Isabella Geriatric Center President and Chief Executive Officer Mark Kator, left, holds a bag of produce from the Your Upper Manhattan program, which distributes fresh fruits and vegetables on Wednesdays. PHOTO: Mike Fitelson
Isabella Geriatric Center has been an anchor in Washington Heights since 1889, which helps explain its deep commitment to every aspect of the community, not just its mission of providing senior services. Isabella has a day care center, an after-school teen program, and a recreation hall that hosts hundreds of community events a year. It also long ago moved away from serving primarily as a nursing home. Isabella is at the forefront of developing new programs and philosophies to help seniors lead more independent, active lives.
Questions and answers have been condensed and edited based on an interview between Isabella Geriatric Center President and Chief Executive Officer Mark Kator and Mike Fitelson on Tue., Oct. 12, 2010.
Manhattan Times: Generally speaking, what is that state of senior care in New York?
Kator: [The state] is in a period of flux and economic uncertainty, and it’s having its impact on everything that we touch, including public policy, because there is no money. You can’t control the fact that there is less money coming in. So how do you ensure that the people we care for, the people we reach out to, the people who reach out to us, are going to have a reasonable chance of getting good services?
It’s a difficult question because none of us has a crystal ball, but I think there are certain things which are kind of apparent. We know the demography is going to be such that older people will be a larger segment of the total population and that is going to increase rather dramatically as the baby boomers age. That’s happening across the world, that’s not just Washington Heights or New York City, it’s everywhere.
There’s things we don’t know. We don’t know whether or not we are going to find a cure for Alzheimer’s Disease. Nothing would make us happier than to see this horrible dementia be preventable – but for a number of years we are going to see not only dementia, but we are going to continue to see people with frailty. Some percentage of the aging population will succumb to chronic illness, and often we see that the chronic illness and the dementia are in conjunction with each other.
That being said, there is an impetus, a thrust to try to find ways that will allow people to be successfully aging in a setting other than a nursing home. So if we are successful in devising scenarios which allow people to age in place, as we call it in the trade, then we will be doing in some measure a good thing for them and for their families.
This will not mean that places like Isabella and other centers where the most frail and the most compromised come to be cared for will cease to exist. The Isabella that you see now that has 705 beds, may not be much smaller, 10, 15 years from now, because we are just going to see more people. So the universe will get bigger, even if we are finding ways to have people age in place.
Ten years from now you will see an Isabella nursing home which is not small, but will have attributes which we have made a great deal of programmatic and philosophical investment in, which is finding ways to treat people as people, to honor their needs, to honor their wishes, to honor their privacy. To support their families in terms of giving them the space and giving them the wherewithal to feel comfortable about having a parent or a loved one in an institutional setting.
I want to see this place as having predominantly private rooms, more communal living space, dining space that’s more like home, and I want us to be able to say goodbye to this archaic model which built these places and made them look like general hospitals. I am concerned about the people who end their lives, usually the last few years of their lives, in what we would call a nursing home setting.
I would like to see for the next 30 years a space that we would all be comfortable in, so that if you or I were to have to come to Isabella to the nursing home you wouldn’t be introduced to a roommate who is going to be living in a room with you two feet away that you’ve never met. You might not even like that person, and even if you did you are sharing a very small space with them.
Manhattan Times: Do you see the number of beds in the nursing home increasing?
Kator: I see the number of beds decreasing, somewhere in the neighborhood of 10 to15 percent, to be replaced by some other things. We should experiment with a less costly but still robust kind of assisted living model. We need to make an investment in low-income and affordable senior housing. We have some affordable senior housing already; we need to do more. If you were to fast forward in our vision and look ahead 10 years from now you will see more housing, you’ll see assisted living, you’ll see a nursing home, you won’t see a new brand new building because I don’t think that the money is there to do that. There will be a good renovation – and it’s going to be a very difficult renovation because we’ve got to do it around people because they are going to be living here.
Now off the campus, we have to continue to do the kinds of things we’ve been doing. Right now we are serving 1,000 people [living at home] north of 110th Street who have had fairly limited access to services. They are referred to us by agencies across Northern Manhattan. We at the very least ensure that they get Meals on Wheels.
Manhattan Times: So in the future there will be more older folks, they are going to live longer, and generally live at home longer. You are going to need a larger workforce of people working with the elderly in their homes.
Kator: There will be more home care. We have a licensed home care agency on 5037 Broadway in Inwood. We probably have close to 260 home health aides. Now that’s a small number but it just started a couple of years ago, it’s growing.
Home care aids are not the most valued folks in our society. Many of them don’t make a living wage, and I think that we will be challenged to find ways to ensure that these people who are taking care of our loved ones, our parents, and will be taking care of us, get the kind of compensation that they deserve. That’s commensurate with their value to society. That’s another issue.
