Where Budget Cuts Strike the Old and Vulnerable 

By Susan Dominus, The New York Times

November 27, 2008

The C. V. Starr Adult Day Services center in Manhattan is scheduled to lose its grant from the Department for the Aging. 

Six days a week, Alma Ortiz, a petite woman who worked for Con Ed for years, waits patiently in front of her home on West 97th Street for a private bus that picks her up and takes her across town to the C.V. Starr Adult Day Services center, a program for people living with Alzheimer’s disease or dementia. 

Ms. Ortiz, 86, who suffers from dementia and lives alone, considers the center a second home. One day this summer, the bus that takes her there was a little late; so determined was Ms. Ortiz to get there, she decided to take the next bus she saw. Lost and disoriented, she eventually ended up at Metropolitan Hospital Center, where someone called her son, who picked her up and took her where she wanted so badly to go. 

We all brace ourselves before we walk into any unknown senior center, emotionally preparing for the painful fluorescent light, the people dozing, heads tilting, in those overheated rooms. It was a pleasant surprise, then, to walk into the C. V. Starr center earlier this week, where aides were keeping the spirits high, despite recent news that the center would lose its grant from the Department for the Aging — half its financing — effective Dec. 31. 

That morning, music was playing, just loud enough that you couldn’t help but take notice. At four tables around the room, about 16 people, from their 60s through their 80s, including Ms. Ortiz, were singing or at least listening, wagging fingers or tapping feet, as songs from their childhoods took them back:

 “Alexander’s Ragtime Band,” “Amazing Grace,” “For Me and My Gal.”

Things moved quickly at the center: After the music, the staff quickly cleared the tables away, and the clients lined up along the perimeter of the wall. Then the men and women took turns rolling a ball in the direction of some lightweight bowling pins. A tall, patrician man in an Oxford shirt and corduroys made a spare. A woman who’d been furiously applying coral crayon to a page of a coloring book put aside her work to waltz right up to the pins and knock each one down. The other guests and the aides hooted, hollered and cheered — they bowl there routinely, but it all had the feel of a lark, a birthday party where everyone was gamely playing along. 

Next, dancing: “In the Mood,” and they were. Ms. Ortiz, whose gray braided pigtails sprouted out from her “American Idol” baseball cap, started making some understated, but practiced, jitterbug steps. Before long, the tall man in the Oxford shirt had taken her hands, and they danced with flair, the memory of those moves still intact, in their corner of the room. He shimmied to the floor; she twirled around. Was he going to pick her up and throw her around his back? He looked as if he’d learned to dance at countless long-ago cotillions, and she said she’d learned to do the Lindy back in Puerto Rico, where she grew up. But that day, they danced as if they were re-enacting a dream they have over and over, one that’s familiar and warm and welcome. 

“I used to do the Charleston,” said Ms. Ortiz when they all sat back down at the tables. She mentioned that again a few minutes later, and then again, a few minutes after that.

Michelle Coombs, the director of the center, isn’t sure she can keep it going without the grant, and she knows that clients like Ms. Ortiz won’t be able to afford the new rates she’d have to charge (currently about $3 a day, it would go up substantially). Ms. Coombs works with one of 15 programs, called social adult day services, that offer care and engagement for people suffering from Alzheimer’s or dementia, or for people with disabilities that make them ineligible for the city’s senior centers. All 15 programs have lost their grants from the Department for the Aging, a result of the city’s budget crisis.

“I really don’t know what’s going to happen to my mother,” said Ms. Ortiz’s son, Randy Ortiz, an assistant dean at St. John’s University who said he can barely afford the monthly bill as it is. “I don’t know. Is she going to sit at home all day? That can’t happen. She’ll just try to go to the center.” 

Cutting these relatively small programs, said Edwin Méndez-Santiago, the commissioner of the department, was considered more targeted than other alternatives, such as cutting back in some way on the home-delivered meals that reach 17,000 older people in New York. “These are painful cuts,” he said, “but this one is more strategic.” His team will be working with the centers to find new options for the clients, hoping to move as many of them as possible to Medicaid-financed medical care centers or provide them with Medicaid-financed home care. 

But Marianne Nicolosi, president of the New York State Adult Day Services Association, estimates that only 25 percent of the programs’ clients are eligible for Medicaid (and points out that the cost to taxpayers for Medicaid care is much higher in any case). The short notice is brutal, she said, for caregivers. The transition for the many clients, she said, will be even harder. 

For the past decade, New York has indulged in a glut of luxuries that are embarrassing in retrospect, and we all know what they are. Then there are the luxuries that represent the best of what the city could offer — the countervailing offerings that delivered exceptional civic services. The C. V. Starr center on East 85th Street is one of those institutions, and like so many more expendable luxuries, its future is shaky at best. It’s a luxury only in the sense that it exceeds expectations; to its clients, it’s a lifeline. 

“Life is a stage, and we are all actors,” said Ms. Ortiz said as she waited for lunch that day. She said it again a few minutes later, and a few minutes after that. Everyone nodded, and waited.

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