Aging in the Shadows

United Neighborhood Houses of New York
70 West 36th Street, 5th Floor ■ New York, NY 10018
Phone: 212-967-0322 ■ Fax: 212-967-0792
Visit our Website: www.unhny.org
AGING IN THE
SHADOWS:
Social Isolation
Among Seniors
in New York City
Spring 2005UNHSpecialReport

United Neighborhood Houses is the membership organization of New York City
settlement houses and community centers. Founded in 1919, UNH’s membership
comprises one of the largest human service systems in New York City, with 36
agencies working at more than 300 sites to provide high quality services and
activities to more than a half million New Yorkers each year. For over 85 years,
UNH has worked with its members to strengthen families and improve neigh-
borhoods throughout the City. UNH supports the work of its members through
advocacy and public policy research and analysis, technical assistance and funding
and by promoting program replication and collaboration among its members.
UNH BOARD OF DIRECTORS
Sidney Lapidus
President
Patricia M. Carey, Ph.D.
Vice President
Roger Juan Maldonado, Esq.
Vice President
Lewis Kramer
Treasurer
Thomas M. Cerabino, Esq.
Secretary and Counsel
Eric C. Andrus
Paul F. Balser
James W. Barge
Robin Bernstein
Tony H. Bonaparte, Ph.D.
Mark Hershey
Alain Kodsi
Jack Krauskopf
David W. Kubie
Anne C. Kubisch
Susheel Kurien
Harold O. Levy
Ann L. Marcus
Ilene Margolin
Janice McGuire
Edward Misrahi
Alex R. Picou
J. Donald Rice, Jr.
Eric R. Roper, Esq.
Stephan Russo
M. Bryna Sanger, Ph.D.
Charles Shayne
Andrew J. Silver
Arthur J. Stainman
Mario J. Suarez, Esq.
Mary Elizabeth Taylor
Judith Zangwill
Lewis Zuchman
Barbara B. Blum
Chair Emeritus
Anthony D. Knerr
President Emeritus
Richard Abrons
Director Emeritus
George H.P. Dwight, Esq.
Director Emeritus
Julius C.C. Edelstein
Director Emeritus
UNH EXECUTIVE DIRECTOR
Nancy Wackstein
UNH MEMBERS
◆ Boys and Girls Harbor
◆ CAMBA
◆ Center for Family Life in Sunset Park
◆ Chinese-American Planning Council
◆ Citizens Advice Bureau
◆ Claremont Neighborhood Centers
◆ Cypress Hills Local Development
Corporation
◆ East Side House Settlement
◆ Educational Alliance
◆ Forest Hills Community House
◆ Goddard Riverside Community
Center
◆ Grand Street Settlement
◆ Greenwich House
◆ Hamilton-Madison House
◆ Hartley House
◆ Henry Street Settlement
◆ Hudson Guild
◆ Jacob A. Riis Neighborhood
Settlement House
◆ Kingsbridge Heights Community
Center
◆ Lenox Hill Neighborhood House
◆ Lincoln Square Neighborhood Center
◆ Mosholu Montefiore Community
Center
◆ Riverdale Neighborhood House
◆ SCAN New York – LaGuardia
Memorial House
◆ School Settlement Association
◆ Seneca Center
◆ Shorefront YM-YWHA of Brighton-
Manhattan Beach
◆ Southeast Bronx Neighborhood
Centers
◆ St. Matthew’s and St. Timothy’s
Neighborhood Center
◆ St. Nicholas Neighborhood
Preservation Corporation
◆ Stanley M. Isaacs Neighborhood
Center
◆ Sunnyside Community Services
◆ Third Street Music School
Settlement
◆ Union Settlement Association
◆ United Community Centers
◆ University Settlement Society

AAggiinngg iinn tthhee SShhaaddoowwss::
Social Isolation Among Seniors in New York City
Table of Contents
Foreword
Executive Summary
I. Introduction
II. The Problem of Social Isolation Among Seniors
III. New York City’s Formula for Disaster
IV. Program Models Working to Combat Senior Isolation
V. Recommendations for Change
Appendix A: Program Model Examples
Appendix B: Interviews
Appendix C: Endnotes
iii
iv
1
4
9
13
20
30
34
36

ii
Authors
Jessica Walker is a Policy Analyst in UNH’s Policy and
Advocacy Department. She covers a range of issues relating
to seniors, housing, homelessness, welfare, health, and
mental health, especially as they pertain to settlement houses
and the communities they serve.
Cara Herbitter recently completed a yearlong AVODAH
fellowship, which allowed her to serve as Project Coordinator
in UNH’s Policy and Advocacy Department. She is now a
research assistant in the Office of Policy and Planning at the
New York City Department of Health and Mental Hygiene.
Acknowledgements
We wish to express our deep appreciation to the many people
who contributed to this report. First, we must acknowledge
Dr. Eric Klinenberg whose award-winning book, Heat Wave,
served as both the catalyst and framework for this work.
Thank you to Rose Dobrof, Lewis Harris, Gerri Matusewitch,
Nora O’Brien, and Erika Teutsch for their invaluable
comments on an early draft of this report. We want to
extend gratitude for the unending support we received within
UNH for this endeavor, most especially from Nancy
Wackstein, Susan Stamler, Anne Shkuda, Tim Mercure, Linda
Lawson, and UNH Board Member Eric Andrus. We also thank
all of the brilliant and talented individuals who sat down with
us to share their expertise and discuss the important issue of
senior isolation.
Finally, we wish to recognize the generosity of The
New York Community Trust, without whose support
this effort would not have been possible.

iii
Foreword
The term “community” has been muddled and overused in recent years. For some, the
meaning is very basic: people who live within a particular place or region. United
Neighborhood Houses and its member agencies see it more broadly. For us, community has
more to do with the relationships within an area than with simple geography. Community is
that place where people are inextricably linked with a common fate. It hopefully leads them
to help one another work together toward a more promising future.
It is a fact that some communities in New York City are stronger than others. The reality
that many of our city’s older adults have little or no social support within their
neighborhoods is disheartening and is the sign of a community in need of help. Some
seniors have been loners all of their lives while others have experienced recent losses that
have left them all alone. The thought that someone could be alone and unable to receive
the help they need in a city of eight million people is troubling, especially since we do know
how to find and help such isolated seniors.
New York City’s network of settlement houses and community centers makes it their mission
to provide social support to such individuals. We work to strengthen communities and the
relationships within them. This can be in the form of instrumental support (any form of
direct assistance or practical care such as transportation or Meals on Wheels service),
informational support (the provision of or access to facts, advice, and referrals), affiliative
support (companionship or fellowship), or emotional support (communication that a person
is understood, valued for his or her own worth, and accepted despite any difficulties or
shortcomings). That is why we often proclaim that we are working “for a city of neighbors.”
Many seniors who might otherwise be socially isolated have been helped significantly by
settlement houses, community centers, and other locally-based organizations. Our member
agencies act as surrogate families for many seniors who no longer have their own.
However, in light of the imminent demographic surge in the elderly population, there is still
much work to be done. This report intends to initiate a larger conversation on the important
issue of social isolation among New York City’s senior population. We hope that this
contribution will shed some much-needed light on those seniors aging all alone in the
shadows.
Nancy Wackstein
Executive Director
March 2005

iv
Executive Summary
As the senior population of the United States swells, and as the movement to assist
elderly people to “age in place” gathers momentum, the issue of senior isolation
becomes increasingly important. In advancing the laudable objective of helping
seniors grow old in their own homes and communities, many experts and advocates
stress how important it is for seniors to remain “living independently” and “able to
determine their own fate.” At the same time, however, the importance of living
interdependently as we age must also be acknowledged. If seniors are to avoid
institutionalization and premature hospitalization, they require the social, physical,
and emotional support of others.
Seniors who are most at risk during emergencies are those who are socially isolated
and have nowhere to turn for help. Yet the problems that many seniors experience
during emergencies are often the result of factors that were already present, such as
physical frailty or lack of a social network. They are living an “emergency in slow
motion” every day of their lives, but because it is progressing slowly, no one is
coming to their aid. UNH believes we have a shared responsibility for the way our
society cares for the elderly, both in and out of emergency situations. Social
isolation among seniors is a social problem and requires nothing less than a social
solution.
This report poses two questions: What is the role of our society in producing senior
isolation, and what can we do as a society to combat it? To answer these questions,
we rely on research, interviews, and discussions with service providers, academics,
and City government officials. In four parts, this report defines and describes the
problem of social isolation among seniors, highlights the particular vulnerability of
New York City seniors, gives examples of programs already in place working to
combat this problem, and, offers recommendations for change.
Senior Isolation in New York City
Senior isolation results when the conditions necessary for maintaining a functional
social network break down. Both individual and societal factors influence the degree
to which seniors become isolated. Individual factors include living arrangements,
health, socioeconomic status, ethnicity, mobility, gender, and sexual orientation; a
host of subjective factors such as individual attitudes and expectations; and the
degree to which seniors receive social support from family and friends, participate in
activities, and have access to information. Societal factors include the health and
cohesion of communities; prejudices such as ageism, racism, sexism, and
homophobia; and American society’s emphasis on individual self-sufficiency and
remaining independent at all costs.
New York City’s 1.3 million seniors are particularly at risk for living and dying alone.
In fact, a citywide formula for disaster is now brewing. Seniors in the City are more
likely to be poor, disabled, and to live alone than their counterparts nationwide and
many are not getting the help they need. The threat of senior isolation can be found
in even the most densely populated areas of New York City; seniors in upper
Manhattan, the South Bronx, central Brooklyn, and portions of lower Manhattan are

