Objective

To determine whether the New York City Department for the Aging provided and paid case management services appropriately for eligible seniors. The audit covered the period from January 2019 through October 2022.

About the Program

An important goal for many older adults and their families is to be able to live independently, safely, and comfortably in one’s home for as long as possible. The New York City (City) Department for the Aging (DFTA) is the City agency primarily responsible for addressing public policy and service issues for the aging. As of 2021, there were over 1.9 million adults aged 60 and older (seniors) residing in the City. Seniors with certain functional limitations may be eligible for case management to ensure access to appropriate services, benefits, and entitlements needed to age safely at home and maintain their quality of life. DFTA reported over 39,000 seniors received case management services in City fiscal year 2022. DFTA contracts with community-based organizations (providers) to deliver case management services. Between City fiscal years 2016 and 2022, these services were provided through 21 contracts with 15 providers. In the past 3 City fiscal years ended June 30, 2022, DFTA paid these providers approximately $123 million. In City fiscal year 2023, DFTA awarded 21 new contracts to the same 15 providers. Providers submit monthly invoices for reimbursement of expenses. All client intakes, assessments, contacts, case notes, and client wait lists are recorded in DFTA’s Senior Tracking, Analysis & Reporting System (STARS).

When services cannot be provided immediately, providers place clients on wait lists until the services become available. According to the May 2022 City Council Report to the Committee on Finance and the Committee on Aging on the Fiscal 2023 Executive Plan, “DFTA has long struggled with meeting the needs of the City’s growing, diverse older adult population and keeping older adults from languishing on wait lists for essential services.” According to DFTA, as of December 1, 2022, there were 1,742 people on the case management, 277 on the home care, and 61 on the home delivered meal wait lists.

Key Findings

DFTA does not provide adequate oversight of its case management program:

• DFTA did not ensure that its contracted providers adhered to DFTA’s Case Management Standards of Operations (Standards); therefore, key milestones for delivering and monitoring needed services to vulnerable seniors were not always met.
• Clients spent significant time on wait lists before they could receive critical services, such as case management and home care. When services became available, referral was not always prioritized such that those with the greatest needs received services first. For example, a 96-year-old client with a mobility impairment and other serious medical conditions had been on the wait list for personal care services for 113 days.
• DFTA reimbursed providers for $10,480 in claimed expenses that had insufficient supporting documentation or were unrelated to the case management program. For example, DFTA reimbursed $1,314 in unrelated expenses to a provider, including $459 for a recliner, $349 for a mattress, $201 for a jacket, $125 for window blinds, $120 for a microwave, and $60 for a blender.
• DFTA’s oversight of its case management providers was inadequate as it did not maximize the use of available case management data, and it did not include certain aspects of case management in its evaluations.

Key Recommendations

• Ensure that case managers comply with all requirements of the Standards, including timely assessments, supervisory review, contacts, and documentation.
• Review wait lists to assess whether clients are prioritized for service referral based on weighted scores.
• Utilize existing case management data in STARS to more effectively review case management provider compliance and performance.
• Review the $10,480 in claimed expenses and recover as appropriate.