The end of 2008 was perhaps not the most favorable moment to assume the helm of the city's Department for the Aging (DFTA). At a time when all city functions were being asked to do more with less, DFTA faced some $38 million in pending budget cuts; broad criticism of its plan to streamline services and centers for the elderly; and the abrupt, scandal-tinged resignation of Commissioner Edwin Mendez-Santiago.

Mayor Bloomberg chose to appoint a veteran public servant as the new commissioner of the agency that oversees the welfare of the city's 1.3 million residents over the age of 60. Lilliam Barrios-Paoli has done everything from holding leadership positions at United Way, Literacy Volunteers of NYC, New York City Partnership and Lincoln Medical and Mental Health Center in the Bronx, to serving as commissioner of the city's Department of Employment, Human Resources Administration, and Department of Housing Preservation and Development – the latter two appointments even overlapping for a time during the Giuliani administration. Immediately prior to joining DFTA, Barrios-Paoli was president and CEO of Safe Space NYC, a nonprofit providing a variety of services to at-risk children and families.

After taking office in February, Barrios-Paoli wasted no time making her mark, postponing the process for overhauling the city’s senior centers by one year and reversing preliminary cuts to programs for case management and home-delivered meals. In June, the department was bolstered by the restoration of $32 million by City Council; DFTA's budget for fiscal 2010 stands at $289 million, down $7 million from last year.

Just last week, Barrios-Paoli joined in the Bloomberg administration's announcement of 59 new initiatives aimed at accommodating growth in the city's senior population, predicted to increase by nearly half a million by 2030. Described in this report, "Age Friendly NYC: Enhancing Our City's Livability For Older New Yorkers," the programs are designed to promote "active aging" along four policy areas: community and civic participation, housing, public spaces and transportation, and health and social services.

Barrios-Paoli, who turns 63 this week, sat down with City Limits recently to take stock of what it means to be a senior citizen in New York City today, how the city helps residents cope with the challenges of aging, and where the agency wants to do more. Here are highlights from that conversation.
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City Limits: The areas of meals-on-wheels services and consolidation of senior centers and case management services all have been major issues for DFTA lately. What is the status of those service changes?

Lilliam Barrios-Paoli: The day that I started working, it was the first day of the implementation of home-delivered meals in Queens, so it was a challenge. I think what we found out is that even though the concept was very good, we had to tweak it so that things would work. We then delayed the implementation in Manhattan for about three weeks, and that went better. Then we did Brooklyn a month later and that went even better. Now we're trying to figure out the issues that emerge around some people not being happy with the kinds of meals they’re getting, and some people complaining that they’re getting meals too late or too early. Those are the kinds of things we’re working on with the implementation, but I think all in all, it’s okay.

In terms of case management, that was a little bit bumpy. The reason for that was we centralized the authorization of the meals to the case management providers. Sometimes people tell you they want a meal – but they have many more needs than that. When you’re elderly and you’re frail, you may not even be aware of those things. So that part has gone fairly well, we still need to tweak it some more ... we’re trying to figure out if we need to add more staff or divide the territory or what to do, but that is also on track.

With the senior centers, essentially we’ve delayed the requests for proposals for another year. We’re trying to build consensus in the community as to what it should look like. I think we all know that the centers were started 40 years ago, and they need to change because life has changed and people have changed. I think seniors are living longer and that’s good news and bad news – the bad news is that as you live longer, you develop more chronic diseases and you have more health issues. So part of the agenda is to create a healthier living [environment] for the seniors, both in making sure that they exercise and eat properly, and remain active both in mind and body, but also learn to manage chronic diseases. I think with things like diabetes and high-blood pressure and all kinds of things like that, managing it is more important than anything. I’ve worked a lot with children and asthma, and having an asthma plan and doing it is 10 times more important than anything else because you're avoiding crisis. I think it’s the same thing with seniors.

Where is the city in terms of implementing the congregate programs for older adults at the city’s senior centers?

I think the way we deliver senior services has to change because populations change, life has changed, it’s a different world. It’s very difficult for people to change, and most of us do not embrace change well. So what I would like to have happen is that the community that serves seniors – providers, academics who are interested, and the seniors themselves – create the new model of what the services should be like. So that it’s not my idea, or your idea, but it’s a consensus, insofar as we can build one, that says: This is what we should be doing for seniors going forward, knowing that one model is not going to fit all.

What population trends is DFTA keeping in mind when dealing with limited resources and putting out requests for proposals?

Right now, we have about 283 senior centers and we have about 40 other centers that serve seniors part-time. They were located in those communities about 40 years ago because those were aging communities. We certainly have to look at whether that’s still true, but the one thing I can tell you about New York City is that because housing is what it is, we all tend to stay where we are. So I don’t anticipate too much shift.

But there have been big demographic changes. So groups that were very large are smaller, groups that never existed before are here now. For example, we never had Pakistani, Indian, Bangladeshi seniors; we now have a lot of them. Visually impaired seniors may not be accommodated in regular senior centers because to be active they need certain equipment that not everybody has, and it's the same thing with hearing impaired seniors. Gay and Lesbian seniors may not feel comfortable going to a regular senior center because they can’t be themselves. So there are other populations and other groups that need to get into the mainstream. We have to figure out how to do that and how to embrace them without turning anybody away.