v
at particular risk. The situation will likely be compounded by the coming
demographic surge in the older population. Baby Boomers, who will compose the
largest cohort group of seniors ever, are even more at risk for social isolation than
their parents.
Program Models Working to Combat Senior Isolation
Settlement houses, community centers, and other locally-based service organizations
are ideally suited to identify and then help isolated seniors. Their intimate
knowledge of their communities, their participation in local networks and
associations, and their web of contacts throughout their neighborhoods make them
the optimal places to receive and act on information about seniors in distress. In
addition, because these organizations offer a range of services in an integrated
setting, they are able to address a multitude of causes of senior isolation.
This report describes some model programs that are currently addressing the needs
of seniors. Additional support for these varied responses will be necessary to keep
up with the population growth. Examples include:
• Integrated program settings, such as those found in most
settlement houses and community centers. These organizations
address the social and environmental factors affecting seniors as
well as their individual problems. They often facilitate the social
networking and community activities that can address
neighborhood problems and keep communities strong.
• Programs that use seniors as resources serving in meaningful
roles such as tutors and mentors for children and youth and
volunteer companions for other seniors. This ensures that
seniors maintain a sense of purpose after retirement while
making a real contribution to their communities.
• Programs that bring seniors together, including traditional senior
centers as well as alternative senior centers that target specific
needs. The success of these programs often depends on the
availability of transportation.
• Programs serving seniors where they live, such as Meals on
Wheels, home visits, and supportive service programs (SSPs)
within naturally occurring retirement communities (NORCs).
• Programs to keep seniors connected to others and to social
services via technology, including conference calls, telephone
reassurance, computerized automatic well-checks, and computer
labs with Internet access.
• Case management and geriatric mental health services that are
tailored for those seniors with complex and intensive needs who
are most at risk of being prematurely institutionalized.
• Social adult day care and elder abuse prevention and support
programs, which also target those seniors most at risk.
• Caregiver support, which ensures that existing relationships
between seniors and their family caregivers (which is often the
first line of defense against isolation) remain intact and beneficial.

vi
Recommendations for Change
This report recommends steps New York City government, along with the nonprofit
and private sectors, can take to combat senior isolation:
• To learn more about seniors at risk for social isolation, the City
should expand its data collection efforts to better gauge the
severity of the problem. A citywide assessment of elderly needs
should also be conducted and a voluntary “check-in registry” to
track the well-being of seniors should be developed and
maintained.
• To strengthen and build on our “sense of community,” the City
needs to take the lead in refusing to tolerate ageism and other
forms of discrimination toward the elderly. A citywide public
education and anti-discrimination campaign might be one way to
initiate this effort. The City should also establish a clearly-
written, widely-publicized protocol for individuals to follow when
they become concerned about the welfare of a senior in their
neighborhood. In addition, a citywide alliance should be
assembled to promote and support the development of “elder-
friendly” communities.
• To address current service gaps, the City should adequately fund
and expand those services that already exist and help nonprofit
organizations develop new service models to address emerging
needs. The City should also conduct extensive outreach to
ensure that seniors are aware of the services available to them.
• To tailor services to the senior population’s unique and changing
needs, nonprofit providers need to constantly re-evaluate their
approach and consider new, more inclusive methods of outreach
and service delivery. The City should be a supportive and flexible
partner in this strategic planning process. In particular, plans
should be developed to engage seniors in the social service
system as early as possible, before a crisis situation occurs or
isolation develops.
• To preserve community-based knowledge and relationships
between local providers and seniors, the City should continue
partnering with nonprofit providers to deliver programming at the
neighborhood level.
By addressing the serious concerns outlined in this report, we can take a giant step
toward improving life for thousands of New York City seniors who otherwise might
be lost in the shadows of a large, impersonal, and complicated city.

1
Seniors are increasingly
selecting alternatives to
nursing homes that
allow them to remain in
their own homes and
receive services there.
I. Introduction
The impending demographic surge among our nation’s elderly population is
staggering. In 2011, the large “Baby Boom” generation will begin to turn 65; by
2030, projections indicate that one in five people will be age 65 or older. In
addition, the size of the older population is projected to double over the next 25
years, growing to over 70 million.1
This change will affect every aspect of our
society, presenting challenges as well as opportunities to policymakers, families,
businesses, and health care providers.
Among the elderly population, the fastest growing segment is among those 85 years
and older. In 2000, an estimated 2 percent of the total U.S. population was age 85
and older; by 2050, the percentage is projected to increase to almost 5 percent. This
statistic is especially significant in terms of its impact on our health care system
because these individuals tend to be in poorer health and require more services than
the younger old.
There is a growing recognition in our country of the importance of allowing seniors
to “age in place.” According to the Journal of Housing for the Elderly, “aging in place
means not having to move from one's present residence in order to secure necessary
support services in response to changing needs as we age.”2
While several service models have long served seniors in their individual
communities, the push to help seniors “age in place” gained momentum with the
1999 Supreme Court case Olmstead v L.C. and E.W.3
This ruling affirmed the rights
of individuals with disabilities, many of whom are seniors, to live and receive services
in their own communities as opposed to being
prematurely and/or unnecessarily hospitalized or
institutionalized.
Seniors are increasingly selecting alternatives to nursing
homes that allow them to remain in their own homes and
receive services there. In 2000, 4.5 percent of Americans
65 years and older lived in nursing homes, a decline from
5.1 percent in 1990.4
During this same period in New
York City, the percentage of institutionalized seniors fell
by 12.7%.5
According to a 2003 study by AARP, the overwhelming majority of
seniors surveyed said they want and plan to remain living in their own homes as
they age. In fact, persons between ages 65 and 85 are the least likely to move of
any age group.6
Since the 1999 court ruling, government has been working to ensure that services
can be provided in “the most integrated setting appropriate.”7
In advancing the
laudable objective of helping seniors grow old in their homes and communities,
many experts and advocates stress how important it is for seniors to remain “living
independently” and “able to determine their own fate.” At the same time, however,
the importance of interdependency as we age must also be acknowledged.

2
The problems that many
seniors experience during
emergencies are often the
result of factors that were
present prior to the
incident, such as physical
frailty or lack of a social
network. They are living
an “emergency in slow
motion” every day of their
lives.
According to a new study published by the Journal of Gerontology,8
more than three
million people in the United States need help from another person in order to remain
living “independently” in their own homes. Without this help, many of these elderly
and disabled individuals face going hungry, falling, or experiencing other problems
that could increase the risk of institutionalization and death. They receive assistance
from another person in the activities of daily living that are essential for survival,
such as bathing, dressing, and eating. Unfortunately, some older adults are not
getting all the help they need. Countless others are currently healthy enough to do
many of these tasks on their own, but are without the social supports necessary to
help them if and when they no longer can. The consequences of this can be
devastating.
According to sociologist Eric Klinenberg, author of the award-winning book Heat
Wave: A Social Autopsy of Disaster in Chicago, which examines the 1995 heat wave
in Chicago, Illinois during which a majority of the 739 heat-related deaths were
among older adults:
The prevalence and danger of living alone without
social contacts were apparent in the heat wave
mortality patterns…‘anything that facilitated social
contact, even membership in a social club or owning
a pet, was associated with a decreased risk of death’;
living alone ‘was associated with a doubling of the risk
of death’; and ‘those who did not leave the home
each day’ were even more likely to die.9
Frequently, as was the case in Chicago, seniors who are most at risk during
emergencies are those who are socially isolated and have nowhere to turn for help.
Yet the problems that many seniors experience during emergencies are often the
result of factors that were present prior to the incident, such as physical frailty or
lack of a social network. They are living an “emergency in slow motion” every day of
their lives.10
As advocates continue to call for measures that will
allow seniors to grow old in their communities and
remain as independent as possible, it is also necessary
to ensure that these seniors do not become socially
isolated and unable to obtain the help and support they
need. (Note: In this report, the terms “social isolation
among seniors” and “senior isolation” are used
interchangeably, each signifying the state of an older
person with limited social ties.)
As Klinenberg explains, when seniors die all alone in
their homes “unprotected by friends and family and
unassisted by the state, it is a sign of social breakdown”
in which we are all implicated.11
We have a shared
responsibility for the way our society cares for the

3
Settlement houses
and community
centers have a long
tradition of fostering
relationships among
neighbors, of being
an “extended living
room” for community
residents seeking
companionship and
mutual support.
elderly, both in and out of emergency situations. Isolation among seniors is a social
problem and therefore requires nothing less than a social solution.
Settlement houses and community centers have a long tradition of fostering
relationships among neighbors, of being an “extended living room” for community
residents seeking companionship and mutual support. From
the settlement’s perspective, these relationships constitute
the primary vehicle through which residents can address the
problems facing them, their families, and the communities in
which they live. As such, this report takes a sociological
approach when examining the problem of senior isolation in
New York City. We ask, ‘What is the role of our society in
promulgating senior isolation and what can we do as a
society to combat it?’
In addition to secondary research, our information-gathering
has included interviews with over a dozen professionals
within the settlement house network, meetings with leading
researchers in the field, and discussions with City
government officials. This report will:
• explain the dangers of social isolation;
• highlight the magnitude of social isolation among seniors in New York City;
• present program models that are working to combat the problem of social
isolation; and,
• identify current obstacles to further reducing senior isolation while
recommending ways to neutralize these problems.

