The second Javier Osorio walked into Grace Moore's Brooklyn apartment early on a mid-July morning, Moore started talking—about Tiger Woods, how to eat on $10 a day, a PBS show on the mysteries of the brain. Only when she took a breath did Osorio get to ask the question that is the crux of case management services: "How are you feeling today?"

Over the din of three oscillating fans fending off the deep summer heat, Moore, 77, said, with a wide, contented smile on her face, "I feel wonderful."

The services Osorio and all case managers contracted by the city of New York's Department for the Aging (DFTA) provide seem simple on the surface—arranging home-delivered meals, finding transportation, making sure bills get paid—yet they offer their 18,000 clients (with nearly 1,000 on the waiting list) across the city a valuable and much desired outcome: the chance to age at home, not in a nursing facility.

Each of the past few years, the city has cut case management funding, making it harder to keep the elderly healthier in their homes. That increases the likelihood that a senior will need a nursing home, which costs the state, via Medicaid, many thousands more per person than if he or she had managed to live at home. For 2010, the average annual cost of a semi-private room in a nursing home in New York is about $115,000, while most clients of elderly case management agencies survive on about $13,000 of services.

"Dollar for dollar, it makes sense for the city to do this," says Bobbie Sackman, director of policy for the Council for Senior Centers and Services, of the cuts to case management, because the city derives the savings while the state gets the bill for the increased nursing home usage. "But policy wise, human wise, system wise, living-in-the-city wise, we're taking giant leaps backward."

A history of help

For years, New York City did an admirable job of building a safety net of services for seniors flirting with poverty, according to advocates. Started in 1968 as a three-year trial program to provide discounted transportation, DFTA has since expanded to provide employment services, crime victims' assistance, health and wellness help and much more, most of which is contracted out to community-based providers. The agency counts on state, city and private funding.

But the Bloomberg administration has cut senior services by $50 million dollars in the past few years, admittedly under extraordinarily trying budgetary pressures, having threatened to cut many millions more. The actual budget reductions deprive vulnerable New Yorkers of much-needed services; the threats scare the elderly, leaving them to wonder when their help will run out. For service providers, bracing for proposed cuts and dealing with real ones take away from the energy they devote to caring for the aging.

The annual rite of slashing elderly programs comes at the front end of a decades-long surge in the city's senior population. The 2010 census revealed that the over-60 population in New York City increased by 155,000—more than a 12 percent increase—since 2000, to about 1.4 million total. By the year 2030, the total elderly population should sit north of 2 million.

If current figures hold steady, a third of that population will struggle financially, making them ideal candidates for city-funded services.

Will the centers hold?

Those services go well beyond case management, including meals on wheels, special transportation, elder abuse protection and much more.

Perhaps no service fulfills so many needs for the elderly as senior centers. Located throughout the city, these neighborhood gathering places offer subsidized meals, periodic health services, education and a sense of community. During the height of the summer, they also serve as cooling zones for seniors who often lack air conditioning in their home.

"We've always felt we can't turn people away. We just don't do it," says Isabel Ching, who directs senior services at the Hamilton-Madison House in the Two Bridges area of the Lower East Side, which serves a predominantly Asian-American clientele. "If we turned them away, what happens if that's their one meal a day?"

Hamilton-Madison House serves about 120,000 meals annually, 30,000 or so more than is budgeted. Each year, Ching and her staff roll the dice, assuming they'll find additional funding in the spring, once the budget is tapped.

"A lot of times, people are here because they can't go any further," says Ching.

Geography is absolutely crucial when it comes to senior centers. Until last year, Grace Moore had a senior center right across the street in Fort Greene. It closed, and the nearest center is over a half mile away, requiring transportation. Given her health condition—she has diabetes and a problem with her nerves—the trip is usually too much.

"They come because they don't want to be isolated," Sackman says. "Hearing them say 'It's my second home' is not a cliché."

Doing the dance

Despite the growing need for senior centers, government officials (both city and state) have regularly threatened their existence, going back to 2008 when DFTA, in an effort to streamline senior services, issued a request for proposals that ultimately would've consolidated/closed numerous centers. An immediate reaction from advocates and seniors prompted the withdrawal of the plan, but some “streamlining” still occurred, weakening senior services.

In early 2010, Gov. David Paterson's budget endangered up to 75 senior centers in the city. A year later, Gov. Andrew Cuomo followed suit, putting 100 senior centers on the line until strong protests stymied the effort. Today, there are nearly 80 fewer centers than there were three years ago, according to Sackman.

