified Home Health Agencies 79
33.Reduce Unnecessary Hospitalizations - Geographic Community Based Pay for Performance 87
34.Address Health homes for high cost/high need enrollees 89
35.Mandatory Enrollment in MLTC Plans/Health Home Conversion 90
36.Carve In for Behavioral Health Services into Managed Care 91
37.Allow Restricted Recipient Program in Managed Care 92
38.Implement Regional BHOs for Behavioral Health Organization 93
39.Include Personal Care Benefit in Managed Care 95
40.Expand Managed Care Enrollment 96
41.Assign Medicaid Enrollees to Primary Care Providers 97
42.Streamline Managed care enrollment eligibility process 98
43.Develop Initiatives for People with Medicare and Medicaid 101
44.Limit divestment and encourage private LTC insurance 111
45.Reform Medical Malpractice and Patient Safety 131
46.Mandate Participation in the OMIG Cardswipe Program for all Pharmacies. 155
47.Eliminate Medicaid Payments for Medicare Part B Co-insurance 162
48.Supportive Housing Initiative 196
49.Accountable Care Organizations (ACOs) 243

Prepared by Valerie Bogart, Selfhelp Community Services, Inc.

Evelyn Frank Legal Resources Program , 2/16/11 212.971.7658 vbogart@selfhelp.net

West Side Interagency Council on Aging
Minutes of General Meeting Held on September 16, 2010 9:30 AM

Laura Poschar, WSIACA Chair, opened the meeting at 9:30 AM and welcomed everyone.


Jim Palmer, WSIACA Program Co-Chair: Next General Meeting will be held on 10/21/10. Speaker will be Bob Kalin from Housing Conservation Coordinators presenting on Elder Housing Issues. An attorney from HCC will also present.

Speaker for the 11/18/10 WSIACA General Meeting will be Kim Williams, Geriatric Mental Health Alliance.

NY Geriatric Care Managers Conference will be held 11/4/10. Further information, nygcm.org

Arleen Stern introduced our speaker, Lucia McBee:
Lucia McBee, LCSW, MPH, CYI
Author: Mindfulness Based Elder Care

Topic and Speaker:

Mindfulness Based Elder Care Skills for managing and living with pain, stress and behavior challenges

  • I. Overview of CAM (Complimentary Alternative Medicines)
  • II. Adapted Practices for work with older adults
  • III.Application to Self

Use of Complimentary Alternative Medicine (CAM) is used by 74% of health care professionals. There are 100 CAM interventions as listed by the National Institute of Medicine. CAM is taught in medical schools and is a consumer driven trend.


  1. Alternative medical system (Ayurvedic, Eastern medicines)
  2. Mind Body practices (meditation)
  3. Biologically based therapy (vitamins, herbs)
  4. Manipulative & body based methods (Energy therapies, Reiki)

For further information: Http://nccam.nih.gov/health/whatiscam/


  • Low risk, low cost.
  • CAM engages patient in the healing process and is a diverse cultural model.
  • CAM can offer pain relief for chronic conditions. Pain cannot be fixed, but managed.
  • Use with Frail Elders:
  • Stress and pain impact quality of life. CAM is a holistic model that addresses the mind/body/spirit
  • Healing options for elders with communication or cognitive difficulties.
  • Can offer relief at end of life
  • Families can learn skills to help loved ones

Staff and caregivers also suffer from stress and physical symptoms. CAM techniques provide tools for self care.

Ms McBee led attendees in an interactive exercise separating associations and judgments from the moment. Participants discussed thoughts, reaction to exercise.

MBSP: Mindfulness Based Stress Reduction
Mind-body interact
Focus on abilities rather than disabilities
Skills taught experientially

S Stop what you are doing
T Take a breath
O Observe how you are feeling
P Proceed


  • Meditation, gentle yoga - with frail elders, calming tone of voice, body language and use of concrete language recommended
  • Guided Imagery-use of senses visual, auditory, olfactory, tactile and taste
  • Yoga Breathing Exercises
  • Aromatherapy-essential oils recommended: Peppermint and lavender. Cautioned against putting essential oils directly on the skin. Almond oil recommended for delivery, or put a few drops on a cotton ball for scent.
  • Hand Massage-use of almond oil, gently stroking hands
  • Familial Involvement-CAM skills can be taught to family members
  • Creativity and humor: Laughter Meditation

Skills for Teaching, Adaptations

Recommended adaptations for older adults:
Shorter groups, use of concrete simple language. Create a calming milieu, use of aromatherapy, music, and chair yoga
For the teacher, calm demeanor, flexibility and acceptance essential.

Stress can create burnout, physical and emotional problems for the caregiver. Stress is contagious. A person living with dementia can sense caregiver stress.
Tips for stress busting include:
Listen to body signals-take time out
Be mindful of the role of perception in stress

Benefits of Caregiver reduction:
Prophylactic CAM increases resiliency.
Studies reveal that meditation may change brain pathways and immune function.

