New York State has the fourth-largest population of older adults in the US, with 3.2 million New Yorkers over the age of 65, a number that is projected to grow to 5.3 million by 2030. Caring for those older New Yorkers is expensive; the state spends more on long-term care services annually ($32 billion) than any other service. To address the needs of the state’s aging population, Governor Kathy Hochul signed Executive Order 23 last fall, which directs the state to develop a Master Plan for Aging.

On today’s episode, Courtney Burke, senior fellow for health policy at the Rockefeller Institute of Government, and Adam Herbst, deputy commissioner for the Office of Aging and Long-term Care at the Department of Health, discuss the process of developing the master plan, the intricate network of government and healthcare systems dedicated to designing this roadmap, and how New York will provide the necessary care and resources to ensure people can age in place.


Courtney Burke, senior fellow for health policy, Rockefeller Institute of Government

Adam Herbst, deputy commissioner for the Office of Aging and Long-term Care, Department of Health

  • Transcript

    Transcript was generated using AI software and may contain errors.

    Alexander Morse 00:06

    Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Alex Morse. Growing older. It’s something all of us do, despite our wishful intentions to stay young forever. States recognize this fact and have to prepare for providing care and resources to the aging population to ensure they have access to health care, housing, transportation, food, security, and other necessities to age peacefully in place. This can be a sizable endeavor. For example, New York State has the fourth largest population of older adults in the US with 3.2 million New Yorkers over the age of 65. And that number is projected to grow to 5.3 million by 2030. Total state spending on long term care services is $32 billion annually, more than any other service that the state supports. To address the state’s growth of its aging population. Governor Kathy Hochul signed Executive Order 23, which directs the state to develop a Master Plan on Aging. The development of this master plan will focus on factors to build upon New York’s “Age Friendly” designation, the first such designation in the country as assigned by AARP. The term “Age Friendly,” coined by the World Health Organization consists of eight domains of livability, including outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, work and civic engagement, communication and information, and community and health services, all of which are integral components to aging in place, and will be pillars of the master plan. On today’s episode, Courtney Burke, senior fellow in health care policy at the Rockefeller Institute, and Adam Herbst, Deputy Commissioner for the Office of Aging and Long Term Care at the Department of Health join to discuss the process of developing the Master Plan on Aging, including the intricate network of government and healthcare systems dedicated to designing this roadmap, as well as outline the goals New York hopes to achieve to provide the necessary care and resources to ensure people can age peacefully and respectfully in place. Coming up next.

    Courtney Burke 02:30

    Hi, I’m Courtney Burke, senior fellow for health care policy at the Rockefeller Institute of Government. I’m here today with Adam Herbst, who is the Deputy Commissioner for Aging and Long-Term care at the New York State Department of Health. So glad Adam could join us today. Adam has a long history in long-term care. He’s worked on aging issues, and he’s worked on issues affecting people with disabilities. And we are pleased to have him here to talk about the state’s master plan on aging. Governor Hochul recently signed Executive Order Number 23, which designates the Department of Health, in collaboration with the State Office for Aging to develop a blueprint of strategies to ensure that older New Yorkers can live fulfilling lives in good health with freedom, dignity, and independence to age in place for as long as possible. So very excited about this topic. And your role in this is very important. So I’d love to hear more about why this plan is important for New Yorkers, all of us who are aging. So what’s in this plan? And what is it about?

    Adam Herbst 03:31

    Thank you, Courtney. It’s a pleasure to join here today, join Rockefeller and speak with you. This invitation cannot be more timely. Last year, the governor set forth some really important priorities, and reorganize the way we are working to better serve New Yorkers. And one of those priorities was the state’s first Master Plan for Aging. It also was a priority of the governor to create this new Office of Aging and Long-Term Care that’s going to be working to drive the process of the master plan. And we’re going to be really dedicated in the Master Plan for Aging, to the needs of aging and disabled New Yorkers. And, you know, I hope that we will ensure that all ageing New Yorkers have greater access through the state’s plan here, not only to essential health services, but to appropriate living settings and programs that reduce isolation. And you know, I’m excited to share with you our vision for the state’s Master Plan for Aging and the mission that we’re going to foster and hopefully some of the policies and programs and services that will implement which includes again, that the importance and supporting those who seek to age in place, as well as those who seek long-term care nursing facilities. And let’s be clear, coordinated about the urgency of our mission. New York State is already home to the fourth largest population of those over the age of 65. And that’s nearly 25% of the state’s entire population. In the coming decade. We are facing a tidal wave of aging New Yorkers. And by 2030, a quarter of the state’s population is projected to be over the age of 60. As many of our aging baby boomers will seek the care and security of nursing facilities and adult care facilities, and other types of residential facilities, we hope to get ahead of this tidal wave and really foster and improve the state’s infrastructure. There are already nearly 100,000 New Yorkers, Courtney residing in nursing facilities, and hundreds of 1000s receiving homecare. And, you know, parenthetical to that long-term care spending accounts for nearly 33% of the state’s total Medicaid spending. It’s the state’s largest driver. So we see this wave approaching. And with the governor’s partnership, we’re trying to approach this this wave before it hits to shore up and support New York’s most vulnerable populations. And that’s what the state’s Master Plans for Aging is hoping to accomplish. We have a lot of expertise that we can talk about today and resources that will help with our impact here. And you know, it’s not just for aging New Yorkers, it’s also to help with disabled New Yorkers and their families as well. And for all the stakeholders and advocates upon whom aging New Yorkers and disabled New Yorkers rely.