4
During their “golden
years,” many seniors
undergo difficult
transitions in their
lives—such as
retirement, declining
health, and the death
of spouses, partners,
and friends—that can
strain their social
network.
II. The Problem of Social Isolation Among
Seniors
During their “golden years,” many seniors undergo difficult transitions in their lives—
such as retirement, declining health, and the death of spouses, partners, and
friends—that can strain their social network.12
This strain is particularly worrisome
because it occurs at a time when seniors most need social support—to help them
recognize emerging problems, provide immediate care, and/or facilitate help from
outside sources.
Seniors who receive social support from family, friends, and
neighbors benefit in terms of their psychological well-being,
life satisfaction, and physical health.13
Yet having social
support is less about the quantity of social ties than it is
about the quality and durability of them: seniors must be
able to both form and sustain strong interpersonal
relationships. This often becomes more difficult with age and
puts the elderly at particular risk of becoming socially
isolated.
In order to ensure that seniors continue to flourish, it is
important to identify and combat the unique characteristics
that result in social isolation.
A.) DEFINING SENIOR ISOLATION
Defining senior isolation is a difficult task. The factors that cause senior isolation
vary from person to person, as does its manifestation. Just because a senior is living
alone does not necessarily mean that he or she is lonely or without social supports.
As sociologist Eric Klinenberg writes:
It is important to make distinctions among living
alone, being isolated, being reclusive, and being
lonely. I define living alone as residing without other
people in a household; being isolated as having
limited social ties; being reclusive as largely confining
oneself to the household; and being lonely as the
subjective state of feeling alone.14
While they are not inherently problematic, the act of living alone and/or being
reclusive are particular risk factors for social isolation. Such seniors may not be
getting the help they need to live optimally in their day-to-day lives—and could be at
elevated risk for experiencing dire outcomes in emergencies—because they have few
places to turn for help. Although the causes of senior isolation vary, the underlying
dynamic appears to be the same. Recently, researchers developed a theoretical
model to explain its etiology.15

5
“Of all seniors living
alone and below the
poverty line, one out of
three sees neither
friends nor neighbors
for as much as two
weeks at a time, and
one out of five has no
phone conservations
with friends.”
Figure 1. Model of the process necessary to maintain an adequate social network.
The model above depicts the fragile balancing act necessary to maintain a vibrant
social network. Social integration refers to the integration into the web of roles and
relationships we refer to as “society” (therefore, social isolation is its inverse).
Functional support refers to the benefits individuals
experience that accompany social integration. Finally,
threats and disruptions are those events and characteristics
that can hinder social benefits from materializing and may
lead to social isolation.
As the creators of the model explain, “gains in one level of
the network may compensate or substitute for losses in the
other.” For example, an abundance of friends can help
ensure that one does not become socially isolated after the
death of a spouse or partner. Social isolation can result,
however, when the threats and disruptions become
overwhelming. An example of this is a senior who loses
sustained contact with the outside world because of a
health problem that leaves her homebound.
The depth of social isolation in the elderly population is staggering. As Dr.
Klinenberg writes:
One of the most striking findings in the studies of
seniors and isolation concern the extent to which
some of the elderly have lost contact with their
friends and families. Of all seniors living alone and
below the poverty line, one out of three sees neither
friends nor neighbors for as much as two weeks at a
time, and one out of five has no phone conservations
with friends.16
Finally, because social isolation so often becomes a vicious cycle, it is very difficult to
reverse once put into motion (i.e., mild social isolation leads to depression which
then leads to deeper isolation).

6
B.) FACTORS INFLUENCING SOCIAL ISOLATION AMONG SENIORS
Below is a partial listing of the most common factors that can influence one’s
capacity to form and sustain a social network, which can originate at either the
individual or societal level.17
Individual factors influencing social isolation
• Living arrangement
Older people who live alone are at a severe
disadvantage because they do not have constant
social support available to them inside their
household. As such, they are more likely than others
to be isolated, depressed, living in poverty, fearful of
crime, and to have more dire outcomes in crises.
• Support of family and loved ones
Close family relationships provide a senior with
emotional and instrumental support. Marriage and
long-term partnerships have been shown to be
beneficial to health and well-being while divorce has
the opposite effect.18
Seniors without children are
more likely to be socially isolated than those who
have living children. Proximity also matters; no
matter how loving adult children may be, those who
live a distance from their elderly parents cannot offer
the same level of social support as those living
nearby.
• Meaningful social participation
The degree to which one feels useful in society is an important factor in
social isolation. Retired seniors who either volunteer their time or work in
community or religious organizations often feel a deeper sense of purpose
and have stronger social bonds than those without such connections.
• Health status and mobility
Physical or psychological impairments can be especially debilitating for the
elderly. As seniors age, they can naturally become frailer or experience
impairments which can severely limit their mobility, interaction with others,
and ability to work or volunteer.
• Socioeconomic status
Seniors who are poor are more likely than those with higher incomes to live
alone, suffer from poor health, have health-related limitations in performing
daily tasks, and experience depression. Seniors with a higher socioeconomic
status have more opportunity to nurture their social relationships. They have
more freedom to entertain in their homes, take classes, travel and visit
others, and use the telephone freely.19
In addition, they can pay for the
specialized supportive services that they may need as they age.
COMMON FACTORS INFLUENCING
SENIOR ISOLATION
Individual factors
Living arrangement
Support of family/loved ones
Meaningful social participation
Health status and mobility
Socioeconomic status
Gender
Sexual orientation
Access to information
Ethnicity
Subjective attitudes
Societal factors
Social environment
Ageism, racism, sexism,
homophobia
Social capital

7
Seniors who are
receptive to help, do
not harbor excessive
fear about crime in
their communities,
have a positive outlook
about life, and do not
see a huge disparity
between their
expectations and
reality are less likely to
become isolated.
• Gender
Men tend to have fewer friends and receive less social support than do
women. Part of this is explained by contemporary models of masculinity,
which often preclude men from exploring the emotional intimacy on which
meaningful relationships are based. Older women, who are generally better
at bonding and maintaining close emotional ties, are at risk because they are
more likely to be widowed, live alone, and be unable to drive.
• Sexual orientation
LGBT seniors (those who are lesbian, gay, bisexual, or transgender) are
much more likely than the general senior population to live alone, have no
children, and age without a life partner or significant other. They are also
less likely to access the senior programs and services they need, putting
them at special risk for isolation.20
• Access to information
Seniors who cannot gain access to information and services because of
illiteracy, language barriers, lack of technological knowledge, or a general
lack of awareness about the help that is available are at a severe
disadvantage when trying to connect with others.
• Ethnicity
In limited instances, certain cultural traits are thought to affect senior
isolation. Some ethnic groups can have stronger multigenerational family
networks, such as groups within the Hispanic and African American
communities, for example, which help shield their elderly from becoming
isolated. However, this benefit may be offset by
the fact that more Hispanic and African American
elders live alone and have lower incomes than
other ethnic groups.
• Subjective factors
The attitudes and expectations that seniors
entertain about themselves, others, and their world
have a great impact on whether or not they are
socially isolated. Some seniors have chosen to be
reclusive and socially isolated their entire lives.
Seniors who are receptive to help, do not harbor
excessive fear about crime in their communities,
have a positive outlook about life, and do not see a
huge disparity between their expectations and
reality are less likely to become isolated.
Societal factors influencing social isolation
• Social environment
Communities are the foundation for social life. They are, Klinenberg writes,
“the soil out of which social networks grow and develop or, alternatively,

8
The phenomenon of
being isolated is very
idiosyncratic. What
affects one senior may
have little or no effect
on another.
wither and devolve.” As such, a community has the potential to promote or
combat senior isolation among its residents. The physical characteristics of
the community, such as deteriorated sidewalks, lack of public space and
parks, high levels of crime, inadequate public transportation, and insufficient
community-based programs and services can limit the degree to which
individuals interact, thus promoting social isolation.
• Ageism, racism, sexism, homophobia
Prejudice, discrimination, and stereotyping—whether overt or systematic—
only serve to separate and alienate individuals of all ages. These issues
affect the lives of seniors in terms of where they can live, who they feel
comfortable interacting with, and how they are treated when trying to access
senior services.
• Social capital
Many analysts argue that the cult of individualism is eroding social trust.
People are increasingly self-interested at the expense of community. This
has implications for seniors who are expected to “remain
independent” and not “burden others” with their problems.
While the above factors can influence the onset of social
isolation, the phenomenon of being isolated is very
idiosyncratic. What affects one senior may have little or no
effect on another. This makes it especially hard to screen
seniors for social isolation. When asked if she has close
friends and family nearby, a senior could conceivably
answer “yes,” yet still be considered socially isolated and in need of additional help.
With this dilemma in mind, the Cornell Gerontology Research Institute is now
developing instruments to accurately assess social isolation in individuals across the
senior population.21

9
III. New York City’s Formula for Disaster
While there is a growing concern for socially isolated seniors nationwide, the 1.3
million older adults living in New York City are at particular risk of living and
dying alone. In fact, a citywide formula for disaster may now be brewing. The
risk of senior isolation is expected to rise to unprecedented levels in the coming
decades. If not addressed, the elderly in New York City will become increasingly
vulnerable to this threat. The three major reasons include:
1.) SENIORS IN NEW YORK CITY ARE ALREADY AT SIGNIFICANT RISK.
It is already true that the rate of poverty among elders in the City is much
higher than in the United States as a whole. When compared to the entire
nation, older adults in the City are also more likely to live alone, speak English
less than “very well,” and be divorced, separated, widowed, or have never
been married in the first place. In addition, older persons in New York City
also have high rates of disabilities, but are more likely to remain living at
home, usually alone.22
The City’s percentage of persons aged 85 and older—those most likely to be
frail and have serious health concerns—has increased at a rapid rate since
1990 (up 19% in Manhattan alone). As such, the elderly in New York City are
at great risk of becoming socially isolated, perhaps more so than many of their
counterparts nationwide (see figure 2).
SEVERAL RISK FACTORS FOR SENIOR ISOLATION: NEW YORK
CITY VERSUS THE ENTIRE NATION (2000)
Selected characteristics
of persons age 65+
New York
City
Nationwide
Living alone, non-institutionalized 32% 28%
With disabilities 46% 42%
Difficulty going outside the home
because of disabilities
8% 5%
Below poverty level 18% 10%
Speak English less than “very well” 27% 7%
Never married 11% 4%
Divorced, separated, or widowed 51% 45%
Figure 2. Several risk factors compared. Source: U.S. Census 2000.
While it is difficult to locate socially isolated seniors, the map on page 10
pinpoints four areas that have some of the City’s highest percentages of
seniors living alone plus a high level of need among their elderly residents.23
This hazardous combination indicates those communities with the highest risk
for senior isolation.24
These areas include upper Manhattan, the South Bronx,
central Brooklyn, and portions of lower Manhattan.