Meeting adjourned at 10:40AM

Submitted by:
Patricia Peterson, LMSW
Home Outreach Program for Elders

West Side Interagency Council on Aging
Minutes of General Meeting Held on 03/18/10

The meeting started as WSIACA Co-Chair, Arleen Stern, greeted and thanked everyone for attending. She asked all attendees to sign in; and encouraged anyone who was not a member, to become a member of WSIACA. Ms. Stern also reminded the group of the next general meeting which will be held on April 15th, 2010. The guest speaker will be Benjamin Cirlin, CSW, speaking on: "Grief and Bereavement: How It Affects Us As Clinicians"

Ms. Stern invited the attendees to introduce themselves.


Diane Schottenstein, President of Elite Home Services, LLC, introduced her new blog, elitehomeservicesmuc.com. She stated that anyone can add comments to the blog on how to deal with financial abuse of seniors.

Michael Hoffman, WSIACA Bea Goldberg Committee Co-chair, reminded everyone of our Annual Bea Goldberg Memorial Lecture, May 12, 2010. Dr. Christina Zarcadoolas, Mt. Sinai, will speak on Medical Literacy: The Pathway to more Effective Communication.

Deborah Scheinberg provided a flyer from The National Network for Social Work Managers. On April 29th and 30th at Fordham University at Lincoln Center, a seminar will be held on the topic of Visionary Management: Preparing to be Agents for Change in a Post-Recession Environment. For further details, www.socialworkmanager.org or contact Shelly Wimpfheimer at swimpf@aol.com.

Guest Speakers:

Jim Palmer, WSIACA Membership Committee Co-chair, introduced guest speakers from StoryCorps, Charlotte Okie and Liam Pierce--StoryBooth Department Interns, and Alexis Creer--Memory Loss Initiative Coordinator. Their topic of discussion was: "Honoring the Life Stories of Older Adults."

Liam Pierce, a booth worker at StoryCorps, began with a question Is there a fact about you, that by looking at you, a person would not know? Mr. Pierce went on to tell us that the mission of StoryCorps is to provide Americans of all backgrounds and beliefs with the opportunity to record, share, and preserve the stories of our lives. This is accomplished through both the StoryCorps interview experience and the content that emerges from these interviews. (http://storycorps.org/about/mission-and-principles). The interview is an opportunity to highlight voices often overlooked in our society and ensure their stories are passed on to future generations.

The next StoryCorps speaker was Charlotte Okie. She informed us that the organization has been in existence since 2003. Over 10,000 people have shared life stories with family and friends through StoryCorps. Each conversation is recorded on a free CD to share and a copy is preserved at the Library of congress. Millions listen to the PBS broadcasts on public radio and the web. StoryCorps is the largest oral history project of its kind. Through these life stories, youth have a chance to learn from their elders and grow closer to family and friends.

Alexis Career is in charge of the Memory Loss Initiative (MLI) at StoryCorps. The MLI was launched in 2006 to encourage people affected by memory loss to share their stories. A person does not have to have clinical diagnosis in order to participate. So far, StoryCorps has done over 1700 interviews and recordings under the Memory Loss Initiative. The Memory Loss Initiative has two other programs: StoryKit The Door-to-Door. Through StoryKit, family members can interview and record their loved ones at home. The Door-to-Door program is the one in which trained staff visits different sites. The Door-to-Door Program is recommended for organizations, schools, churches, institutions, and families. StoryCorps will bring portable recording equipment to a location to record up to six 40-minute interviews per day. Organizations across the country have used Door-to-Door sessions to celebrate anniversaries and milestones, add a personal voice to fundraising and marketing materials, and provide the meaningful StoryCorps experience to their community.1 Both the StoryKit program and Door-to-Door program are not exclusive to the Memory Loss Initiative, but under the Memory Loss Initiative fees are waived for both programs

The meeting concluded with a Q&A session. The representatives from StoryCorp answered questions from the audience. It was an enlightening and informative meeting.

Respectfully Submitted,

Ruth F. Lewis
Amsterdam Adult Day Health Care Pgm.

Minutes, WSIACA General Meeting
February 18, 2010

WSIACA Co-Chair, Arleen Stern welcomed attendees to the meeting and encouraged everyone to peruse wsiaca.org where it is now possible to sign up for e-mail meeting notices. Arleen encouraged attendees to support WSIACA by joining the organization. She then introduced our new administrative person, Dee Greenwood. Introductions of all attendees followed.

Upcoming WSIACA Meetings:
March 18th will feature Veronica Ordaz, NY Site Supervisor of Story Corps speaking on "Honoring the Life Stories of Older Adults."

April 15th, Ben Cirlin,CSW, will speak on "Grief and Bereavement: How it Affects us as Clinicians".

May 12th, Wednesday, our annual Bea Goldberg Lecture, will feature Dr. Christina Zarcadoolas, Mt. Sinai, speaking on Medical Literacy: The Pathway to more Effective Communication.

Jewish Home Lifecare's Insights Connections is available by e-mailing Rise Landsman rlandsman@jewishhome.org with your request and e-mail address.

Susan Mandel, JHL is looking for a LMSW's for fee-for service social workers. Must have home care experience. Interested applicants should check the JHL website, www.Jewishhome.org.