    Courtney Burke 06:39

    Well, that’s a great overview of why this is so important, because so many people will be impacted by it. And the fact that it’s not just about aging New Yorkers, but those with disabilities are anybody who needs long-term care is really important to know. I think one of the things that’s particularly interesting about it is that two agencies are named in the master plan for coordinating these efforts. The New York State Department of Health and the New York State Office for Aging, if you could just tell us a little bit more about how those two agencies are coordinating because you mentioned the things that the Department Health does with paying for a lot of skilled nursing care, home care, those types of thing. And of course, the state officer Aging has 59 area agencies on Aging. So tell us a little bit more about the coordination between the two agencies?

    Adam Herbst 07:26

    Sure. Well, I’ll say first, that the most important priority is to ensure that New Yorkers can age in place as long as possible with dignity and independence and have access to quality care when they need it. So because that’s our most important priority, the department of health needs to work with the State Office of Aging. You know, this obviously holds true for New Yorkers with disabilities and people who need short term rehabilitation, but, you know, supports the supports that help aging New Yorkers live meaningful lives, is something that is going to require the partnership with other state agencies. And you mentioned the State Office of Aging, which will help co-lead the initiative here. But you know, it’s important just to give context, as well, that it’s not just the Department of Health and the State Office of Aging, to will be partnering collaborating here. I want to ensure that people understand that the other state agencies are also going to be included here, which includes the Office of Mental Health, the Office for People With Developmental Disabilities, Department of Transportation, the Office of Emergency Management, we have the Division of Veterans Services, and we have Home and Community Renewal. We have the governor’s Chief Disability Officer involved. There are so many different offices across state government that will be working in partnering with us to collaborate and ensure that all aging New Yorkers are really consider and you know, fundamentally ensuring that we don’t lose sight of the most important priorities that we’re trying to accomplish. In the course of our work here. We’ll be working with the Division of Budget, the you know, obviously the governor’s office, and ensuring that there is no silos. So as we, the Department of Health and the Office of Aging co-lead this, our actions and our programming and our conversations will ensure that we cut across all the different state offices that I just mentioned before, to help with our data, to help with our communication and programs that help educate and build consensus. This way, all of the consumers that rely on the various offices are considered and in all the different Commissioners and their, their offices can participate in the conversation.

    Courtney Burke 09:52

    It’s really refreshing to hear that there’s going to be that cross agency collaboration with a goal all being the same amongst those different agencies, but it’s a lot to coordinate. And I’m very curious to hear about how the work will be done. Over what timeframe? I know in the executive order. There’s an advisory committee that’s named and a draft plan and a full plan. So if you could just explain that a little bit more detail, how this will be administered and implemented, that would be great.

    Adam Herbst 10:21

    Well, let me also say, the low hanging fruit here is, is talking about the regulation of and the payment for medical facilities, you know, including nursing homes and hospitals. But, you know, what we’re trying to do is also engaged in supporting competitive care, and developing new programs to help keep people out of medical facilities and again, age in place in their homes, or in other types of housing contexts that retain independence and connection to their families and their communities. And, you know, one thing I want to stress is that we’re going to work on social determinants of health and consider that quite a bit, you know, including economic stability and education, social and community context, health and health care, in neighborhood, and, you know, building environment. So, you know, we are looking at a value-based payment roadmap that will provide, you know, the various state agencies and stakeholders, the ability to review outcomes and costs. And, you know, we’re we’re working to integrate all of these traditional functions that I just mentioned with the different groups that will participate in view of what drives health throughout a person’s life. And that includes these aspects of life that have become a more urgent part of our Master Plan for Aging’s mission. So you mentioned the state agencies. And I think if I can take a step back for a second and just give a roadmap of what is to be accomplished in the timeframe that it’s going to be accomplished pursuant to the executive order. We have a preliminary report to you to the governor in July, which we expect will focus on identify existing systems and set out the areas that I mentioned, that are ripe for innovation, and restructuring and increase support. And then we have a final report. That will be due the following July 2024. And you mentioned that we’ve assembled an advisory committee of stakeholders from across the aging landscape. And this does include quite a bit of clinical expertise. It includes community advocates and business leaders and care providers. So we’re sorting everyone in into and onto different subcommittees that will engage in depth with a wide spectrum of topics that impact aging New Yorkers, from long-term care services, to housing to economic security, to the caregiver workforce. And what we intend to develop is a set of policy proposals that can be implemented either through regulation or legislation at the state and local level to address the whole ecosystem of aging.