10
Figure 3. Community Districts in New York City that are likely the most at risk for senior
isolation based on the amount of seniors living alone and the level of need among the
elderly residents. Sources: U.S. Census 2000; NYC Department of City Planning; NYC
Department of Health and Mental Hygiene.

11
Below is a chart outlining the twelve community districts identified as being
most at risk (out of the 59 community districts that comprise New York City).
Of course, senior isolation is a problem that can occur anywhere and should
be addressed everywhere.
Overall
Rank
(at risk for
senior
isolation)
Community
District
Communities
Seniors
Living Alone
(citywide
avg.=32%)
Elderly Pop.
in Need
Score
(lower score=
greater need)
Rank for
Elderly
Pop. in
Need
(out of 59)
1 Manhattan CD 10 Central Harlem 49.7% 71 2
2 Manhattan CD 11 East Harlem 39.2% 57 1
3 (tie) Manhattan CD 5
Midtown, Times Square,
Herald Square, Midtown
South
54.9% 140 19
3 (tie) Manhattan CD 9
West Harlem,
Morningside Heights,
Manhattanville,
Hamilton Heights,
37.2% 79 4
3 (tie) Bronx CD 1
Mott Haven, Melrose,
Port Morris
39.7% 112 11
3 (tie) Bronx CD 6
East Tremont, Bathgate,
Belmont, West Farms
41.4% 102 10
7 Brooklyn CD 16 Ocean Hill, Brownsville 39.1% 97 9
8 (tie) Bronx CD 4 Highbridge, Concourse 35.9% 81 5
8 (tie) Brooklyn CD 8
Crown Heights,
Prospect Heights,
Weeksville
36.3% 95 7
10 (tie) Bronx CD 3
Melrose, Morrisania,
Claremont, Crotona
Park East
38.8% 117 14
10 (tie) Brooklyn CD 3
Bedford Stuyvesant,
Tompkins Park North,
Stuyvesant Heights
33.4% 75 3
12 Manhattan CD 3
Lower East Side,
Chinatown, Little Italy
36.5% 117 14
Figure 4. Twelve NYC Community Districts most at risk for senior isolation.
2.) MANY OF THESE SENIORS ARE NOT GETTING THE HELP THEY NEED.
A recent needs assessment of seniors living on Manhattan’s Upper West
Side found that 49 percent of people age 65 and older who need assistance
in basic daily living activities (such as help bathing or getting dressed) have
one or more unmet need.25
Among the elderly population, social isolation
and unmet needs are often interrelated.26
Having unmet needs likely
increases an individual’s chances of being prematurely institutionalized or
hospitalized, and reduces an individual’s participation in society.
Many seniors in need are not taking advantage of the social services
available to them, either because they are unaware of these programs or
they choose to not participate. For instance, the Senior Citizen Rent
Increase Exemption program (SCRIE), which provides rental assistance to

12
New York City must act
now to ensure that its
elderly population
does not fall through
the cracks.
seniors on fixed incomes, is still greatly underutilized; recent findings show
that only 40% of all eligible households appear to be benefiting from it.27
Some of this unmet need stems from attitudes held by seniors themselves:
many want to remain self-reliant at all costs, which is consistent with
American society’s emphasis on individual self-sufficiency. Over the last 30
years, analysts have witnessed a steady climb in the “rugged individualism”
found within our society. Many argue that this widespread civic
disengagement will increase in the coming decades, causing Americans to
become even more independent. This stance can inhibit seniors from
obtaining the help they need while also hindering neighbors and friends
from intervening when they perceive a senior is in need of help.
In addition, while New York City’s crime rate has declined, there is still a
strong perception that crime is prevalent. In 2002, for example, residents
age 65 and older became, for the first time, the most likely of all Americans
to own a gun.28
This fear can reinforce their distrust of others and increase
the likelihood that they will become more reclusive and less likely to
request assistance if and when the need arises.
Even when seniors do manage to seek out help, they are not always
getting their needs met adequately. Recently, Mount Sinai Visiting Doctors
brought problems within the City’s Adult Protective Services (APS) unit to
light, stating “APS is failing to deliver care to the City’s most vulnerable
residents...Unless this agency is completely overhauled the City will
continue to neglect to provide basic care to those in need.”29
3.) THE AGING BABY BOOM GENERATION IS AT UNPRECEDENTED RISK.
While seniors in the City are already at significant risk for senior isolation, the
trend is expected to worsen as the Baby Boomer generation begins to retire.
Between 2000 and 2015, the number of older adults in New York State is
expected to increase by 19%.30
As a group, Baby Boomers
harbor more risk factors for social isolation than their
parents’ generation: they are more likely to be self-reliant.
In fact, seven in ten Baby Boomers don’t want to depend
on their children during retirement.31
They are also
expected to have lower marriage rates, higher rates of
divorce, fewer offspring, higher rates of poverty, and higher
incidence of frailty.32
The threat of senior isolation among the City’s current generation of elders is
alarming enough. In light of the imminent increase in the older population—a
group that will be at unprecedented risk for senior isolation—New York City
must act now to ensure that its elderly population does not fall through the
cracks.

13
Settlement houses,
community centers,
and other locally-
based service
organizations are
ideally suited to
identify and then help
isolated seniors.
IV. Program Models Working to Combat Senior
Isolation
Settlement houses, community centers, and other locally-based service organizations
are ideally suited to identify and then help isolated seniors. Their intimate
knowledge of their communities, their participation in local networks and
associations, and their web of contacts throughout their neighborhoods make them
the optimal places to receive and act on information about seniors in distress. In
addition, because these organizations offer a range of services in an integrated
setting, they are able to address a multitude of causes of senior isolation.
This section outlines some of the many program models currently in place to
alleviate senior isolation in New York City, though their scope is often limited by a
lack of funding. Specific examples of these program models can be found in the
appendix to this report.
1.) CREATING AN “ELDER-FRIENDLY” COMMUNITY
Integrated program settings, such as those found in most settlement houses and
community centers, look at a neighborhood and community
as the unit of attention for enhancing quality of life for
isolated seniors. While senior centers and individual
programs can serve some of the individual needs of
seniors, settlement houses and community centers attempt
to address the total experience of seniors in need, including
social and environmental factors. With a focus on building
an elder-friendly community composed of welcoming
community-based services, creating safe neighborhoods
and strong social networks, and promoting access to
medical care, settlement houses and community centers
are working to improve the landscape of New York City’s
neighborhoods while simultaneously addressing the needs
of individuals.
a. Assessing Community Needs
While social service programs can greatly help seniors, many issues fall
outside their purview: deteriorating sidewalks, for example, can keep frail
seniors at home. To create an overview that takes all factors affecting
seniors into account, a number of organizations have come together to
undertake community needs assessment surveys. Although these are not
focused specifically on social isolation among seniors, a needs assessment
provides a powerful tool to determine the needs of isolated seniors within
their neighborhoods, which can form the basis of a planning process to
create a more elder-friendly community.

14
Seniors, like all people,
do best when they have
meaningful roles and
feel a sense of purpose
in their lives.
b. Community Organizing
Recognizing that seniors’ skills and experiences are often underutilized,
community organizing is a strategy that seeks to maximize the potential of
community members. The goals of organizing can include both bringing
people together to create community as well as working to address problems
in the community through social or legislative change.
Community organizing does more than help to improve communities in the
macro sense; it also works to reduce social isolation by bringing people
together and by increasing individuals’ sense of personal value to that
community. This model is particularly helpful among LGBT seniors, among
whom social isolation is often quite severe. In fact, it is often difficult for
them to find community without making a concerted and organized effort.
2.) USING SENIORS AS RESOURCES
Seniors, like all people, do best when they have meaningful roles and feel a sense of
purpose in their lives. Retirement can threaten this feeling. As such, some
programs provide a meaningful role for seniors while also garnering their
contributions to help others. Volunteer work allows able-
bodied seniors to use their talents and skills in service to
individuals and organizations that rely on unpaid workers.
In fact, the 26.4 million seniors who regularly volunteer
give approximately 5.6 billion hours of their time each
year—a value of $77.2 billion to nonprofit organizations and
other causes in this country.33
Such work can also be a
tremendous source of joy, fulfillment, social stimulation,
and satisfaction for the seniors themselves.
a. Intergenerational Programs
Intergenerational programs promote and encourage connections and
interactions between the old and the young, with rich rewards for both.
Seniors can teach children math or reading, or work with them doing
activities like cooking, music, or art. For seniors, this regular interaction with
younger individuals has the potential to help lessen depression, relieve
boredom, and improve health. The excitement of seeing the world through
younger eyes can be a potent medicine.
b. Friendly Visiting
Friendly Visiting is a program that allows senior volunteers to provide
homebound older persons with regular socialization. The purpose of this
program is to reduce loneliness and isolation, and to monitor the health and
safety of homebound elderly persons. However, the senior volunteers gain
something too. The one-on-one socialization provides both seniors with an
outlet to relieve loneliness by reminiscing with them, reading, playing cards
or games, going for a walk, shopping, or just having a conversation.