Dorot's Passover Package Delivery, Sunday, March 21, 2010 - 10:30 a.m. - 1:00 p.m. Annual volunteer opportunity to visit the home bound. Call 212 769-2850, Carrie Jacobs, Mgr. Volunteer Services or Alexandra Newman-Kofinas, Prog. Asst. Volunteer Programs.

Irene Zola, Executive Director, introduced a new volunteer organization called Morningside Village, providing volunteer services in the Columbia University area. This gratis service for older people, serves the 108th-116th St. areas, Morningside to Riverside Drive. Call 917- 775-1199 or e-mail info@supportseniors.org for more information.

Our Speaker:
Jim Palmer, WSIACA membership Committee co-chair, then introduced our speaker, Valerie J. Bogart, J.D., Director, Evelyn Frank Legal Resources Program, Selfhelp.

Ms. Bogart spoke on "Elder Law Update: New Power of Attorney Forms & NYS Proposed Budget Changes for 2010.

Handouts were distributed on: "Statement of the Ad Hoc Statewide Coalition Opposing Cap on Medicaid Personal Care and Consumer Directed Personal Assistance Program (CDPAP) Services", "NY State Consumer Coalition on Part D, "Wrap-around" coverage in the EPIC and Medicaid Programs for drugs not covered by Medicare Part D plans"; "The New Form M11q in the Medicaid Personal Care (a/k/a Home Attendant) Program in NYC".

Selfhelp will be offering training to understand the new form slated to go into effect on APRIL 1ST. Tuesday, 3/9/10 and Monday, 3/15/10. Valerie Bogart, Esq. and David Silva, Esq. will be the trainers. Please contact Selfhelp if you are interested. vbogart@selfhelp.net or call 212 971-7693.

Ms. Bogart discussed the new Power of Attorney forms, stressing that this is not a do it yourself form. In almost all situations, a lawyer should be involved in facilitating this form.

As always, Ms. Bogart was a fount of information.

Arleen Stern thanked her for her clear and informative presentation.

Respectfully submitted,
Sheila Schlosser, Director, Community Relations, The Esplanade

Minutes, WSIACA General Meeting
November 19, 2009

Co-Chair Arleen Stern: Introductions and next meeting will be February 18, 2010. Valerie Bogart, attorney for Self Help will presen on the new power of attorney and other legal updates. Arleen encouraged all present join WSIACA, and help us with your membership dollars.

Today's speaker is Ms. Gale Brewer, Council Member for New York City since 2002, Upper West Side and Clinton. Ms Brewer is Chair of the Technology and Government Committees, was Chief of Staff for Ruth Messinger.

Ms. Brewer focussed primarily on the topic of bed bugs.

Bed Bugs: Two to three years ago they started to become more visible in New York from SRO's, hotels. This has expanded to private homes, and they are primarily found in mattresses. Department of Health, Dr. Friedan, said at the time that it was not a health problem, but this has since changed. Ms. Brewer contacted the State of New York to institute a program for refurbishing mattresses. Adult Protective Service, hospitals and co-ops have been involved, working together to develop strategies to address this every spreading problem. There is a bed bug task force, with weekly meetings. There is a web site, New York vs. Bed Bugs (newyorkvsbedbugs.org). This contains useful links and information on how to address the bed bug problem. There needs to be education for agencies, workers, etc. in how to advise people to avoid, prepare for and clean up after fumigation. There is also work with moving companies to clean up their trucks and moving equipment.

City Council: Thirteen new members began in the City Council as of last January. Their work focuses heavily on budget rather than legislation which comes out of the state. Councilmember Arroyo is the chair for aging issues.

Commissioner of DFTA is thinking about the issues of helping to keep people at home. There are tenant's workshops once a month on Wednesdays at Goddard-Riverside to provide legal support and advocacy for tenant's problems. Another incentive is to put up timers near bus stops that indicate how long it will be until a bus arrives; this has been very successful in other cities.

Arleen Stern thanked Ms. Brewer for her time and very helpful presentation.

The meeting adjourned at 10:40a.m. following questions and comments.

Respectfully submitted,
Helena Ross,
Mt. Sinai Visiting Doctors Program

West Side Inter-Agency Council for the Aging, Inc. (WSIACA)
Minutes Thursday 10/15/2009

The meeting was opened by Arleen Stern, WSIACA Co-Chair, who invited everyone, including new attendees to join. Arleen announced the next general meeting's speaker will be Council Member Gale A. Brewer. Arleen also stated that membership letters will be sent out in November.

Arleen R. Stern invited the attendees to introduce themselves and take the opportunity to make announcements as well.


1. Selfhelp Manhattan Nazi Victim office has an opening for a full time position of MSW social worker. The job will be starting on November 15, 2009. Please contact Lilian Sicular at 212-971-5475 or email to lsicular@selfhelp.net.

2. Caring People is looking for a full time Registered Nurse. Please contact Caring People at 718-425-4600 or check on line at caringpeopleinc.com.

Speaker: Mark Goreczny, Program Officer, Citymeals on-Wheels Prior to the spring, there were a number of different meal providers throughout the city that did assessments of possible clients for their individual programs.

Then, New York City's Department for the Aging enacted some changes that would affect the enrollment procedures for the home delivered meal program and how it would be structured.

