The drug regimen that has changed AIDS from a death sentence to a chronic disease for many New Yorkers requires patients to follow a complicated daily routine, which they do at a far higher rate than patients with other diagnoses comply with their medical instructions. AIDS and HIV patients do what they are supposed to 70 percent of the time, while other patients do so only about half the time. Unfortunately, to be effective, HIV treatment regimens require 95 percent compliance, a level nearly impossible to maintain without a clear mind, stable housing, adequate food and cooking facilities, and consistent coverage for medical care and prescriptions.
That is why AIDS activists see social and support services as a crucial factor in the health of people with AIDS, and why they so bitterly criticize Mayor Michael Bloomberg for his proposals to change Local Law 49, which governs the city agency known as the HIV/AIDS Services Administration.
WHO USES THE CITY’S HIV/AIDS SUPPORT SERVICES?
The city’s HIV/AIDS Services Administration’s 31,000 primary caseload includes the majority of New Yorkers with AIDS, plus a small number of those with HIV infection only. Over 14,000 family members of people diagnosed with HIV/AIDS also receive certain HIV/AIDS Services Administration services: counseling on daily living skills, housing—if they live with the HIV-positive person —and if their relative dies, bereavement counseling and help in finding non-AIDS-related housing.
Not all people with AIDS need HIV/AIDS Services Administration’s help. With therapeutic drugs, some are able to continue working, maintaining insurance that covers their treatment, including medication. Others receive long-term disability payments through private insurance provided by former employers. However, all but the wealthiest people with AIDS face the possibility that they may eventually become too sick to work, and/or outlive their savings or other resources.
AIDS is most prevalent among people who are already poor, but it also makes middle-class people poor. It forces them to cut back on work or quit their jobs, pay extraordinarily high bills for prescription drugs—which are rarely completely covered by health insurance—and cope with unpredictable symptoms. The diagnosis alone creates emotional turmoil, sometimes requiring mental health treatment. Newly-diagnosed parents must decide whether or not to tell their children, who should care for the children if a parent dies, and how to juggle medical appointments, child care, and financial commitments.
A 1997 study by the national Centers for Disease Control found that people receiving care for HIV-related disease were twice as likely as others to be unemployed, to have household incomes below $25,000 per year, and to have either public insurance, such as Medicaid, or no health insurance at all. For low-income HIV-positive New Yorkers, government benefits (not necessarily health care) can be the most crucial life support system.
BLOOMBERG’S PROPOSALS TARGET HIV/AIDS OFFICE AND SERVICES
Mayor Bloomberg has announced his intention to seek unspecified changes in Local Law 49, so that the city can provide more help for women and more job training for clients wanting to return to work. However, changing the law could also remove legal limits to the number of clients per caseworker, and to how long the administration can take to deliver benefits. Opponents of this proposal believe that the mayor’s real goal is to weaken the law, so that his proposed budget actions would no longer violate it.
Under the mayor’s executive budget for Fiscal 2004, 29 HIV/AIDS Services Administration case manager positions would be eliminated, case management services for all clients would be privatized, and city funds for HIV-prevention services for communities of color would be eliminated, Under the more drastic “doomsday” scenario, each contractor providing supportive housing for people with HIV/AIDS would take a 10 percent funding cut, affecting 4,000 residents with HIV/AIDS. Also, the city would eliminate all government benefits case management, public and private, for people with HIV/AIDS.
AIDS activists are vigorously protesting these policies. “People are disappointed that we have to do the same thing we were doing with Giuliani,” said Terri Smith-Caronia of Housing Works, an AIDS service and advocacy organization. “At least Giuliani came out and said ‘I hate poor people, I hate the disabled.’ Bloomberg is far more disingenuous, more dangerous.”
The executive budget also proposes that the Mayor’s Office of AIDS Policy Coordination be folded into the health department.
“The implications are huge,” explained Smith-Caronia. “Having this office affirms to the world that this city has a commitment to develop a coordinated policy on AIDS. The Mayor’s Office is a hair’s breadth above all the other agencies that deal with AIDS, so it can make sure the city doesn’t waste federal dollars on duplicating services across departments.”
THE NEED FOR MORE COORDINATION IN THE HIV/AIDS SERVICE SYSTEM
In February 2003, the Center for an Urban Future released a critique of the New York City HIV/AIDS service system, in which author Julie Hantman detailed how the lack of coordinated, objective planning has produced a glut of some social support services and a shortage of others, with a disproportionate share of nonprofit services being located in Manhattan. Of the 250-odd nonprofit organizations providing one or more HIV/AIDS-related services, only 15 offer a full selection at a single site. The rest advocate for “one-stop shopping” for public benefits at the HIV/AIDS Services Administration, but are themselves fragments in a labyrinth of community-based social services. It is just as difficult for a person with nausea, fever, and dementia to travel between multiple nonprofit agencies for mental health care, case management, substance abuse treatment, and food pantry bundles, as it is for them to travel between HRA offices to coordinate welfare benefits, Medicaid, and food stamps.
The term “case management” can refer to coordination of different kinds of services. Medical case managers coordinate health care services. Case managers at community-based organizations coordinate services ranging from housing and food to substance abuse and mental health treatment. For consumers who are poor enough, the HIV/AIDS Services Administration’s staff performs government benefits case management, coordinating public assistance, Social Security Disability benefits, Supplemental Security Income, Medicaid, food stamps, and emergency food and housing assistance.