15
The fact that the
overwhelming
majority of senior
center participants
are frequent
attendees testifies
to the centrality of
these centers in
many seniors’ lives.
3.) BRINGING SENIORS TOGETHER
For seniors able to travel, those programs and services that bring people together to
socialize, support one another, and gain access to vital services are invaluable
antidotes to social isolation. These include:
a. Traditional Senior Centers
For seniors dealing with loneliness, a senior center is a
place to connect with others while engaging in
meaningful activities. Senior centers host a variety of
social programs such as congregate lunches, exercise
classes, intergenerational programs, cultural programs,
discussion groups, senior advisory councils and
advocacy groups, and special holiday events. On the
most basic level, these centers help seniors remain
active, independent, healthy, and engaged with
others—all of which help ensure seniors’ social
integration. In addition, senior center staff members
are often trained to link seniors to other social services
that they may benefit from.
The City’s Department for the Aging (DFTA) provides funding for over 325
senior centers in the City. According to a 2001 report by DFTA on senior
center utilization, over 51% of participants attend their center everyday while
another 29% attend three to four times a week.34
The fact that the
overwhelming majority of senior center participants are frequent attendees
testifies to the centrality of these centers in many seniors’ lives.
While many participants rely on nutrition services provided at senior centers,
the opportunity to socialize with peers motivates them to engage in
educational and recreational programs. As one senior at Sunnyside Senior
Center in Queens said of the congregate lunch program, “The lunch isn’t the
food, it’s the people you meet.”
b. Alternative Senior Center Models
Some seniors avoid traditional centers because of disinterest in the daily
meal program. Their reasons vary but often involve self-image. Some are
too proud to accept a “handout;” for others, accepting a meal implies
relinquishing their middle-class status. Though they may need other
services, they tend to stay away from centers, thus losing out on a vital
conduit to social interaction or the help they need. Alternative centers have
found ways to overcome these concerns by reaching out to the marginalized
in unconventional ways. One such example is the senior center that does
not serve meals at all and instead creates specialized programming for LGBT
seniors.
The success of both types of senior centers depends on the availability of
transportation. As discussed earlier, one of the greatest indicators of
isolation among seniors is limited mobility, which can result from health

16
A number of programs
have come up with
creative ways to make
a difference in the lives
of homebound seniors
who might otherwise
be completely isolated.
problems, frailty, or a lack of available transportation. These seniors need a
variety of transportation options—shuttle buses or vans, escorts for walking
or driving, reimbursement for taxis or car services—so they can tend to their
daily needs, such as keeping doctor’s appointments, doing their grocery
shopping, and attending senior centers.
4.) MEETING SENIORS WHERE THEY ARE
A number of programs have come up with creative ways to make a difference in the
lives of homebound seniors who might otherwise be completely isolated.35
Because
these seniors cannot regularly participate in the activities at their local senior center,
these programs come to them.
a. Supportive Service Programs (SSPs) in Naturally Occurring
Retirement Communities (NORCs)
A partnership between several social service agencies, NORC-SSPs provide
comprehensive services to the active and homebound senior population of a
particular housing development, with the goal of helping
seniors age in place and avoid institutionalization.
NORC-SSPs are unique because participants are able to
obtain services very close to their homes; sometimes
seniors need venture no further than their lobbies. By
providing services to members of a specific housing
development, NORC-SSPs not only meet the basic needs of
their clients—many of whom may be frail and unable to
access off-site services—but also combat isolation by
building community among neighbors. Another benefit of
the NORC-SSP model is that the inter-agency collaboration
promulgates change on a neighborhood level and creates a more elder-
friendly community.
According to the United Hospital Fund, 28 government-funded NORC-SSPs
serve communities and housing developments in New York City as of June
2000; more than 46,000 seniors live in these communities.36
Currently, there
are eight NORC-SSPs run by UNH member organizations (seven of which
receive government funding).
b. Meals on Wheels
One of the most well-known, vital services for the homebound is the
Meals on Wheels program that delivers a daily meal to homebound
seniors unable to cook for themselves. The program has more than
nutritional value; it also provides a regular check-in by food deliverers for
those who are not likely to have many other visitors. On countless
occasions, food deliverers have become literal lifesavers, arriving just in
time to address a medical emergency. Currently, most senior programs
that deliver meals in the City do so five days a week while a few also
provide hot or frozen weekend meals.

17
Connecting
seniors with the
Internet, and
helping them to
maintain those
connections, will
become more
important as the
Baby Boomers
begin to retire.
In October 2004, New York City implemented a pilot program in the Bronx
that delivers frozen meals in bulk once or twice each week to eligible seniors.
Ongoing monitoring will be necessary to ensure that the components of this
program that can help prevent social isolation (i.e., the contact between food
deliverers and the homebound seniors) are maintained and/or provided
through other methods.
c. Friendly Visiting
Most friendly visiting programs are staffed by volunteers who are trained and
supervised by a paid staff member, resulting in a low-cost program that not
only benefits the homebound seniors but the volunteers as well. Many
volunteers are retired seniors looking for a meaningful way to use their time
and energy, while others are young people eager to find a mentor and
develop intergenerational relationships.
Homebound seniors appreciate the connection to the outside world, and are
thankful that their health and safety is of concern. The challenges to this
program include finding volunteers and making an appropriate match. In
addition, some seniors resist allowing a stranger into their homes, a feeling
which is particularly strong among those seniors who are reclusive and
socially isolated.
5.) KEEPING SENIORS CONNECTED VIA TECHNOLOGY
Technology has vastly expanded in recent years. Many programs and services have
found ways to harness this power to help isolated seniors remain socially connected.
a. Computer Labs with Internet Access
Many organizations offer seniors access to the World Wide
Web. Using the Internet, seniors can stay in touch with
friends and relatives and they can also research and study
any topic they choose to learn about. Recently, a national
survey of older Americans found that less than a third of
seniors age sixty-five and older have gone online,
compared to more than two-thirds of those between the
ages of fifty and sixty-four.37
Connecting seniors with the
Internet, and helping them to maintain those connections,
will become more important as the Baby Boomers begin to
retire.
b. Conference Calls and Telephone Reassurance
Telephone reassurance programs, which can often be found at senior
centers, provide homebound seniors with daily, weekly, or occasional phone
calls from staff or volunteers. While a phone call cannot replace face-to-face
contact, it has many advantages: volunteers can virtually “visit” a dozen
homebound seniors in one sitting, it does not invade the privacy of the
person being called, and it only requires a telephone and a handful of
volunteers.

18
“I want to thank all you
people for keeping me
alive. If you people
didn’t call me I would
not know that I have a
telephone. At least
someone knows I’m
alive.”
For some seniors, these phone calls are the only daily contact they have with
the outside world. As one senior who receives the calls expressed, “I want
to thank all you people for keeping me alive. If you people
didn’t call me I would not know that I have a telephone. At
least someone knows I’m alive.” In this way, the daily
phone call provides a safety net for participating seniors. If
a call goes unanswered, the protocol calls for the volunteer
to contact family, neighbors, or a landlord to ascertain the
senior’s well-being.
Similarly, conference calls provide a rare opportunity for
many homebound seniors to engage in a social group
setting while remaining comfortably in their own homes.
The program also benefits those devoted volunteers placing
the calls by affording them an opportunity to remain useful, make a
difference in the lives of fellow seniors, and socialize with the other
volunteers.
c. Automatic Well-Checks
Using technology, some programs have implemented automatic check-ins or
emergency alert systems to help seniors age in place while making sure they
receive assistance in the event of an emergency. One such example in
Nassau County uses computers to automatically call participants at a preset
time each day; if no one answers, the system calls back 15 minutes later. If
there is still no response, the pre-designated contact person is phoned; if
that person is unavailable, a police officer will be dispatched to the elderly
person’s home and enter if necessary.38
Participants even receive a special
call on their birthdays. While a computerized phone call cannot replace a
personal one, this program has the potential to protect thousands of seniors.
6.) SERVING COMPLEX NEEDS
Some seniors suffering from isolation require more intensive interventions than those
offered by socialization and nutrition programs. This population—the most difficult
to care for—are most likely to be prematurely institutionalized or hospitalized
because of their high level of need. Understandably, many of these seniors’
caregivers frequently report high levels of stress, which if persistent and unrelieved,
may lead them to abuse their charges, or to institutionalize them inappropriately.
Social services that address these complex needs are highlighted below:
a. Case Management
Case management programs assess the individual needs of a client, address
them through direct services or outside referrals, and then link seniors to
appropriate services, such as counseling, other social work services (i.e.
entitlement and benefits assistance, etc.), home care, shopping, Meals on
Wheels, home visits, telephone reassurance, referrals, or financial
management assistance.