Many of the same agencies that provided meals are still doing so, but there are only a small set number for the entire city, divided roughly by community districts.

Now, in order for a client to enroll in the program, they must contact the case management agency that serves their area. Case management agencies may screen their clients for home delivered meals and authorize all those deemed presumptively eligible to receive meal services prior to performing an in home assessment.

To be eligible, a client must be 60 or over, homebound, and unable to cook meals or shop for themselves. If a client has 20 or more hours of homecare, they are not eligible. You can call the case management agency with any more specific questions on eligibility.

For Community Boards 4 and 7, the case management agency to contact is Selfhelp Project Pilot, 212-787-8106. To find out the case management agency outside of these districts, you can go to www.citymeals.org , click on "Get Meals" and then put in the zip code under "Find your Case Management Agency"

Speaker: James Nussbaum, PhD, MSPT
Mr. Nussbaum is the Clinical Director of ProHealth and Fitness. He has extensive experience in physical therapy and physical fitness.
Topic: Fall Prevention in the Aging Population
In this country, 35% to 40% of 65 and older adults fall every year which amounts to approximately 350,000 people yearly. Patients in the hospitals and residents in the skilled nursing facilities have three times more falls than in the community. Among all the cases, 25% of the falls result in fracture, laceration and hospitalization. Falls are ranked number five in the cause of death. All these statistics indicate that Medicare pays a huge amount of money to heal and care for people from the results of falls. We can reduce the cost of Medicare by providing fall prevention program to the at risk population.

Goals of fall prevention are improving the quality of life and longevity.

Fall prevention:

Assessment/screening-It is preferred to use a team approach. The team should include patient, family, social worker, home health personnel, physical therapist, occupational therapist, psychiatrist and physician.

Education-Identify the problems and offer solution.

Awareness-Understand the risk factors.

Group Program-Exercise is the key to prevention of many ailments.

Individual Program-Physical therapist needs to work up the program for the specific needs.

Proper Use and Fit of Assisted Devices-All devices need to be fitted by a professional person, such as MD, PT or OT for appropriate usage.

Arleen Stern thanked Mr. Nussbaum for his most helpful presentation. His organization can be reached at 212.600.4781.

Respectfully submitted,
Lillian Tsai, Assistant Director of Social Work
St. Lukes Roosevelt Hospital Center

West Side Inter-Agency Council for the Aging, Inc. (WSIACA)
Minutes Thursday 9/17/2009

Topic: Combining Innovation with "Tried and True" for best Geriatric Practice: Mount Sinai's Visiting Doctors and the Martha Stewart Center for Living Programs

Sheila Barton, LCSW -Martha Stewart Center for Living at Mount Sinai
Helena Ross, LCSW - Mount Sinai Visiting Doctors Program

The meeting was opened by Arleen Stern, WSIACA Co-Chair, who invited everyone, including new members to join. Arleen announced that WSIACA holds 6 valuable and informative meetings throughout the year. The website is up and running and she encouraged everyone to visit the site.

Arleen R. Stern invited the attendees to introduce themselves and take the opportunity to make announcements as well.

1. Carol Brown, Executive Manager at COHME INC. is currently seeking an LCSW Social Worker, interested in Elder Care Case management. Please contact Carol by email at c.k.brown@cohme.org or 212-514-7147.
2. Dr. Michael Hoffman of MBIA - inviting all to attend a panel discussion on 10/6 and 11/10 at 3pm on Information on changes of delivery services. These meetings will explore impact on recipients. For more information, please send an email to info@mbiac.org. Both meetings will take place at the Manhattan Borough President Office,1 Centre Street, 19th floor.
3. Helena Ross of Mount Sinai Visiting Doctor's is seeking a bi-lingual Social Worker. This is a full time position making home visits and working with an interdisciplinary team out of Mount Sinai. For more information please email, helena.ross@mountsinai.org.

Bruce Nathanson, Director of Communication and Marketing at Jewish Home Lifecare, provided a brief update and explained building plans in a nutshell. He announced the Land swap deal which will move the Nursing Home 6 blocks south to Park West Village. Jewish Home hopes to build a community of caring where the elderly can maximize their independence. They are in the early phases of this project. It will take 2 years to close site there and 4 years to build residential housing. Bruce shared a blueprint which will hold 9 floors for long term patients and 4 floors for short term patients. Jewish Home is working on legal zoning and the residents of Park West Village as they realize the impact on their quality of life.

Sheila Schlosser, Program Committee introduced guest speakers, Helena Ross, LCSW - Mount Sinai Visiting Doctor's & Sheila Barton, LCSW -Martha Stewart Center for Living at Mount Sinai.

Sheila Barton, LCSW - Social Worker, Coffey Practice Associates at the Martha Stewart Center for Living
Ms. Barton explained that Coffey Associates at the Martha Stewart Center for Living at Mount Sinai has always taken the lead in caring for the elderly. They are a hospital based, primary care practice for Geriatric patients staffed by specialists in Geriatric Medicine. Coffey Practice is also a teaching center for Geriatric and Palliative Care fellows who follow their own panels of patients under the supervision of Geriatric and Palliative Care attendings. Coffey Practice follows an interdisciplinary approach in which patients are assigned to a Geriatrics team comprised of a Geriatrician, Social Worker, Nurse Practitioner, Registered Nurse and Medical Office Assistant who work together to provide comprehensive care. Weekly health enhancement programs such as yoga, tai chi and meditation as well as educational seminars are also offered .

