Helping New Yorkers age with autonomy, dignity and community

Between the rising cost of living and an overall dramatic shortage of affordable housing, aging is a challenge for many New York City residents. According to a report last year from the Center for an Urban Future, the number of older New Yorkers living below the poverty line increased by 37.4% over the past decade. Right here in New York City, the Bronx has the highest adult poverty rate (25%) of any county or city in the state examined by the report, with Brooklyn's rate at 20.9% and Manhattan’s at 16.3%. Additionally, according to New York state's Office for the Aging, nearly 14% of older adults in the state experience food insecurity.

Such are the challenges that JASA attempts to address every day. Founded in 1968 as the Jewish Association Serving the Aging – and still a member of the UJA-Federation of New York – the agency, with a 2,000+ staff and 50 locations in all boroughs except Staten Island, calls itself "the go-to agency serving older adults in New York City" and provides services to more than 40,000 people annually. It offers a broad array of resources and services to give older New Yorkers autonomy, purpose and the ability to remain in their homes and communities. The agency has ten affordable housing properties, is a licensed home care agency and provides services citywide including legal, health and mental health, home-delivered meals, social programming at senior centers and community trainings on elder abuse, peer health support, caregiver assistance and more.

On February 1, New York Nonprofit Media talked for more than an hour with Kathryn Haslanger, 68 and the agency's CEO since 2012, about what a typical day is like, the skills she's attained over a long career that help her helm JASA and what she'd do with a huge budget increase. 

Kathryn, thanks for talking to us today. Tell us about your day so far prior to this call (at 3pm) and what you'll do after? 

I live in Flatbush with my husband. I got up at six, which is pretty usual for me, and had a cup of Brooklyn Roasters coffee and wrote down a few work-related notes I'd been thinking about through the night. It was still dark, but I got my husband to go with me for my five-mile walk through the wood paths in Prospect Park. I like to be alone with the birds and the ducks but I also like it when he joins me. After that, I did a little core work, an adapted Pilates routine. 

Then for breakfast I had some Shredded Wheat, plain yogurt, blueberries and flax. Then I went downtown to the offices of United Neighborhood Houses because JASA is part of a consortium of nonprofit homecare providers and we're grappling with some difficult issues.

Can you describe them?

Homecare is challenging for all of us because we all need to pay the workforce more. The state actually mandated a wage increase but didn't put the funding through to cover it. So now there are these new New York State Medicaid waivers and we're trying to understand what they mean for the populations we serve, and to figure out on what points we're going to speak with one voice versus where it makes sense for each of us to find our own path. 

This waiver is about $7.5 billion over 3.5 years, its purpose being to address issues of health inequities. They're putting some of the money into health professions with particular shortages. For us, the fact that they're putting money into psychiatry and dentistry is great. They're also putting $2.2 billion into distressed hospitals. And they're creating these social care networks that'll be responsible for screening Medicaid beneficiaries, and if the person fits into one of their priority categories, they'll be eligible for case management, and for Medicaid to pay for some of their social services. Because it's an understanding in research that unmet social needs drive bad health outcomes and higher healthcare costs down the road. If you don't have a house or know what you're going to eat, it's hard to do anything about your chronic illness or what.

So the waiver is supposed to put money into those needs, which is exciting, but those of us in the aging services realm are struggling because it seems like the program targets populations other than aging New Yorkers. 

Hm… Why?

I don't have a good answer. I don't know if it's because they were really focused on Medicaid dollars, and a lot of services for older New Yorkers are paid for by Medicare. The really high costs within Medicaid are people who have significant substance and behavioral health issues. There's a lot of targeting in the program for children, too, which is great—it just doesn't help the population that we work with.

What'll be your next step on that issue?

We're continuing our discussions and trying to learn more how the state is envisioning these networks operating. We're in an information-gathering stage so we can formulate a strategy.

Okay, thanks for explaining that. So after that meeting, you...?

I'd been sitting so long that I walked a few blocks before I got on the subway and came to my office in the Garment District. I love that we're in this area because, though we have a diverse staff and client population, our roots are in Jewish philanthropy [and the Garment District historically has been very Jewish]. We still have guys pushing racks of clothes down on the street. 

So once I got here I ate my lunch, which I packed this morning. 

Which was?

A salad. You knew the answer to that. [laughs] Then I found on my desk an early birthday present – my birthday is tomorrow – from one of my executive team members who baked me these amazing lemon bars. Then I've been in meetings and on phone calls about operational issues and communications and government relations issues. And now I'm talking to you.

And after this call?

I have a meeting with the consultants who've been working with us on our homecare program to give us some advice about how we can operate more efficiently and grow the program and implement recommendations. I also have a phone call related to Gov. Hochul's Master Plan for Aging. I've been spending a lot of time on that.

What is it and what stage is it in?