19
Though they may
live with caregivers
and/or appear to
have strong social
networks, seniors
who are victims of
elder abuse suffer
from an invisible,
but no less
dangerous, form of
social isolation.
b. Geriatric Mental Health Services
Seniors with untreated mental health problems often experience a unique
form of isolation from loved ones and neighbors as their disorder may serve
as a barrier to socializing and accessing services successfully. To compound
this, many seniors with mental health disorders, especially older seniors, are
reluctant to seek help because of the stigma attached to mental health
services. There are several program models—some of which are described in
the appendix—that can help seniors overcome these
obstacles.
c. Elder Abuse Prevention and Support
Though they may live with caregivers and/or appear to
have strong social networks, seniors who are victims of
elder abuse suffer from an invisible, but no less
dangerous, form of social isolation. Elder abuse can
take many forms, including emotional, physical and/or
financial abuse. Often, it remains invisible to the
outside world. Programs addressing this issue need to
take into account the fact that often a victim’s abuser is
also that person’s primary caregiver.
d. Social Adult Day Care and Respite Care
Programs such as social adult day care (daily group
care out of the home) and respite care help frail seniors
age in place and remain more socially connected while supporting their
family caregivers. These programs are extremely important, as they are
often able to serve seniors who might otherwise face institutionalization.
e. Caregiver Supports
Strengthening the bond between seniors and their family caregivers is often
the first line of defense in deterring social isolation. Because caregivers are
often under a great deal of stress, they need support to maintain their well-
being so that they can continue to care for their loved ones. Caregiver
support helps prevent cases of elder abuse and neglect by providing
caregivers with a needed reprieve, outlets for their stress, as well as tools
and training.

20
While there is
widespread agreement
that senior isolation is
a major problem, we
simply do not know
enough about the
magnitude and unique
characteristics of
senior isolation in New
York City.
V. Recommendations for Change
While much effective work is being done to confront senior isolation in New York
City, barriers remain. This section outlines these major obstacles and presents
several policy recommendations to help address them. Many of these
recommendations speak directly to the role of local government which, in
conjunction with community partners, is often best positioned to understand, serve,
and protect the most vulnerable individuals.
1.) NOT ENOUGH IS KNOWN ABOUT SENIORS AT RISK FOR SOCIAL ISOLATION.
While there is widespread agreement that senior isolation is a major problem, we
simply do not know enough about the magnitude and
unique characteristics of senior isolation in New York City.
The U.S. Census tracks how many of City seniors reside
alone and other basic demographic information; the City’s
Department for the Aging (DFTA) reports how many seniors
participate in various programs and services. However,
very little else is known or tracked, which limits our ability
to locate and help seniors in need. As Eric Klinenberg
writes, “In surveys and censuses isolates and recluses are
among the social types most likely to be uncounted or
undercounted because those with permanent housing often
refuse to open their doors to strangers and are unlikely to
participate in city or community programs in which they can
be tracked.”39
RECOMMENDATIONS:
a. The City should expand its data collection efforts in order to gauge
the severity of senior isolation.
Currently, the City’s Department of Health and Mental Hygiene (DOHMH)
collects and publicly releases comprehensive data on the City’s overall health
and well-being. These “Vital Statistics” report on trends that offer insights
into senior isolation, such as the leading causes of death by sex, age, and
ethnic group; as well as the number of deaths in various locations (i.e.,
home, hospital, nursing home, etc.) The ailments from which seniors are
dying, where they are dying, their level of independence, and the degree of
neglect or caregiver support can then be inferred from these statistics.
However, the City could collect statistics that would provide an even better
view of the magnitude of senior isolation. Examples include statistics on the
death rates of seniors whose bodies go unclaimed by family or friends (and
must ultimately be buried by the City) and of those seniors who die alone in
their apartments only to be discovered later on (even if their bodies are
eventually claimed). This information could effectively be tracked using the
City’s new electronic death registration system.

21
If the goal is to create
communities where
seniors can grow old
with dignity in their
own homes, then we
must fully understand
what is necessary to
sustain “elder-friendly
communities” and also
see where we are
presently falling short.
Collecting this kind of data would allow DOHMH to describe and track
patterns of social isolation among seniors in New York City. It would also
provide information to other City agencies, elected officials, hospitals, and
community-based organizations to help them better understand and address
senior isolation.40
b. A citywide needs assessment of all seniors should be conducted.
If the goal is to create communities where seniors can grow old with dignity
in their own homes, then we must fully understand what is necessary to
sustain “elder-friendly communities” and also see
where we are presently falling short. Of course,
factors that hinder a community from being “elder-
friendly” highly correlate with those factors that
perpetuate social isolation.
This citywide needs assessment should evaluate
each community’s ability to address seniors’ basic
needs, optimize their physical and mental health
and well-being, promote their social and civic
engagement, and maximize independence among
the frail and disabled. Having a clear sense of the
common obstacles facing communities throughout
the City would be invaluable to informing policy
decisions.
c. The City should keep a voluntary “check-in registry” to track the
well-being of seniors.
After the September 11th
World Trade Center disaster, a recommendation
was made to develop City maps that highlight neighborhoods with high
concentrations of older people, and to create a comprehensive database of
frail older people in these neighborhoods who would be at special risk during
an emergency.41
One such database was created for the frail elderly on
Manhattan’s Upper East Side. Several service providers for the elderly,
including two UNH member agencies, partnered to create the East Side
Community Emergency Preparedness Project, which compiled a master list of
their frail clients and rated their level of risk in the event of an emergency.
Because confidentiality is an important element of such a system, this list
was voluntary: seniors who signed up were guaranteed that their privacy
would be maintained.
During New York City’s blackout in August 2003, this list proved invaluable
insofar as it allowed providers to easily contact their clients and then quickly
send workers out to help those in need. A voluntary database like this is
beneficial for more than just emergency preparedness; it can be used to
alleviate the “everyday emergency” of social isolation.
The City should also develop and implement a voluntary “check-in registry”
that is tailored to the unique needs of New York City seniors. Some

22
“We all aspire to live to be
old, and consequently we
all must work to create a
society where old age is
respected, if not honored,
and where persons who
have reached old age are
not marginalized.”
communities outside the metropolitan area instituted voluntary automatic
well-check phone calls for homebound seniors. One such example, which is
discussed in this report’s appendix, is Nassau County’s RUOK (Are You OK?)
program which, though currently underutilized, could be adapted for New
York City so that seniors are not required to be home everyday. For
example, many senior centers offer a special service for their “disassociated
seniors” (those seniors who have not come in for services in some time) so
that if they stop showing up, someone from the center checks in on them.
2.) COMMUNITY ASSETS AND SOCIAL CAPITAL ARE NOT BEING MAXIMIZED.
In recent years, academics have argued that American society is undergoing a
process of civic disengagement that is eroding our communal structures (i.e.,
volunteerism and civic associations). Social capital, such as neighborliness and
harboring a “sense of community,” are reportedly declining as a result. Americans
are thought to be growing more and more individualistic at the expense of “the glue
that holds us together.”
The negative implications are clear: people in need
are less willing to reach out for help, and those who
do are less likely to find the community support they
need. This loss of “generalized reciprocity” often
stems from privacy concerns, fear of others, time
constraints, declining health, and a lack of community
facilities that promote social interaction.42
In this
context, social isolation is an extension of changes
occurring throughout our society.
Opportunities for social integration among older adults are further eroded by ageism,
defined as "any attitude, action, or institutional structure which subordinates a
person or group because of age or any assignment of roles in society purely on the
basis of age."43
The elderly are frequently stereotyped and viewed—not as human
beings—but as objects so that their rights and opportunities can be more easily
denied. It is no wonder some seniors choose self-imposed isolation to avoid these
ageist attitudes.44
RECOMMENDATIONS:
a. The City should take the lead in refusing to tolerate ageism.
While several trends indicate that ageism is slowly declining, the City should
take the lead in hastening its demise.45
As Dr. Robert Butler, who first
coined the term “ageism” explains, “We all aspire to live to be old, and
consequently we all must work to create a society where old age is
respected, if not honored, and where persons who have reached old age are
not marginalized.”46

23
Without a protocol in
hand, many neighbors
shy away from helping
isolated seniors in the
first place; even when
people do act, it can
result in squandered
opportunities because
emergency responders
may miss warning
signs of an “emergency
in slow motion.”
The City should organize an effective and ongoing campaign against ageism in
collaboration with various partners. A recent report issued by the International
Longevity Center-USA offered several possible examples, such as holding public
meetings to inform and persuade people to oppose ageism, disseminating
information about the true aging process, publishing
advertisements and running commercials opposing ageism,
lobbying for legislation to oppose ageism, organizing
watchdog activities to ensure that businesses and the
media do not discriminate against older people, and
enlisting the cooperation of other organizations (i.e.,
churches and unions) to support campaigns against
ageism.47
While the City’s Department for the Aging (DFTA) is
to be applauded for including the need to “confront
ageism” as one of the strategic goals in their 2005-
2006 Annual Plan, much more work needs to be
done to formulate and enact a plan of action. A
citywide public education and anti-discrimination
campaign might be one way to initiate this effort.
b. The City should establish a clear and widely-publicized protocol for
those citizens who become concerned about the welfare of a senior.
Presently no standard citywide protocol exists for concerned neighbors who
notice a senior’s mail has gone uncollected or a senior has not left his or her
home in several days. The Adult Protective Services (APS) unit within the
City’s Human Resources Administration has an intake referral hotline to
accept and act on reports of seniors in need, but the unit is often
understaffed and inadequately supported. In addition, this unit is usually
more reactive than proactive, becoming involved only after a crisis erupts.
Although mail carriers, utility workers, and others who regularly come in
contact with the elderly have often been told to look out for signs of distress,
neighbors remain an elderly person’s most important eyes and ears. Yet
without a protocol in hand, many neighbors shy away from helping isolated
seniors in the first place; even when people do act, it can result in
squandered opportunities because emergency responders may miss warning
signs of an “emergency in slow motion.”
Nassau County police officers conduct formal “well-checks” on seniors if a
neighbor calls to voice concern, making home visits, and referring those who
could benefit from non-emergency assistance to their Department of Senior
Citizens Affairs. In 2003, Nassau County police received 1,783 requests for
“well checks.”
New York City should establish such a protocol, either through the 9-1-1
emergency number, the 3-1-1 informational number, or another mechanism
to be determined. Once in place, the public needs to be educated about its
existence and how to use it. This will help encourage New Yorkers to feel a