Coffey Practice accepts patients from every geographic area. Currently their patient population comes from East Harlem and north of the East and West 50's St. Although the majority of their patients are over 65, Coffey Practice will see younger patients if they have a geriatric diagnosis.

Coffey Practice does not accept patient's with managed care. This option for funding was explored in the past and was found not to be beneficial to continuity of care.

In order to provide continuity of care to their hospitalized patients, Coffey Practice provides a Geriatric Care team to follow them as inpatients. The team is comprised of an Attending Geriatrician, a Registered Nurse and a Social Worker. The team reports to the patient's personal Geriatric Attending at Coffey Practice.

Coffey Practice believes in the convenience of a centralized location to see all of their physicians for primary care as well as for specialized care. Rheumatologists, cardiologists, urologists, and gero-psychiatrists see their patients at the Coffey Practice location.

Future Directions:
Right now they have 1.5 Social workers for 2700 patients and hope to have additional Social worker support in the future. As leaders in Geriatric Care, Coffey Practice will continue to produce state-of-the-art literature and programs on healthy aging for their patients. Future directions include recruitment of additional volunteers and translators to assist their patients in navigating expansive Mount Sinai medical system.

For more information call 212-659-8522

Helena Ross, LCSW - Program Coordinator at Mount Sinai Visiting Doctors Program
Helena started by sharing the famous quote by George Burns "If I had known I was going to live this long I would have taken better care of myself."

M.S.V.D.P. provides high quality, patient centered primary and end-of-life care to homebound patients. M.S.V.D.P. is the largest academic primary care program for homebound patients in the country. They offer emotional support and social services to the families and caregivers. In additional, they provide education and experience in home care to medical trainees. The doctors are very committed to their patients and the program. During home visits, the doctor may have a fellow or a student with them as a way to train and educate the next generation of providers.

Patients can call 24 hours as doctors are on call. Patients will get a call back and this can prevent a trip to the Emergency room.

The program does accept some managed care programs which they find challenging. One reason it can get difficult is because they require pre-approval. 40% of patients in the program are dual eligible.

End of life care - 56% of patients in Visiting Doctors die at home compared to 20%. in general. They provide assistance with end of life care. During end of life care they work with hospice and palliative care.

A pilot project will commence 10/1/2009. Visiting Doctors received a two year grant to pilot a program to take care of more patients, to accommodate a waiting list of 100-150 people. Under this project, patients will be assigned to a team. Physicians and NP's (Nurse Practitioners) will use a team approach in caring for patients, with the physicians having primary responsibility. The NP will provide the follow- up visits and will do triage. With this new structure, physicians will be able to see 8 patients a day as compared to 5-6 patients.

For more information visit the website: www.mountsinai.org/visitingdoctors

Respectfully submitted,

Yesenia Zuniga, MSW
Director, Home Outreach Program for Elders

West Side Interagency Council on Aging
Minutes of General Meeting, 3/19/09

Topic: Hoarding- A Clinical Understanding and Pragmatic Approach

Susan Siroto, LCSW, Search and Care Inc.
Kristen P. Bergfeld, Owner, Bergfeld's Estate Clearance

The meeting was opened by Arleen Stern, WSIACA Co-Chair, who reminded the attendees about Bea Goldberg's memorial lecture on Intimacy and Aging, which will be held on May 13th, 2009. The next general meeting will be held on April 23rd, the guest speaker will be Valerie Bogart, who will be discussing wins and losses in the 2009 NY State Budget; updates on Medicaid home care and the Lombardi program.

Arleen R. Stern invited the attendees to introduce themselves and take the opportunity to make any announcements as well.

Barbara Danish from SPOP announced that her agency wishes to hire a Spanish speaking Part-Time CSW.

Deborah Scheinberg, WSIACA CO-Chair, introduced guest speakers Susan Siroto and Kristen P. Bergfeld.

Susan Siroto provided a detailed hand out that explained the definitions and presenting features of a hoarder, which primarily occurs in the elderly population. A hoarder is an individual who collects and accumulates an excessive amount items primarily in their home. The individual is almost always reluctant to discard any items which cause significant clutter at his or her residence.

It is unlikely for a hoarder to acknowledge that he or she exhibits hoarding patterns and that the home environment is unsafe. Hoarders tend to block walkways with their objects and/or utilize their bed or bathroom to store items.

There are proposed explanations for hoarding behavior that is not limited to the elderly. Individuals with a diagnosis with Obsessive Compulsive Disorder may develop compulsive hoarding syndrome. Associated diagnoses include dementia, anorexia, and mental retardation and individuals who experience significant depression, social phobia and isolation.

Hoarders may have emotional attachments to possessions and may have distorted beliefs about the nature and importance of items. Also, individuals with hoarding behaviors may be cognitively impaired which would affect their ability to make decisions and process information. Behavioral and cognitive treatment is recommended during and after a heavy cleaning is completed.

