Objective

To determine if the New York State Office for the Aging’s policies and procedures for select programs are adequate to ensure Area Agencies on Aging are appropriately monitored and the older New York population is adequately served. The audit covered the period from April 2017 to July 2021.

About the Program

The New York State Office for the Aging (NYSOFA) helps New York residents aged 60 or older be as independent as possible for as long as possible through advocacy and the development and delivery of person-centered, consumer-oriented, cost-effective policies and programs. NYSOFA’s overall goal is to improve access to, and availability of, non-medical support services for older individuals to maximize their ability to age in their community and avoid higher levels of care and publicly financed care. Programs are administered at the county level through a network of 59 Area Agencies on Aging (AAAs). NYSOFA directs AAA operations in part through program instructions and monitors performance through annual on-site program and tri-annual fiscal evaluations.

NYSOFA’s Community Services Program encompasses a range of specialized programs for the elderly, including the Expanded In-Home Services for the Elderly Program (EISEP) and Community Services for the Elderly Program (CSE). If an AAA is unable to fulfill a client’s request for EISEP or CSE services, the client is placed on a wait list. AAAs report Unmet Need (based on wait list data) to NYSOFA as part of their annual on-site evaluation.

A 2015 Office of Community Living Feasibility Study by NYSOFA identified long wait lists for services as an area of concern among stakeholders. As noted in the study, the wait for some services can last as long as 1 year. In some cases, clients have had to resort to nursing home placement. According to written testimony by the Association on Aging in New York at the 2020-21 New York State Joint Legislative Budget Hearing on Human Services, the 59 AAAs reported that more than 10,000 older New Yorkers are currently waiting for services. In response, the 2019-20 enacted budget contained an appropriation of $15 million, based on AAAs’ reported Unmet Need in 2017-18, to specifically fund services for clients who are eligible for but not receiving services. The 2020-21 New York State budget allocation of $261,541,500 for NYSOFA’s Community Services Program included appropriations of $65,120,000 and $29,801,000 to EISEP and CSE, respectively, including a $15 million annual appropriation to Unmet Need. NYSOFA also received the additional $15 million appropriation to Unmet Need in 2021-22.

Key Findings

Despite $15 million in appropriations for each of the years 2019-20, 2020-21, and 2021-22, intended to reduce or eliminate reported Unmet Need, weaknesses in NYSOFA’s methodology for allocating Unmet Need funds to AAAs and its oversight of AAAs may undermine this goal.

• While the initial fund allocation in 2019-20 was based on AAAs’ reported Unmet Need in 2017-18, for 2020-21 and 2021-22 – when more senior citizens likely required home services due to the isolation and restrictions imposed with the COVID-19 pandemic – NYOFA did not reassess AAAs’ Unmet Need and revise its allocation plan based on AAAs’ most current reported Unmet Need.
• Of the $30 million in Unmet Need appropriations for 2019-20 and 2020-21, a total of $5.9 million allocated to 29 AAAs remained unspent as of July 30, 2021. Contrary to its own program instructions, NYSOFA did not make allocation adjustments for those AAAs that did not spend or need their full allocation, nor did it redistribute the unused funds to AAAs most in need.
• NYSOFA did not always adhere to its policies and procedures for program and fiscal monitoring of the AAAs’ administration of EISEP and CSE programs. For the 4 years of our audit period, only in 2017-18 did NYSOFA perform on-site evaluations for all 59 AAAs. The number of evaluations performed decreased each year thereafter: to 54 in 2018-19, 50 in 2019-20, and 0 in 2020-21. As such, NYSOFA has no assurance that AAAs are adequately monitoring the services provided on behalf of older adults.

Furthermore, NYSOFA officials placed constraints on our audit, including delays in and denial of access to data essential to our audit work. As a result, there is considerable risk that material information concerning NYSOFA’s administration of Unmet Need funds was withheld from us, and ultimately limited the scope and depth of the audit conclusions.

Key Recommendations

• Maintain documentation to support the allocation of Unmet Need funds among the AAAs and promote transparency.
• Periodically reassess Unmet Need allocations based on the AAAs’ most current information available.
• Take steps to strengthen monitoring efforts of the AAAs to ensure both program and fiscal reviews are conducted according to NYSOFA policies.