We're still creating it. A preliminary report should be out this summer and a final version in the fall. We're supposed to be taking a ten-year perspective and making recommendations about policies and programs that can make New York a good place for people to grow old and live independently and with dignity. 

What are some of the things that need to happen?

One of the most significant is housing. Overall in New York, we have a crisis of affordable housing – and for older New Yorkers, that crisis is really severe. As I said, if you don't have a safe place to live, then you can't begin to think about [other health and wellness concerns]. Nationally, more than one in four unsheltered adults are over the age of 54. We know from research that living on the streets ages a person by about 10 years, so all of these folks over 54 could fairly be considered to be older adults, or senior. And in New York City, nearly 40% of seniors are cost-burdened, which means they are paying more than 30% of their income for housing. 

It's been estimated that we need 400,000 more units of senior housing in the next 15 years because of growing demand. We're involved with a new development in Bushwick called Linden Grove that'll be opening soon. It has 152 units, many of which are for people coming straight from the shelter system, and 80 of them are available via a lottery being run by the city. We're halfway through the two-month lottery window and already we have 23,000 applicants. So that shows that there's an extraordinary demand for affordable housing, as well as the kind of support around it so that someone can be engaged in, and contribute to, a strong community. Older adults have a lot of knowledge and skills, but sometimes they need a boost – like home-delivered meals, for which there is currently a waiting list. Also, transportation can be challenging if you can't walk up and down steps.

So the idea of the plan is to take a broad look at all the gaps in those areas and identify the policies and programs needed to address them. I'm hopeful the plan will lead to a more substantial commitment to housing and social care.

So after those meetings, I have dinner with the CEOs of the other human service agencies within the UJA Network.

When do you usually get home?

I work remotely Monday and Friday, but otherwise usually by 6:30pm. I like to cook dinner and eat with my husband, then I'll do a little more work reading or knock off some emails. Then I like to listen to music or read to calm down.

You don't watch something on Netflix or Hulu or whatever?

Sometimes but not regularly. I'd rather go to some kind of live performance. And I'm usually in bed by ten.

Can you give us a brief bio?

I'll be 68 tomorrow. I was born and grew up in Dayton, Ohio, then went to Brown for undergrad, then went to law school in D.C. for one year and hated it. Washington was an unbelievably sexist, hostile environment. So I went to Boston and did a joint degree program of city regional planning at Harvard and Boston College Law School. B.C. Law was very public service- and social justice-oriented, being Jesuit. Then I moved to New York and worked in city government at the end of the Koch Administration. I was in the Human Resources Administration and was working for the head of the Medicaid homecare program. I got to observe and learn about the operation, sitting in on high-level meetings. My boss was a really good manager and kept me with her as she got more responsibilities. We did some important Medicaid reform projects. 

That's interesting. How do city services then compare to now?

More of them have been outsourced to nonprofits and I think there's less – in city government overall – I want to be careful how I say this.

A big complaint the past year or two from nonprofits with city contracts is the understaffing of city agencies.

It's a huge problem. There are so many vacancies. And so many workflow changes that the city could reconsider to streamline what it does to make it fit with the downsized workforce.

So after HRA?

I went to the United Hospital Fund where I worked on homecare policy and also on extending health insurance coverage for the uninsured. I was there when 9/11 happened and we spearheaded the disaster relief Medicaid initiative that got 380,000 people enrolled in Medicaid through a streamlined process. And those people stayed covered when the regular process came back in place. That's the difference between an open door where you're really encouraging people to apply, versus putting a lot of barriers in the way.

After that I was briefly at Maimonides, doing projects completely designed to keep people out of the hospital, then I was at the Visiting Nurses Association doing community health projects. Then I got recruited to run JASA and started right after Hurricane Sandy in 2012.

Wow, what a great resume. What were the skills you learned through all those jobs that are valuable to you now?

There's two things. The first is the importance of having people feel comfortable disagreeing with you and giving you bad news. In the literature they call this a culture of psychological safety. I didn't understand how important that was at first because the first couple of people I worked for wanted to know what I had to say. And then I briefly worked for someone who didn't want to hear the bad news and I saw what that did to decision-making and how it could damage an organization. So I feel really strongly about that.

And the other thing I feel strongly about is that it's really valuable to be genuinely curious, so that when someone says something and your initial reaction is to disagree, instead of saying "no" and arguing, you should instead ask a question and try to understand what's behind it. When you do that, you learn things and break through assumptions. There's always more to learn.

What's a skill or tool that you use every day?

[pauses] Energy isn't a skill, right? [laughs] Focus? I'm focused on what's in front of me and I don't get distracted. I was writing something for work on the subway this morning and got so focused on it that I went past my stop.

What are some of the newer things JASA has done in the past year or two that you're proud of?