24
Funding for most
programs under the City’s
Department for the Aging
(DFTA) has remained
relatively flat for several
years. New money to
cover increasing costs,
such as salaries, rents,
and insurance premiums,
has not been made
available since 1999.
sense of responsibility for their elderly neighbors. In addition, substantial
training will need to occur to ensure that first responders know how to
interpret warning signs and refer seniors in various stages of distress to the
proper services.
c. A citywide alliance should be assembled to promote and support
the development of “elder-friendly” communities.
Creating communities where seniors can age in place takes both planning
and commitment. Government cannot be expected to accomplish this alone.
A citywide alliance should be assembled to conduct a
needs assessment (as previously recommended) to
tackle problems head-on, raise visibility about the need
for “elder-friendly” communities, highlight current
obstacles, create and fund new program models, and
implement solutions to emerging problems.
Recently, Dennis Kodner, Executive Director of The
Brookdale Center on Aging, proposed developing such
an alliance (“AgeWell New York”)— composed of
research centers, City agencies (i.e., the Department
for the Aging and the Department of Health and Mental
Hygiene), health and social service providers,
neighborhood and block associations, and
foundations—to give all of the ‘major players,’ each
with different expertise and resources, a seat at the
table.48
The group’s collective goal would be to analyze the problem of
senior isolation and the obstacles to the formation of elder-friendly
communities throughout the City, identify and/or create program models and
other remedies to combat these problems, and work together to fund and
replicate these effective strategies.
3.) SERVICE GAPS STILL EXIST.
Despite the many exemplary service models currently in place, the City is ill-prepared
for the coming surge in the elderly population. Although Governor George Pataki
commissioned the “2015 report,” which studied the shifting elderly demographic in
the state and instructed all State agencies to plan for the coming influx, current
funding for senior services remained vulnerable to cuts in recent State budgets. To
date, the City has done little to study or plan for the coming increase in its senior
population and their changing needs.
Funding for most programs under the City’s Department for the Aging (DFTA) has
remained relatively flat for several years. New money to cover increasing costs, such
as salaries, rents, and insurance premiums, has not been made available since 1999.
Several programs and services have even been threatened for funding cuts since
then. In a recent survey of many DFTA-funded service providers, over half stated
that they have met these increasing costs by cutting funds from another part of their
budget, such as staff and programs.49
Other programs have reached, or exceeded,

25
If every senior over the
age of 60 used a local
senior center, only six
meals per person
would be available
each year. If all
individuals over 65
years old living below
the poverty level used
senior centers, 46
meals per person
would be available
each year.
their allocated funding to serve clients and have stopped doing outreach to locate
seniors in need.
A recent report by City Public Advocate Betsy Gotbaum
highlighted this issue of capacity limitations. The report
found that New York City has just one senior center for
every 3,638 seniors; and only one senior center for every
465 seniors over the age of 65 living in poverty.
But if every senior over the age of 60 used a local senior
center, only six meals per person would be available each
year. If all individuals over 65 years old living below the
poverty level used senior centers, 46 meals per person
would be available each year. In addition, it is estimated
that there are 93,687 seniors in high need of home-
delivered meals, but the program can only serve 18%
(17,164) of them.50
But even these statistics do not tell the
whole story. Because some providers stop outreach efforts
for programs already filled to capacity (usually because of
funding constraints), it is hard to know how many seniors are actually in need. This
can become a vicious cycle where programs are going underutilized even though
there is actually a great need for them.
Seniors need to be made aware of the services available to them. DFTA has made
great strides in the past few years to improve outreach to seniors. The advent of 3-
1-1 and effective usage of their website has been a major boon to the agency’s
effectiveness. Their UNI-Form benefit assessment system also helps to screen
seniors for various government benefits. In addition, DFTA has worked with UNH
and the Council of Senior Centers and Services (CSCS) to increase awareness of the
Senior Citizen Rent Increase Exemption (SCRIE). Yet there are still many seniors,
perhaps those who most need them, who simply are not aware of programs and
services that they could be benefiting from right now.
To meet existing and future needs, the City must expand current programs, develop
new service models, and then also ensure that seniors are adequately aware of the
services available to them.
RECOMMENDATIONS:
a. The City should adequately fund and expand effective service
models wherever possible.
Effective programs, some of which have been outlined as part of this report,
should be adequately funded. The City should work with its community
partners to determine which models are worthwhile and where expansion is
necessary. A senior center’s effectiveness should be measured by its overall
impact and level of participation for all of its components, not simply by the
number of meals that it serves to seniors. Programs that reach capacity
should maintain wait lists to measure actual need. In addition, funding must

26
The next wave of
seniors is expected to
be even more socially
isolated than the
current generation.
This requires not
merely an expansion
of services but a new,
more inclusive
approach, tailored to
the unique
characteristics of the
Baby Boomers.
be available to cover operating expenses that naturally increase over time
such as salaries, rents, food costs, and insurance premiums.
b. The City should develop new service models to address emerging
needs, specifically in the areas of geriatric mental health and
caregiver support, which are especially important to the Baby
Boomer generation.
According to the newly-established Geriatric Mental Health Alliance, “the
failure to address mental health problems adequately now, and the failure to
plan for the elder boom, reflect dreadful policy failures and that the time to
address them is now.” In addition, the alliance stressed the need to support
family caregivers by providing help during crises and financial assistance.51
c. The City should do more and better outreach for its senior supports
and services.
There are a variety of reasons why seniors do not utilize programs and
services from which they could greatly benefit. There are some seniors who
are aware of these programs, but choose not to participate;
others simply do not know that help is available. The City
must work with providers to continue outreach efforts about
available senior services.
Informational campaigns, conducted by the City and
community groups, about specific benefits—such as SCRIE,
blood pressure screening, tax assistance, and flu vaccines—
can help seniors find the services they need. The City knows
how to construct effective public awareness campaigns,
which often include advertising on City buses and subways.
Recent examples include the Department of Consumer
Affairs’ campaign to increase the number of eligible New
Yorkers claiming the Earned Income Tax Credit (EITC) on
their tax returns; and the Department of Health and Mental
Hygiene’s “Take Care New York” campaign, which offers tips
for maintaining good health.
4.) NOT ENOUGH HAS BEEN DONE TO TAILOR SERVICE APPROACHES TO THE
CHANGING ELDERLY DEMOGRAPHIC.
As we have seen, the next wave of seniors is expected to be even more socially
isolated than the current generation. This requires not merely an expansion of
services but a new, more inclusive approach, tailored to the unique characteristics of
the Baby Boomers. Some of the current approaches to service delivery can be
alienating for seniors who are made to feel like outsiders or “needy clients” when
partaking in programs. Programs must meet the needs of a racially and ethnically
diverse senior population. LGBT seniors who do not feel welcome at a program, for
example, are less likely to seek out and/or continue benefiting from services.

27
Nearly two-thirds of
recently-interviewed
senior center
participants in New
York City indicated
that they used
education and
recreation services
most often; only 12
percent said
“socialization.”
In addition, many seniors do not feel as though they should seek services in the first
place because they do not see themselves as “seniors,” or at least the type of people
they believe would use “senior services.” This phenomenon
is expected to worsen as Baby Boomers age.
According to Dr. Roy Aday, director of Aging Studies at
Middle Tennessee State University in Murfreesboro, “Baby
Boomers equate senior centers with nursing homes and see
them as a place for low-cost meals in an institutional setting.
No question, we’ve got some misperceptions and stereotypes
to overcome.”52
Much of the current programming and
marketing of senior services was not designed to reach the
next wave of individuals approaching retirement age.
Currently, the City’s average age of senior center participants
is 77. Many traditional centers may have trouble attracting
Baby Boomers who will begin retiring in the next few years.53
RECOMMENDATIONS:
a. Providers should constantly evaluate their approach and be open to
trying new and more inclusive methods of service.
The best program models prevent their clients from feeling marginalized,
excluded, or alienated. For seniors to truly benefit from a service, they must
feel welcomed, accepted, and included. Not only should staff be trained to
accommodate and integrate various groups of people in the same setting,
they should also embrace new methods of service delivery that best
accomplish this goal. In short, providers and their funders must be open to
change as the world around them changes.
b. Providers should make a concerted effort to engage seniors early.
For obvious reasons, it is best to have contact with and offer support to
seniors well before any crisis develops. Engaging seniors around the time
they retire is optimal. Retirement is a stressful time for many seniors: they
worry about their finances, their social lives, and self-esteem. To appeal to
these “younger seniors,” many senior centers and services will have to
reinvent themselves.
For starters, they may consider taking the word “senior” out of their names
insofar as it can have a negative connotation. Some senior center planners
think names like “Center for Healthy Aging” or “The Wisdom Center” might
have more appeal.54
Updating programming and facilities can also help
attract new seniors. Nearly two-thirds of recently-interviewed senior center
participants in New York City indicated that they used education and
recreation services most often; only 12 percent said “socialization.”
Examples of services or programs that might appeal to “younger seniors”
include fitness classes, wellness workshops, seminars on financial
management, book clubs, and cultural activities.