    Courtney Burke 13:06

    Now, that’s great. And earlier, you mentioned the Medicaid program and its importance to paying for services for people who are aging or have disabilities. How do you anticipate and it may be a little bit early to try to figure out what this means for the Medicaid program. But at this point in time, how do you see the Master Plan on Aging impacting Medicaid?

    Adam Herbst 13:30

    Quite a bit. That’s why my friends and colleagues is going to be engaging with us. That’s the State Medicaid Director. He’s already participated on some preliminary conversations with the stakeholder committees. You know, payer models is a critical element to you know, obviously, the aging infrastructure, our vision is to create a bold and comprehensive roadmap, which looks at payers, and different levels of focus on the need to present for people to have the ability to age in place and afford to get the care they need. That’s obviously a very broad vision and goal that we’re trying to accomplish here. I’m reluctant now to get into specifics, because you know, it’s not going to just be me talking about some of our guiding principles of of the Master Plan for Aging. But I will say that, as we create these efforts, with an understanding of the state government’s financial realities, and the governor’s guiding principles for New Yorkers in need of long term care services, you know, the state master plan is defining services for for people who are unable to remain in their homes and communities without support with activities of daily living, and that’s why it’s critical for us to ensure that Medicaid is considered. We look at achieving equitable standards, health care for people with limited incomes of all races and geographies in need of long term care in aging services that he conforms to the Olmstead directive that that people with with disabling conditions are entitled to live in a setting that’s appropriate to their needs. And, you know, we implement recommendations, not just for Medicaid but also within the state’s budget and a five year financial plan that achieves meaningful savings to the Medicaid program, including alignment with Medicare to capture acute care savings generated by long-term care services and aging services. You know, we need to ensure that providers and plans receive funding consistent with their their service obligations to protect access to quality care for future generations. And, at the same time, safeguarding the development of a comprehensive person centered care plan for every individual eligible for either skilled nursing care, or other type of care, whether in their home community or in an institutional setting. And that includes, by the way, providing fair pay and appropriate working conditions across the long-term care and ageing workforce continuum to enable that those people can help fulfill their obligations to both their patients and the families and those who seek to age in place.

    Courtney Burke 16:18

    So that’s a great overview of how Medicaid is playing a role in relates to the Master Plan on Aging. But there’s also a big part of the care system that is less formal, and isn’t necessarily Medicaid funded. And that is the workforce of people I call the informal caregivers. They’re the people who support people who are aging or have disabilities, and may not necessarily receive Medicaid to do so. So how does this plan help address and support people who are informal caregivers?

    Adam Herbst 16:52

    That’s a great question. I mentioned training, I mentioned compensation and respite care are all critical parts of informal caregiver support. Policies that strengthen family medical leave protections are critical. Better hybrid models that pay informal and formal caregivers allows for more gradual transitions from families professional care, which hopefully improves outcomes and reduces the burden on informal supports. You know, there’s no question that we need to address the workforce shortages on three fronts. And that’s what I’ve said to the group in our first few meetings on the master plan. And I’ve said this in other contexts with respect to my colleagues and state government, you know, that’s making sure that New York state remains an attractive place to work, making sure that healthcare work remains competitive against other fields, and securing stronger training pipelines to invest in the next generation of workers. Efficient and effective communication with homecare workers, formal and informal workers and improve patient monitoring are critical to our goal of maximizing the number of people who age in place in their homes or in their communities. Not only that, but more consistent and uniform record keeping helps spot health problems before they get worse and allowing early interventions that improve outcomes and reduces costs. Ultimately, this is going to require better documentation, which will help provide help medical providers give better care and better communication and monitoring technology that will really allow people to age in place with the proper support. One thing I want to say that, you know, we’re incredibly proud of our age friendly designations by AARP, ultimately, you know, people don’t move out of the state. They stay because of what they hear in the media, they move because it becomes less attractive or more difficult to continue aging where they are, whether it’s financially or because of family, or other circumstances. And I think New York State is a fantastic place to grow old and I think every retiree should move here. But what we care about is New Yorkers continuing to enjoy their lives, here, at every age, and how do we do that? It’s by making sure that we have access to affordable housing that accommodates their needs. We have located convenient transportation options and are accessible for whatever supports may need or arise. And really making sure that caregivers have adequate transportation themselves and the resources that helps ageing New Yorkers with their health care needs, and you know, their activities for daily living and ensuring that people have food security and economic security. If we do these things, Courtney, then people will continue to want to stay in New York throughout their lives and will continue to benefit from the presence of, and we will continues to benefit from the presence of an aging population in our state. And that is really, what I’ve tried to continue to remind that was on the state builder committee.