Kristen P. Bergfeld reviewed the services offered by her agency. Bergfeld's Estate Clearance Service was founded in 1987. The agency's primary purpose is to clear a home vacated by death, move, or relocation with care and dignity. Moreover, the agency assists in improving the quality of life of individuals who live in hazardous conditions due to hoarding behaviors. The discussion was mainly focused on the steps that need to be taken when assisting an individual with hoarding patterns.

Bergfeld's provides potential clients an on site evaluation at no cost, then a contract is drawn up specifying the cost, task, estimated time of completion, and follow up procedures to be conducted once the heavy cleaning is completed. The agency emphasizes the importance of the client having a support system in the community. In dealing with individuals with hoarding patterns, it is essential to be non-judgmental when discussing the details of the home of a hoarder. The agency will itemize belongings room by room and will not discard a particular section if the client has an emotional attachment to it.

Deborah Scheinberg thanked our speakers for their informative talks.

Respectfully Submitted,
Melody Lespier, MSW

West Side Interagency Council on Aging
Minutes of General Meeting, 2/19/09

Topic: NYC Budget Changes in Aging: What to expect in our Neighborhood and our City

NYC Council Member Gale A. Brewer
NYC Council Member Melissa Mark-Viverito

The meeting was opened by Arleen R. Stern, WSIACA Co-Chair, who discussed the charge of the organization. WSIACA was introduced as the first interagency council in NYC, founded in 1968 to encourage organizations and individuals to unite their resources and their efforts to better serve the elderly in the NYC Upper West side.

Deborah Scheinberg, WSIACA CO-Chair, invited the attendees to introduce themselves and their agencies. Attendees were encouraged endorse a petition to President Obama to make homebound elderly the beneficiary of the national service movement.

Council Member GAIL A.BREWER was introduced as representing the NYC Upper West Side since 2002 and the member of the Councils Committee on Aging and the Budget Negotiating Team. Ms. Brewer spoke about what she sees as happening in the district in the area of improving services for the aging. There are budget issues and policy concerns, and discussions about what the services for seniors should look like. Issues of case management, specifically delivery of food are being thoroughly explored. Technology and seniors issues were discussed in terms of ways to encourage Senior Centers to use more technology, in accordance with President Obamas ideas, providing seniors with opportunities to use computers, thereby staying connected to the contemporary world.

Council Members Brewer and Mark-Viverito are members of City Council Budget Negotiation Team. This year, budget hearing at DFTA will be taking place on March 13. The Budget Negotiation Team will be looking on how we are doing given the budget cuts of the previous year, making plans accordingly for the year 2010. They will be looking at what programs are needed, not at the $ 60 - 69 million budget that they have. For example, several programs, such as legal elder abuse prevention and mental health for seniors, are some sort of champions, the Council is adamant about these programs. The major budget decisions are being formulated between now and June, advocating, lobbying, speaking to the Council members now is very important. From this point of view, this meeting is very timely. The program advocates have to have their programs seen and heard by the Council members. We do not know what the Stimulus Package would bring but we know how important the advocacy on behalf of the non-profit community is. We represent hundreds of programs on the West Side of our city, we continue working as a Budget Negotiation Team, as Council Members, as individuals, because we care for our seniors.

The next speaker is Council Member MELISSA MARK-VIVERITO. She has served in this capacity since the year 2006. She has focused on preserving affordable housing and maintaining programs for seniors in the East Harlem, South Bronx, and from 96 to 110 streets on the West Side. The speaker shared how the City Council works. She spoke about the world of the City Council being very interesting in terms of how it interacts with the Mayor. She emphasized that it plays a vital role in setting up priorities for agencies and programs, in the ways they are seen, for example, by DFTA. The City Council works closely with the Administration on how they look at the services. Therefore, when it comes to funding, they give valuable recommendations about priorities. Since Council Members have their own individual allocation funds, they make active use of this money to enhance the DFTA funding of programs they consider most important. They have initiated funding of a number of their own unique projects to create an Age-friendly New York City. Another example, City Council used its own funds to enhance the DFTA funded food programs, to assure space and food allocations in the Senior Centers. Other programs, such as NORCs or prevention of AIDS, are mentioned as those under the close attention of the City Council in terms of their funding and functioning. The idea that caregivers to the elderly should be protected by the Human Rights Law is pending, and was given as an example of the legislative work of City Council.

QUESTIONS mainly reflected on the audiences concern about the quality of services provided to the elderly. Suggestion was made to establish a system, which would assure that those elderly who do not attend Senior Centers and are not the NORC residents, would not be left behind. Attention was brought to the matter of seniors having difficulty paying their rent or affording long-term care. Also highlighted was the need of directing funding into inter-generational visiting programs in order to address the growing social isolation amongst seniors in our community. Keeping Access-A-Ride and Meals-onWheels available was emphasized.

Council Members Brewer and Mark-Viverito assured the audience that they understand and share their devotion to helping seniors live with dignity.