Manhattan Times: Our community seems to have particular physical obstacles for seniors.
Kator: The terrain is very very tough. You have trouble and I have trouble walking up Fort George Hill. What if you were 82? What’s of more concern is much of the housing stock uptown, here, is in walk-ups. And they are old walk-ups. And you know if I’m not able to get around too well anymore, even if I can walk, I’m not going out too much if I live on the fourth floor of a six-story walk-up. I might do it, but maybe I'm only doing it once a week, you know to schlep all the way back up those steps. So am I going to the senior center, am I going out shopping, am I seeing friends, am I socializing? Ultimately if I need home care, I may get it but what is the price I am paying in terms of isolation? If I become frail enough, maybe I'm better off in a place like Isabella in a nursing home especially if we realize the kind of nursing home we are talking about in our master plan.
Manhattan Times: One of the social hurdles that we need to overcome is the stigmatization of the elderly. How is that being addressed in this neighborhood?
Kator: Well I’m going to be romantic about this, which may be a little bit wishful thinking, although I really don’t think it is. There is a great deal of love and respect for older people in this community. How do I know it? By the way these high school kids treat their elders. I don’t want to ascribe it totally to the Latino culture. But I think it might have something to do with the nature of family living and family culture either in the Dominican Republic or in Latin America. But they haven’t forgotten about respect and there is a certain caring for older folks. You see it in the work force here. You see it in the kids who come here to volunteer and work under our stipend programs.
I do think that there is such a thing as ageism and you always worry as the dollar shrinks, are we going to distribute in a way which cares for the most vulnerable, and how will society define which groups are more vulnerable than others. There is a concern about that but I think we are ahead of the game up here and it’s one of the reasons I like working in this community. Because that’s not something you can create in people. It’s there. You can nurture it but I think it has a lot to do with why we are what we are.
Manhattan Times: What about providing employment opportunities for elderly to remain active and be a part of society?
Kator: I have a feeling that the work force demands are going to be such that in the next 10 to 20 years you may see people working into their 70s when [before] they would retire in their 60s.
Just as an example of engaging older people is what we are doing with this YUM [Your Upper Manhattan] program. The idea behind this was not really to distribute nutritious fruits and vegetable to members of the community. The real reason was civic engagement and allowing seniors to be as useful and as engaged as they can be, and bringing that message across to the people who are buying those fruits and vegetables. On top of that you get these people who are getting these good foods. And the seniors are managing it. They have their own work groups, steering committee, they make decisions about how they are going to select, how they are going to distribute, how they are going to sell, going to package. We’re not doing it, they are doing it. So these are productive people. Some of them are in their 60s; some are in their 70s. We have one or two people who are in their 90s.
Manhattan Times: That is an interesting point you just hit on: the fact that people have developed these skills over their lifetime and they can still use them in their so-called retirement.
Kator: They don’t want to stop. They don’t want to go work at Home Depot. You know, if you’ve had a career in finance, or marketing you want to keep practicing that.
Manhattan Times: What role do public-private partnerships play in Isabella maintaining and growing its programs?
Kator: We have always been a partnership oriented organization. In terms of public-private partnerships, we need to work creatively and advocate with policy makers. In addition to advocating for what we need with government we also have to advocate for the opportunity to find solutions with government. You can’t just go to [Assembly Member] Denny Farrell and say: “Find me money! Why are you cutting my budget?” You have to go to Denny Farrell and say: “You know we have to sit with your staff, but we also have to sit with the [Department of Health] staff and other staff and people across the state, figure out how to make sure that we don’t only maintain the status quo but that we do better.”
So I think that if you look at what our responsibilities are in terms of partnerships they are not just interventional, “Oh we’ll take you when you get sick enough, or when you are old enough, you’re frail enough, you’re demented enough.” We want to work with people before that happens. To me that’s very exciting. The picture has to be much bigger than, “We are running a nursing home here and we will open the doors and they’ll come.” That’s not what it is all about: it’s much bigger than that.
Manhattan Times: In 10 years, will seniors living in Washington Heights and Inwood be better off than now?
Kator: I have to say yes. Because if I didn’t say yes I wouldn’t want to be right here. Will all of them be better off than they are now? No, because this is a big community. But I would like to think that the majority, in one way or another, will have access to some things, depending on what they need, which is more positive than what they have now. So if I am living in a walk-up and my family can’t care for me anymore, there is an apartment available on the northeast corner of Isabella’s campus where I can go, and I don’t have to be a wealthy person to be there. Or there is some kind of primary care that we are either doing here or we are doing it in a partnership with NewYork-Presbyterian Hospital or the Columbia University Medical Center or someone. I like to think that that is the case. I like to think that some of the high school kids will teach their parents and grandparents about nutrition, things they learn here or things they learn in school. So I would like to say yes, that in 10 years things will be better. They are certainly a lot better than they were 10 years ago.