28
“The social distance
between city
administrators and the
disadvantaged people
they serve is increasing.
As governments operate
more like professional
firms, commissioners
become CEOs, agencies
subcontract more
services out to private
companies…”
As they retire, younger seniors can also benefit vastly from serving as
volunteers for various senior services. A recent survey found that about 20%
of retirees describe themselves as bored, and about 25% see themselves as
unproductive, both of which can lead to depression, social withdrawal, and
isolation. Yet those seniors who are volunteering report higher self-esteem,
greater life satisfaction, and more energy.55
In addition,
those young seniors who volunteer will find their own
transition to ‘older’ senior that much easier.
Volunteering is an especially useful way to engage
seniors who are economically secure and may not see
themselves as the “type” of senior in need of such
services. As several researchers explain, “Our society
typically prepares individuals for moving into new roles,
whether it is kindergarten or employment, but we do not
prepare individuals for role disengagement, such as
leaving the world of work.”56
Providers seeking out ways
to create volunteer opportunities for younger seniors will
themselves benefit from the unique contributions of these
individuals.
5.) THE CITY IS MOVING TOWARD A BUSINESS MODEL OF PROVIDING PROGRAMS
AND SERVICES FOR THE ELDERLY.
Generally speaking, government is increasingly moving toward a market-based
model of service delivery. As Eric Klinenberg writes:
The social distance between city administrators and
the disadvantaged people they serve is increasing. As
governments operate more like professional firms,
commissioners become CEOs, agencies subcontract
more services out to private companies,…political
organizations risk losing contact with citizens.57
In New York City, several public agencies have already altered their methods of
service delivery in an attempt to achieve cost-savings. Recently, the City sought to
“streamline” services for the elderly by moving from a community-based
infrastructure to a larger, regional scale of service (only 21 regions citywide for
home-delivered meals); and by moving away from nonprofit contractors toward
private, for-profit ones. While these changes might save money in the short-run,
they could result in the further isolation of some seniors. Relying on for-profit,
private contractors in the human services sector could result in service disruptions if
those services are not deemed profitable.58
A second problem, according to Eric Klinenberg,
…is the expectation that city residents, including the
elderly and frail, will be active consumers of public

29
Nonprofit organizations
that offer compassionate
services tailored to a
specific community are
the most appropriate
providers for isolated
seniors, and the most
likely to successfully
locate and engage them.
goods, smart shoppers of services made available in
the market rather than ‘citizens’ entitled to social
protection. This market model of governance creates
a systematic mismatch, whereby people with the
weakest capabilities and greatest needs are the least
likely to get them.59
This phenomenon is troubling because it disregards the needs of isolated seniors and
implies that people who need help are either already receiving it or do not want it.
RECOMMENDATION:
a. For the delivery of human services, the City should continue to
partner with nonprofit providers at the community level.
While services for the aging, like all government
services, should be efficient and cost-effective,
streamlining must not adversely affect the
quality of service or alienate program
participants. Nonprofit organizations that offer
compassionate services tailored to a specific
community are the most appropriate providers
for isolated seniors, and the most likely to
successfully locate and engage them.
As authors David Osbourne and Ted Gaebler
explain when comparing the business and
nonprofit sectors:
The [nonprofit] sector tends to be best at performing
tasks that generate little or no profit, demand compassion
and commitment to individuals, require extensive trust on
the part of customers or clients, need hands-on, personal
attention…, and involve the enforcement of moral codes
and individual responsibility for behavior.60
As such, the City should try to maintain and expand its partnerships with
these vibrant community-based organizations.
By addressing the serious concerns outlined in this report, we can take a giant step
toward improving life for thousands of New York City seniors who otherwise might
be lost in the shadows of a large, impersonal, and complicated city.

30
Appendix A: Program Model Examples
Assessing Community Needs
• The Community Health Organization for the Elderly of East Harlem was created in 1998 as the culmination
of a joint research project undertaken by Union Settlement, Mount Sinai Medical Center, and the Center for
Human Environments. Notably, the project considered the effect of social networks on seniors’ health, as
“social isolation has clear and demonstrative negative effects on health and quality of life.”61
Researchers
felt that it was important to take social networks and social isolation into account when designing services
so as to better “integrate formal and informal supports.”62
• As a pilot of the AdvantAge Initiative,63
the Lincoln Square Neighborhood Center’s NORC completed a
needs assessment survey of the over 600 adults who are 65 and older and living in their housing
development to determine the elder-friendliness of the community-based on 33 indicators in the following
four areas: addressing basic needs, promoting social and civic engagement, optimizing physical and metal
health and well-being, and maximizing independence for the frail and disabled. After analyzing the
survey’s findings, Lincoln Square assembled the NORC Advisory Council, a coalition composed those with
a stake in creating a more elder-friendly community: seniors, nonprofits, local businesses, legislators, the
police, government agencies, funders, and hospitals. The council is now addressing the three most
prominent issues identified in the survey – safety and quality of life, hunger, and health. As a first step,
representatives from the police department attend the NORC Advisory Council meetings, provide crime
reports, and are available to speak to the seniors directly about their safety concerns. In addition, the West
Side Crime Prevention Program assures seniors that they can report crime to the police anonymously. Many
seniors did not previously report crime because they feared retribution.
Community Organizing
• Goddard Riverside Community Center holds monthly Family Council meetings, primarily attended by
seniors, to educate participants about issues that affect their lives. Participants can then take action by
writing letters or making phone calls to elected officials, attending relevant hearings at City Hall, or
organizing demonstrations.
• At SAGE (Senior Action in a Gay Environment), a senior initiated a project called SAGE Neighbors on the
Upper West Side by bringing seniors together in each others’ living rooms to share their experiences, needs,
and hopes for the future. This small gathering soon blossomed into a group of 200-300 LGBT seniors from
various neighborhoods who meet together to socialize, visit homebound LGBT seniors, and work on
projects such as producing a newsletter and compiling a resource directory for LGBT seniors on the Upper
West Side. Thanks to this directory, two LGBT seniors who had been living in the same building for
several years met for the first time at a SAGE Neighbors gathering and became important social supports for
one other. As society moves beyond traditional family networks, this concept of constructing families out
of friends, lovers, and neighbors, which is based on community organization, will become even more
important.
Intergenerational Programs
• Experience Corps utilizes volunteers, ages 55 and over, to improve the literacy skills of elementary school
students at risk for academic failure. Experience Corps literacy volunteers, working in teams of 10-12 per
school, provide one-on-one individualized tutoring to K-5 students who are reading significantly below
grade level and are in danger of failing. Each week, volunteers provide one-on-one literacy instruction
using the Book Buddies tutorial program. In addition, volunteers provide overall classroom assistance by
conducting small reading groups and working with individual children.

31
Alternative Senior Centers
• Forest Hills Community House in Queens has addressed this issue through a program funded by the Queens
Borough President, which does not provide meals but rather social programming alone. Sporting the non-
stigmatizing name, “Kew Gardens Community Center,” it has been highly successful in attracting seniors
who feel out of place at traditional seniors centers but are in great need of social contact. Also, these seniors
can access social services should the need arise. Forest Hills also has a second offsite program that
specifically serves LGBT seniors, who may feel marginalized at traditional senior centers. This unique
program provides an opportunity for LGBT seniors to come together in a setting where they feel safe,
appreciated, and supported by friends.
Naturally Occurring Retirement Communities (NORC-SSPs)
• Founded in 1994, Co-op Village Senior Care (CVSC) serves seniors in a twelve-building development on
the Lower East Side. With The Educational Alliance serving as the lead agency, CVSC is a partnership
with Cooperative Village (East River, Hillman), Seward Park, Amalgamated Dwellings, United Jewish
Council of the East Side, Beth Israel Medical Center, Visiting Nurse Service of New York, NY Service
Program for Older People (SPOP), UJA-Federation of New York, State Office for the Aging (SOFA), and
NYC Department for the Aging (DFTA). Like most senior centers, CVSC provides case management;
nursing and transportation services; and group social, educational, and health-related activities.
• Baruch Elder Services Team (B.E.S.T.)—a partnership between Grand Street Settlement and Cabrini
Medical Center with support from several foundations, New York City Housing Authority, and New York
State Department of Health—provides bilingual services similar to those provided by CVSC to the primarily
Latino/a elder residents of NYCHA Baruch Houses. Because B.E.S.T. is a relatively new program, its
outreach efforts have been very creative: the free blood pressure screenings B.E.S.T. sponsored in the lobby
of each building attracted many seniors who were then given information about the organization’s programs
and services. It has also relied upon its senior volunteers to do outreach. These efforts range from door-to-
door visits to group “visibility walks” during which a large group of volunteers walk through the housing
development wearing B.E.S.T. t-shirts and distribute pamphlets. Outreach that relies on personal
connections not only helps to build community, but also is more likely to reach seniors who might not
otherwise be reached.
Conference Calls and Telephone Reassurance
• Stanley Isaacs Neighborhood Center in Manhattan began its now famed conference call program over
fifteen years ago and currently hosts about 3-5 conference calls each weekday. The conference calls bring
together homebound seniors, volunteers, and staff for activities that include guided “sittercise” (seated
exercise) classes, writers’ workshops, group sing-alongs, book readings, bingo, political and film discussion
groups, and support groups.
• At Riverdale Neighborhood House, which has been running a telephone reassurance program for over thirty
years, a group of ten senior volunteers makes daily phone calls to approximately 50 homebound seniors.
Automatic Well-Checks
• For seniors who do not want a daily call, the Emergency Alarm Response Systems (EARS) program, run by
CVSC, provides frail, elderly clients with a mechanical device that activates an alarm in case of medical or
safety emergency. Clients are also provided with ongoing assessments and case management. While the
program is not foolproof—seniors don’t always activate the alarm in time—it can prove lifesaving for those
seniors who may not have telephones or are unable to dial a phone in an emergency.
Case Management
• Mosholu Montefiore Community Center in the Bronx operates an Expanded In-Home Services for the

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