    Courtney Burke 20:10

    That’s a great overview because you talked about food, housing, transportation, all of those things which are important for people to be able to age in place. One that I wanted to just talk about a little bit more is technology. And during the pandemic, we saw an increased use of technology to allow people to stay in their homes, and the use of that technology was fairly widespread among people of all ages. So if you could tell us a little bit more if you anticipate that the Master Plan on Aging will help accelerate the use of technology, as another way to help people age in place, it would be great to hear about how the state anticipates technology as a means to keep people aging at home.

    Adam Herbst 20:56

    Sure, well, technology, what we’re going to say is that enabling people with with aging or long-term care needs, their families, their friends, their trusted caregivers, you know, with the information and guidance and technology for coordination is critical. And we see that and we see where there are gaps, you know, currently, you know, in terms of different providers offering technology services or plans ensuring that people have the the the the highest ability to ensure they receive technology in the community. You know the master plan is going to be an evolving program. And you know, it’s going to be reevaluated with programs and outcomes. And as new technologies and methodologies and treatments come available, we want to ensure that we facilitate the newest technology, the newest methodologies and treatments that help facilitate the care in home that ensures that, you know, people can have that continue the continuity of transitions between settings and ensuring that there’s no disparity that prevents people from you know, having the access to technolog. We saw during the pandemic the benefits for all populations, but particularly for the aging population, to utilize technology with their providers with their families, reducing social isolation. There are so many reasons related to disparities across racial and ethnic lines that we saw during the pandemic play out in different populations as relates to technology, this is something that we need to continue to really focus on. There are language differences, there’s geographic disparities. So technology is a wonderful tool. But there is a lot of room for us to cover the gaps, which currently exist, and encourage for providers to partner with them stay for, you know, a lot of startup organizations who have reached out that want to participate with us and you know, ensuring that everyone has access to best serve technology.

    Courtney Burke 23:03

    Well, it will be interesting to see what’s in the master plan on aging as it relates to equity, and the efforts around reducing disparities to the access to that type of technology. So I’m looking forward to hearing about that, as the plan is released in in July. One last question before we wrap up today, the governor just released her budget. And we’d love to know more about how you anticipate when the plan is finalized next July, basically a year and a half from now, whether there will be things in that budget that you anticipate will help with implementation of the master plan.

    Adam Herbst 23:43

    It’s really important that we acknowledge the governor’s commitment to the state’s Master Plan for Aging. And as it relates to the budget for this year, we really did undertake a significant amount of work related to aging, and other long-term care fields. Once again, you know, proving that New York is a leader in the space. And we’re taking that as a foundation this year, to continue to build up respite care aging in place and all the experience that we’ve gained, from the few years that we have been talking the master plan now what we’ve learned, and building upon all of that to develop the master plan. We are excited to put the plan into action. And then you know, next year’s budget, we anticipate quite a bit of additional commitment to reinforce and strengthen the decisions, the recommendations of the plan. And, you know, again, New York being proactive, to help put this, you know, at the forefront of what the governor’s priorities are and we’re very excited for the commitment from our partners in the Division of Budget, our partners across state government and from all stakeholders across the continuum.

    Courtney Burke 24:59

    Well, this is been very helpful to learn more about the topic of the master plan on aging. We would love to have you back at some point in the future to tell us how it’s evolving. And what’s been recommended. So perhaps this summer we’ll talk again about this topic, but very informative and appreciate you taking the time to speak with us today was a pleasure.

    Adam Herbst 25:19

    Thank you so much.

    Alexander Morse 25:27

    Thanks to Courtney Burke, Senior Fellow in health care policy at the Rockefeller Institute, and Adam Herbst, Deputy Commissioner for the Office of Aging and Long-Term Care at the Department of Health, for taking the time to discuss the state’s Master Plan on Aging initiative, and highlight the importance of preparing for the impending change in the state’s aging demographics to ensure all New Yorkers are able to live healthy, productive lives as they grow older. Did you like this episode? Let us know. Please rate, subscribe and share. It’s the best way to help others find the podcast and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcasts. And transcripts are available on our website. Special thanks to Rockefeller Institute staff Joel Tirado, Heather Trela, and Laura Schultz for their contributions to this episode. Thanks for listening. I’m Alex Morse. Until next time. Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York state and the nation. Learn more at or by following at Rockefeller inst. That’s Rockefeller i n s t on social media. Have a question comment or idea? Email us at [email protected].

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