Respectfully submitted,
Inna Kreyman

West Side Interagency Council on Aging
Minutes of General Meeting, 10/08/08

Arleen Stern, WSIACA Co-chair, made the opening remarks. After introductions, Arleen encouraged all present to become WSIACA members and to complete updated agency forms. Estelle Abramson announced that membership letters would be mailed out the following week, with the cost of membership remaining at $50 for an agency and $35 for an individual. Michael Hoffman pointed out that the Bea Goldberg lecture is scheduled for May, 2009.


Barbara Danish made the following announcements:

SPOP has an opening for a bilingual (Spanish) psychiatrist, 7 hours per week.

SPOP will be conducting Educational Seminars on "Cultural Considerations in the Treatment of Adults" on 10/23/08 at 9AM and "Music Therapy with Older Adults" on 11/13/08 at 9 AM. Call 212-787-7120 x520 or go to www.spop.org.

The SPOP Widowed Persons Service is sponsoring free bereavement support groups on the West Side and the East Side. Call 212-787-7120 x520 for more information.


Mayumi Okuda, M.D. Gambling Counselor at the Columbia Gambling Disorders Clinic of the New York State Psychiatric Institute, spoke on "Gambling in Older Adults."

Dr. Okuda defined the difference between recreational gambling and disordered gambling and provided the diagnostic criteria for pathological gambling, which is estimated to have a prevalence of 0.4% to 2.0%.

Dr. Okuda spoke of the adverse consequences of pathological gambling. These include:

  • Family dysfunction and domestic violence: 15%
  • Money losses: 22% reported losing
  • Loss of jobs, debt and bankruptcy
  • Alcohol and drug related problems: 30%-50%
  • Smoking
  • High rates of suicidal ideation and attempts
  • High rates of criminal behavior
  • Health consequences: Insomnia, GI and Cardiac problems, High Blood Pressure, and headaches

Dr. Okuda then spoke specifically about older adults and gambling. She reported that the percentage of 65-and-older Americans who recently gambled jumped from 20 percent in 1974 to 50% in 1998, a surge unmatched by any other age group. She stated that 1 in 10 older adults may face a significant risk of getting addicted.

Dr. Okuda then listed the warning signs of pathological gambling. She offered suggestions on "how to help," which include knowing where to find help, learning about legislation and public policy, increasing community awareness, education and skill development, and early intervention.

The Columbia Gambling Disorders Clinic can be accessed at www.ColumbiaGamblingDisordersClinic.org and is located at 1051Riverside Drive, NY, NY, 10032. Telephone: (212) 543-5367 or (212) 543-5280

Dr. Okuda's slide presentation may be viewed at www.wsiaca.org.

The next general meeting will be held on: Thursday, November 20th at 9:30AM, in the JH&H, Friedman conference room.

Submitted by:
Rob Bruno, Morningside Retirement and Health Services (MRHS)

West Side Interagency Council on Aging
Minutes of General Meeting, 9/18/08

Deborah Sheinberg, WSIACA Co-chair, made the opening remarks. Everyone was asked to introduce him or herself and encouraged to help boost WSIACA's membership. It was announced that the WSIACA website (www.wsiaca.org) is up and running and that WSIACA is aiming to go green. All WSIACA announcements and correspondents will soon be transmitted via the Internet. Co-chair Arleen Stern then collected feedback and ideas for the new website.

DOROT seeks volunteers for their Friendly Visiting program. This is a flexible volunteer opportunity to make weekly visits to seniors on the West or East Side of Manhattan. Volunteers of all ages are welcome to engage in a mutually rewarding relationship. Professional support is provided. Contact: Deborah Scheinberg, Director, Friendly Visiting program at 212-769-2850 for more information.


John Ramos, Community Affairs Police Officer, spoke on Identity Theft, the #1 crime in the country.

Only a few pieces of valid personal information are needed for a thief to commit fraud and they can be obtained through dumpster diving, skimming, stealing, shoulder surfing, dishonest employees, hacking, and changing an address through stealing mail.

Numerous types of identity fraud can be committed; including credit card fraud, utility fraud, check fraud, telemarketing fraud, and Internet fraud. All types can be devastating to one's credit, finances, and personal affairs.

Ways to prevent becoming a victim include keeping your personal paperwork private, shredding unneeded personal information, only carrying necessary personal information away from home, protecting computer passwords, updating computer virus protection programs, being careful with debit and credit card use, and never giving out your social security number.

To report identity theft:

  1. Close all open fraudulent accounts .
  2. Place a "Fraud Alert" on credit report.
    Equifax: 1-800-525-6282 www.equifax.com
    Experian: 1-888-EXPERIAN www.experian.com
    TransUnion: 1-800-680-7289 www.trw.com
  3. Go to your resident precinct to file report.
  4. Report theft to Federal Trade Commission
    Online: www.ftc.gov/idtheft
    By phone: 1-877-ID-THEFT or TTY, 1-866-653-4261
    By mail: Identity Theft Clearing House
    Federal Trade Commission
    Washington, DC 20580
  5. John Ramos can be reached at:
    212-694-7723 or 646-246-7719

    The next general meeting will be held:
    Thursday, October 16th at 9:00AM, in the JH&H, Friedman conference room.
    Meeting subject: Gambling Addiction and Older Adults.

