Partnering with the Community
A Committed Housing Partner
When New York City announced its intention to provide a new pool of funding for NORC programs, the Samuel Field Y identified Deepdale as a potential site. Staff made a presentation to the Deepdale Gardens coop board of directors about its existing Clearview Gardens project, and then scheduled a series of follow-up meetings to address questions as they surfaced. “We did a hard sell about why it would be advantageous to have a NORC program,” said the Y’s Karen Schwab.
The coop board already understood some of the challenges its elderly residents were facing, and they knew those problems had consequences for the entire apartment complex. They had heard complaints from unhappy neighbors, knew that seniors regularly called the management office when they did not know where else to go for help, and paid legal fees when eviction became necessary.
But the board also recognized that the city’s requirement for matching funds meant it would have to make a financial commitment from the outset. Ultimately, its decision to do so reflected more than just altruism. “It is not just that the board is so interested in being wonderfully helpful to elders,” said Ms. Schwab. “They are looking at the economics. They don’t have the staff or the knowledge base to manage some of the challenges faced by an aging population.”
By all accounts, the coop has been a willing partner for many years. Keeping residents safe is in everyone’s interest, and the management office is well aware that it doesn’t have the knowledge or staffing to deal effectively with a resident who wanders or forgets to pay bills. Deepdale CARES offers training at luncheons and other forums to help management know how to identify isolated and vulnerable seniors, and when to alert program staff to potential problems. Maintenance personnel learn to be alert to signs of trouble when they are in apartments making home repairs.
But if the NORC program is an asset to the coop, no one at Deepdale CARES takes its annual contribution of $25,000 – plus other in-kind services -- for granted. Recognizing that board members keep changing, and priorities can shift at any time, “we have to constantly reeducate the board about what a NORC program is, what it does and how it is helpful,” said Ms. Schwab. “I don’t make the assumption that they are willing to write me that check every year.”
Nursing Services: From a Community Benefit to a Budget Line Item
North Shore-Long Island Jewish Health System enthusiastically accepted the Samuel Field Y’s invitation to join as a partner to Deepdale CARES. “Our health system has been very involved in integrating and coordinating care to the elderly,” said North Shore-LIJ's Lynda Cooper. “We thought it was a terrific opportunity to become known in the community as an innovative health provider.”
Traditional reimbursement streams rarely cover the kind of long-term, home-based nursing that North Shore-LIJ’s community nurse now provides in the Deepdale NORC program. “No one pays to have someone come in to help a resident manage chronic illnesses, keep the home safe, and help families understand what they can do,” said Ms. Cooper.
But hospitals are required to provide some level of non-reimbursable services, known as “community benefits,” to maintain their tax-exempt status, and that is what North Shore-LIJ intended by covering nursing services two days a week without charge. “We are committed to giving back to the community that patronizes us with a certain amount of activity that no one pays for,” said Ms. Cooper.
The partnership with Deepdale CARES, which Ms. Cooper called “a great fit,” also gave the health system an opportunity to experiment with innovative programming; to conduct research to learn how best to promote good health among seniors living in the community; and to inform some of its other activities involving elderly populations.
But over time, and as other NORC programs also requested nursing services, North Shore-LIJ decided the stable funding streams for nursing was needed. It was a matter not only of economics, but of sustainable program design. “The margins of health care have changed over the years, and there is a lot of competition for that margin,” said Ms. Cooper. “Nursing is critical to NORC programs and we felt that as a principle in their development, it has to be paid for.”
At Deepdale CARES, the budget transition occurred gradually. In 2004, through the NORC Health Care Linkage Project, the United Hospital Fund and the New York Community Trust provided funding for two additional days of nursing service to focus on falls prevention, while North Shore-LIJ continued to underwrite the other two days. Two years later, the Samuel Field Y was able to assume the full costs of nursing through its public sector grants. Continued...