We've been really excited to be involved in opening new affordable housing buildings. We're managing and providing services at 1490 Southern Boulevard in the Bronx, where we came in as a 25% equity partner. We'll be doing another development in the Bronx. We're interviewing tenants who are moving in as we speak. I'm really excited about that, partly because those buildings were built under the city's fair housing plan, which means that 30% of units are set aside for people who've been unhoused and coming through the shelter system. And our staff has been so creative at finding ways to build a community of very disparate people. We have residents where all their worldly possessions were in one garbage bag, and our staff gives them choices about how they set up their kitchen, picking their linens and towels so they're putting their own stamp on [their home], not just getting handed something.

So I feel really good about that. I'm also very proud of the work we've been able to do expanding teaching peers who can help others with managing their chronic illness. We have a nutritionist, Tania Collazo, who is so creative in how she works with clients to help them think about what they're eating and how to use healthy whole foods in a tasty way that connects to their history and culture.

And one more thing I'm proud of is the partnership we have between our homecare program and clinical services. Our home health aides have the ability to just hit a button and get a nurse who has the patient's complete medical history. If the homecare worker walks into a situation they're not sure about, they can call that nurse immediately. 

JASA has so many sites throughout the city. How often do you visit them?

We have 50 locations. I don't have a regular schedule. I go for special events. I was out at our Brookdale Village in Far Rockaway a few months ago for a ribbon cutting. I'll be going back up to the Bronx again soon.

Do you feel like you see the sites enough to have a palpable sense of what's going on there?

I have a terrific team. My COO, whom I talk to all the time, is always going out [to the sites]. We also have monthly virtual town halls with usually more than 250 people, calling in from all the sites, and I learn things.

Can you tell a few stories about clients that bring to life what JASA does on a daily basis?

This is an older story, but once I was at one of our older adult centers and I sat in on an art class. If you read the literature about loneliness and social connection, there's a lot of research about what doing something with any kind of creativity does to open people up and increase their ability to connect with others. And in this class, people were talking about how much everyone in the group meant to one another. Yes, they were painting, but one person was just coming back after cancer treatment had laid her low and she talked about what the people in this group meant to her. That was also said by another woman who had recently lost her longtime husband. So within an art group, they created this community of support. And that goes on in many places across the JASA universe.

Another story is, we had a tenant named Michael who for years was employed and had a solid life but then struggled with addiction and got himself sober. But then he had a stroke and was blind and in the hospital for quite a while. Everything spiraled down for him. He lost his job and apartment and ended up living on the street. But since then he's moved into one of our very wonderful apartments in new JASA housing. To be able to bring that kind of safety and solidity back into somebody's life – that's amazing. And that's what we do. And I have the privilege of working with the JASA staff, who are so committed and engaged. I want so much for them to have fair compensation.

What is stopping that?

We're constrained by the resources available in our city contracts. Such as, for positions where city employees and nonprofit employees are doing comparable work, city employees are paid about 30% more. Many JASA employees are members of the DC37 union, and the raise they received over the five-year-plus term of their new contract is 16.2%. We haven't gotten anything in our city contract even vaguely approximating that raise amount for our staff. It's a compensation gap. We need to raise our staffers' salary base so that it's equitable among people who are doing similar work, and there needs to be a regular cost of living increase year to year. And we need a multiyear contract with the city so that we can plan. Year to year, we have no idea what kind of funds are going to be available to us, even while everyone tells us to run our agencies like a business.

If we knew that there was going to be a yearly cost of living raise, if we could offer that security and assurance to our staff, it would help us both recruit and hang on to people. We do a really good job of training people and giving them skills so that if they want to leave human services, they can go into healthcare or health insurance and double their salary. If we could offer more competitive salaries, we could keep the terrific people we develop and train. 

Another challenge we have in aging services is that there are so many ageist tropes in our society. That creates a barrier of trying to get people to think about working in aging services as a career – the way they're passionate about working in homelessness or criminal justice. So the last couple of years we've had this program with New York Community Trust where we've been working with masters of social work students at Lehman College, saying to them, "If you're passionate about people who are unhoused in the justice system, you can work with those issues in the area of aging services, because we're dealing with a lot of older adults who have those issues." 

So we have this program now where they've done some education sessions and  internship opportunities with mentors. When they come out of it, they tell us they're really interested now in doing this work. It's a very exciting way of bringing new and fresh eyes into our work.

Okay, final question: What would you do if you got a huge budget increase, say 25% to 50%? Dream out loud for a moment.

I would pay staff a lot more. I would also use some of that money to test and assess new models of service delivery to see if we were really making a difference in people's lives, so we'd know how to tweak the services, and to know if they were worth scaling and replicating.

And I'd celebrate more! I'd give people more opportunities to have fun and celebrate their good work and enjoy one another, to renew their connection to one another and commitment to the work. Sometimes they're working with clients who say "Thank you," sometimes with clients who don't want them in their lives. So it's important for staff to feel appreciation. 

And I'd also create more learning and professional development opportunities. There's always more to learn.