What is the department’s role in addressing the mental health needs of the elderly?

I think we don’t do enough around mental health. I think that there’s a tremendous amount of depression amongst seniors. I think that they have responses to medicine that we don’t recognize.

In the process of living, there’s a lot of grief that sets in, there’s a lot of losses that happen as you get older in life. I remember my father feeling that he had lost my mother but he also lost most of his friends, he had gotten to be 84 and had very few friends who were still alive. The support system wasn’t there, he couldn’t pick up the phone and talk to somebody. So just acknowledging that that’s the case and having more along [the lines of] grief counseling about loss is a priority.

I think end-of-life issues are difficult to deal with. I was talking to some people that deal with end-of-life issues and they were saying that Americans are the only people who think that death is optional, they sort of pretend and say, ‘it’s not going to happen to me.’ And so, we have to talk about these things because a) they're going to happen, but b) there’s a certain amount of planning [for the end of your life] that makes you feel in control. So what do you want to happen after you’re gone, how do you want to go, what are the things that have to happen. I think all of these things should happen within the context of a senior’s life and we don’t make too much room for them. So I think it’s important to do that. And I think that mental health is something we have not put emphasis on but going forward, we will be trying very hard to do so.

Although the City Council restored $32 million in funding to the department’s budget, one of the larger areas where cuts remained was with discretionary spending allocated to borough presidents. How do you anticipate building linkages with the borough presidents?

A very large chunk of [the department’s budget] is discretionary, so I have to work very well with the borough presidents and the City Council. The council restored the money to the borough presidents and it all came back to the agency, so in essence it’s been a great partnership and hopefully it will continue to be. I have a very good relationship with all of them, and absolutely will continue to have a very good relationship with all of them, because everybody’s interested in aging. Aging is not optional; we’re all getting there.

For the city’s elderly population that’s unable to age out of the workforce, are there any initiatives in place to help them?

The federal government funds us under Title V to have some degree of workforce development – but we have to reconsider what aging is. I think the traditional retirement age of 60 or 65 is very young for how long people live now and how vital they are. So I think we have to sort of redefine that, and I think people have to think in terms of not one career or even two careers – maybe there’s three careers in people. What they receive in terms of Social Security or a pension is not enough, so can we think of the elderly as a resource going forward. We have so many very young teachers – can older teachers come back and help them learn how to manage a classroom, and prepare a curriculum? Can older workers come back and help in customer services? I think there are many, many possibilities for people to have other careers because also, they have to live longer.

What do you think about the Senior Center Rent Increase Exemption (SCRIE) program and what it means for seniors?

Only about 33 percent of the people eligible for SCRIE receive SCRIE, so there are a lot of people who could be receiving SCRIE who don’t receive it. Part of it is that people don’t know about it, part of it is that with the process, you have to dig up a lot of papers to prove who you are and where you live and all of that. The good news is that, through an authorization by the City Council, we’re about to transfer the SCRIE function to the Department of Finance, although we will keep a walk-in center here. The very good news about that is that you will not need that much supportive documentation because by law they have access to records that I cannot access. So they can figure out who should be eligible who is not receiving it, and send a letter that says: You’re eligible to receive it and if you would like to receive SCRIE, let us know.’

The reason I think that’s going to be very important is that 75 percent of seniors live in rental apartments; the majority of seniors are renting on a fixed income. Every time they’re not receiving SCRIE, their rent is going up every year or every two years and that’s huge. So if we can help them with any of these income supports, like SCRIE, like food stamps, it will be huge, because this is a population that is not about to go out and make more income but we can bring them help this other way.

Tell us about other income supports important to seniors.

Well, the two main ones are SCRIE and food stamps, and if they’re not receiving Social Security and are eligible for SSI (Supplemental Security Income), to get them into SSI. The reason why we try and do this is that even though there are 33 percent of seniors living in poverty, according to the [Center for Economic Opportunity] measurement, 40 percent of Latino seniors are in poverty and 38 percent of Asian seniors are in poverty. The reason for that has to do with immigration, because many of them did not work enough quarters to qualify for Medicare or Social Security. One of the things that we’re considering is, can we help them through employment to qualify [for Social Security and Medicare] if they’re able-bodied? Those are the things that we’re really looking into because there are two expenses that seniors cannot avoid: one is out-of-pocket medical care, which is huge – even if you’re on Medicaid or Medicare, it’s very expensive – and rent.

In terms of looking at the city’s infrastructure as part of the mayor’s PlanNYC 2030 program, what are some things that you would identify as challenges for the city’s senior population?

I think that the transportation system is not as user-friendly as it could be. It’s difficult to navigate the subways if your knees hurt, or if you need a walker or anything like that. I think that we can be much more user-friendly in terms of the walkability of the city. In terms of accessibility to subways and buses, I think that we’re really going to look at that very seriously. I think the mayor will in the near future be announcing a number of walkability surveys for seniors to ascertain, what are the obstacle courses that you have? Many seniors have poor vision, so how do you navigate crossing intersections? Especially when trucks make a left turn and they turn right into you, those kinds of things. We’re definitely conscious of it and are going to try and make some differences going forward.

- Nekoro Gomes