    West Side Interagency Council on Aging
    Minutes of General Meeting Held on 03/20/08

    Arleen Stern: Co-chair of WSIACA, made the opening remarks. Everyone was asked to introduce themselves.


    Anne Cunningham: Council member Gail Brewer monthly housing clinic is held every third Thursday of every month at Goddard Riverside Community Center.

    In conjunction with One Stop Senior Services et al, Council member Gail Brewer is holding a forum on Aging Friendly in New York City on Thursday, March 25th at the American Bible Society. Everyone who wishes to attend must RSVP.

    Michael Hoffman: Bea Goldberg lecture at Jewish Home and Hospital,

    May 14th.

    Deborah Scheinberg: full time social worker position opening DOROT. Call at 212-769-2850 for further details.

    Lilian Sicular: NV (Nazi Victims) program has opening for a social workers. Call 212 971-7600 for more information.

    Arleen Stern: New website in operation. WSIACA.com. All meeting material will be posted. Member and member organizations can now update their information. Also need people for WSIACA Board.

    Valrey Richards-Lucas: Project Pilot has several vacancies for social workers and case managers. For more information call 212-787-8106.

    Deborah Scheinberg introduced the speaker:

    Ted Finkelstein, MSW, Social Worker,

    Director of PEA (Project of Equal Access) in the Mayors Office New York City Commission on Human Rights

    Highlights of the Presentation

    *Aim of PEA (Project Equal Access) is to resolve cases without litigation.

    *Educate people on the programs

    * Enforce civil rights law and protect people against discrimination, housing, entitlements, public accommodations etc.

    *NYC Human rights law very inclusive, known as the GRAND SCRAM


    *Landlords cannot discriminate against whom an apartment is rented to if the vacancy is publicly advertised.

    *Against the law when renting for landlord to ask about citizenship or permanent residency.

    *Employers should not discriminate against people with criminals records. *Employers should not discriminate against battered women (including terminating employment).

    *Poor people are not a protected class of people.

    *Co-ops can reject people as long as the reason is nondiscriminatory. Bill is pending which will mandate coop boards to disclose to potential buyers the reason for a rejection.

    *People are entitled to damages when they are discriminated against.

    *The bulk of the discriminatory complaints at this time are from the disabled and older people.

    For further information and assistance call:

    Ted Finkelstein - 212-306-7330

    Harvey Fisher 718-722-3133 (Brooklyn Coordinator)

    Respectfully Submitted

    Valrey Richards-Lucas, Recording Secretary

    Selfhelp Project Pilot

    West Side Interagency Council on Aging
    Minutes of General Meeting Held 02/15/08

    Arleen Stern: Co-chair of WSIACA
    She made the opening remarks. Everyone was asked to introduce themselves. People were encouraged to become members of WSIACA.
    Arleen announced that the new website is finished and the webmaster is making final edits. Current members will be afforded the first opportunity to update their information on the newly redesigned website.
    This year's Bea Goldberg's speaker will be Dr. Gary Kennedy, geriatric psychiatrist who will speak on aging and mental health concerns; the event will take place on Wednesday, May 14th at the Jewish Home and Hospital.

    Carla Slomin -WSIACA Board member announced that the WSIACA board is seeking new members; interested parties can call her at 212-580-0535. The Board meets 1st Thursday of each month at DOROT.
    SPOP is hosting a series of educational seminars, starts March 7th.
    DOROT has opening for a full time SW. Call 212-769-2850.
    Selfhelp Project Pilot has openings for a number of Social Workers and case managers. Call 212-787-8106.

    Arleen Stern introduced our speaker.
    Brett Saarela, LMSW of SPOP:
    Her experience includes working with individuals and groups in Substance Abuse. She has worked as Post Graduate Center, Jarvie and SMART recovery program among others. This spring she was nominated as a NASW Member-at-Large and would be delighted to have votes of NASW members.

    Highlights of the Presentation

    • There are many barriers to overcome in order to detect and treat substance misuse in older adults.
    • Substance misuse in older adults is viewed as a hidden epidemic because it is often under recognized, under reported in older adults.
    • Barriers to detection and treatment in older adults includes such factors as social isolation; the invisibility of older substance misusers; enabling family members; bias of stereotyping older adults as "drunk;" bias against ability for change; invisibility of older substance misusers
    • Examples of chemicals which can be missed or "abused" include alcohol, tobacco, caffeine, sugar, prescription drugs and illicit drugs.
    • Substance Abuse in Older Adults can be difficult to detect due to varied reasons. Symptoms can often be confused with signs of dementia, depression, anxiety and other physical problems including memory loss, falls, mood swings, insomnia, irritability and social withdrawal
    • The benefits of treating substance misuse elderly are
      -improved quality of life
      -improved ability to care for self
      -less cost for health care system overall
      -positive response to treatment likely

    Web sites for self-help groups, exercises & readings:

    To make a referral to SPOP: 212-787-7120 X514

    Respectfully submitted
    Valrey Richards-Lucas, Corresponding Secretary
    Selfhelp Project Pilot




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