The fight against cuts gets to be tedious. "In my 14 years," says Ching, "too much of my time is spent worrying about money instead of making programs."

Bloomberg's initial budget for fiscal year 2012 threatened to shut down a net total of 17 centers. The final budget resolution avoided any closures. And the city made a strong step in the right direction when it baselined—government speak for locking in a section of the budget for future years—about $14 million for senior centers. The mayor's office hadn't baselined money for senior services in years.

The precarious economic situation hardly guarantees similar, positive outcomes in the future. Asked what the city would be able to do in the future, Department for the Aging spokesman Chris Miller said, "At the end of the day, we'll have to look to the federal government to understand and support the aging."

One look at the headlines these days suggests that it's unlikely that Congress will shower any state or city with extra funding. If anything, the city might anticipate having less money available. And that will trigger yet again what those working in the aging network call "the dance": A budget proposal comes out with steep cuts across the board, and advocates go on the offensive, rounding up seniors to speak out, pleading with the administration to reconsider, and begging the City Council for discretionary funds.

With everyone properly alerted and frightened, the mayor's office releases a revised budget whose cuts are more digestible than the original offering. This year, the mayor's office threatened CityMeals on Wheels ($1 million cut restored), naturally occurring retirement community support ($900,000 cut restored), and the entire Elder Abuse Program ($800,000 cut restored).

These limited victories don't erase the real trauma that, some advocates say, proposed budget reductions cause for seniors.

"Every year, you're scaring seniors into thinking their home away from home is going to disappear," says New York City Council Member Jessica Lappin, who chairs the Committee on Aging. "I can't believe that's really what we want to do, or what our leaders stand for."

New idea, few details.

The mayor's initial 2012 budget partially offset the proposed closure of existing senior centers with the creation of a series of new Innovative Senior Centers, part of the mayor's Age-Friendly Initiative. The details on these innovative centers are a little loose right now. At least one will cater to the vision- or hearing-impaired, and another to LGBT elderly. All of the new centers will be expected to establish "linkage" through technology to elderly services, like BenefitsCheckUp, and to city and cultural resources, such as MOMA. Chris Miller, a spokesperson for the Department for the Aging, says it'll be up to each center to determine the nature of its programming and how it will exploit other city services to make the center truly innovative.

But some wonder why the city would pull money from existing senior centers that are serving a vital purpose. "You don't start something new by eliminating something that is working and already exists," says Lappin. "We've got to solidify our core services before embarking on new ones."

As with so many other budget issues, the reality of the mayor's cuts didn't match the early threats. All existing senior centers are, for now, safe. The Innovative Senior Centers, many of which will be revamped versions of existing centers, will start to launch in January 2012. And because the Age-Friendly NYC initiatives were based on creating synergies that didn't cost any money, they remain intact and include programs like artist residencies, bus rides to healthy food outlets, and gym membership discounts. Of course, even with a 25-percent discount, the New York Sports Club's pricey membership is beyond most seniors who are on fixed incomes.

More clients, less money

Grace Moore has plenty of days where she does feel, as she told case manager Javier Osorio, "wonderful." But those days can dwindle as life spans lengthen and medical issues complicate. "Some days you wake up and feel like Might Joe Young. And other days you can't put your socks on," she says.

Case management services will survive this year with $3.6 million less—far better than Bloomberg's original proposal of $6.6 million in cuts, about 30 percent of the budget, which would've resulted in 100 case workers losing their jobs and thousands of elderly losing all or part of their services. But even this smaller cut will hurt.

Osorio learned how the new budget would affect the front lines just days before his visit with Grace Moore. He will inherit 20 new clients, a 28 percent hike without an increase in pay or the magical appearance of two extra hours in his work day. He might not be able to spend the extra 10 minutes chatting with Moore in the future, not if he's got all those extra people to take care of.

He approaches the situation pragmatically. "It'll be all about priorities," he says. Asked how that might play out, Osorio instead remembered a story about one of his clients. One day, she didn't answer the door when her daily meal came. Osorio called a few times before she finally picked up. She'd fallen down and dragged herself to the phone. Osorio immediately called an ambulance, which rushed her to the hospital. Now, when the client introduces Osorio to neighbors, she says, "This is the man who saved my life."

The ability of case managers to do things like make more than one phone cal l might change when there is less money and less time to accomplish everything needed. At some point soon, the city will have to confront the reality of its growing elderly population, hundreds of thousands of whom will be poor and need help in their final years.

"They're humble and reticent to speak up for themselves," says Lappin. "And frankly, they really shouldn't have to."