AIDS activists are critical of the city’s use of federal housing funds to pay the salaries of HIV/AIDS Services Administration employees. “This is $50 million that was meant to be used to build housing for people with AIDS,” says Jennifer Flynn of the New York City AIDS Housing Network. However, she does not support privatizing or eliminating HIV/AIDS Services Administration case management in order to free up federal funds for AIDS housing. According to Flynn, the administration’s case managers are unique, in that as city workers, they are authorized to decide whether applicants are eligible for government benefits and to issue checks, food stamp cards, and other concrete benefits.
“State law requires that it be a state or local district employee that decides eligibility,” she points out, noting that this function could not be performed by private agency employees, but would revert to regular welfare eligibility workers. Those workers lack expertise in AIDS issues, and carry far higher caseloads than the maximum of 34 allowed under Local Law 49 for HIV/AIDS Services Administration caseworkers.
THE MEDICAL IMPACT OF UNMET SOCIAL NEEDS
A diagnosis of symptomatic HIV illness or AIDS entitles HIV/AIDS Services Administration consumers to individualized service planning, financial counseling, support counseling, referrals to private service providers, and child custody planning. Staff can make home and hospital visits, and are mandated to try to find consumers who have dropped out of services -- although the administration does not claim to continue searching for them for the full 90 days required under Local Law 49. In theory, applicants with sufficient income are charged program fees and/or part of their rent.
The majority of people with AIDS in New York City rely on the HIV/AIDS Services Administration for financial assistance with their housing costs, often in the form of rent subsidies. The administration receives about 100 requests a day for emergency housing placement. This reflects the findings of a survey by New York City’s HIV Planning Council, in which more than half of HIV-positive people surveyed named housing as their major need.
Researchers interviewed patients at a Bronx HIV Clinic about factors influencing compliance with antiretroviral treatment. In January 2003, Jane Simoni, lead investigator, noted that the most common reasons given for not taking medications were forgetting to do so and negative side effects. Depression and social isolation also made it less likely that patients would comply with treatment regimens.
At least 27 percent of New Yorkers diagnosed with HIV/AIDS as of March 2003 were intravenous drug users. A national study of HIV-positive patients found that over a 6-month period in 1996, over 60 percent used substance abuse treatment or mental health services. But there is a shortage of affordable mental health services and substance abuse treatment for New Yorkers who are HIV-positive, especially for those who need both.
Bloomberg has not announced any changes in his proposed cuts to HIV/AIDS services since the state legislature took action to pass a state budget more favorable to New York City than the governor’s version. On April 30, protestors marched across the Brooklyn Bridge to demonstrate opposition to the HIV/AIDS cuts. Activists were arrested following a demonstration on May 8 just outside the mayor’s “bullpen” office on the second floor of City Hall , and additional civil disobedience is planned.
Linda Ostreicher, a former budget analyst for the New York City Council, is a freelance writer and consultant to nonprofits. She is currently on the staff of Bronx Independent Living Services.
Many older people rely on assistance beyond medical care and Social Security, but governments are mandated to supply almost nothing else. When the mayor and governor look for places to cut spending, services for the aging are therefore especially vulnerable. The shortage of support services that could keep older people at home sends them to nursing homes instead, where the New York State average cost of $73,000 a year buys a greatly reduced quality of life.
OLD AGE IS DIFFERENT IN NEW YORK
Being old in New York City is not like being old in the rest of the United States: you are less likely to be getting Social Security and much more likely to be poor. The percent of over-65 New Yorkers living in poverty rose to over 17 percent during the 1990's, while nationally it dropped to 10 pecent. Within the elderly population, African-American, Asian and Latino elders are poorer than their white peers. As people of color form a bigger share of the aging population-they are now 43 percent of New York City's elderly-the overall income level of their age group falls. (For more information on the elderly population, see Gotham Gazette's "New York City's Elderly,")
MORE NEW YORKERS LIVE ALONE AS THEY AGE
New York City's elderly are more than three times as likely to live alone as their peers nationwide, even though more New Yorkers have disabilities. Half the senior citizens living alone in the city are surviving on $10,450 or less a year.
Researchers have found that impoverished elders who live in poor Manhattan neighborhoods are twice as likely to live alone as their peers in wealthy neighborhoods, according to a report by the International Longevity Center-USA. This is surprising, because low-income neighborhoods are home to more Latinos and African-Americans, who have traditionally relied on family members to care for their aging. It is possible that the gentrification of nearly all Manhattan neighborhoods is reducing options for low-income families to make room for elderly members. In the outer boroughs, nearly two-thirds of elders live with their families, as they do in the rest of the state, according to one report [pdf file].
THE HOUSING SHORTAGE CREATES A NEED FOR SERVICES
The shortage of affordable housing in New York City is responsible for much of the need for social services for the elderly. In many cases, apartments are too small for aging parents to move in with children, or for old people living alone to offer room and board to an aide in return for everyday assistance. As deteriorating health limits their ability to climb stairs, elderly tenants of walkup apartments can be cut off from shopping, socializing, and other activities taken for granted when they were younger.
Aging tenants can't always move to a larger apartment, or one in an elevator building. Rent regulation protects long-term tenants who stay in place, but penalizes those who move by sharply increasing their rent. Rent-controlled apartments, which are like gold in this city, require tenants to have lived in them since 1969 (or inherited them) in order to maintain their low rents. Most rent-controlled tenants are now old; according to the Eastern Paralyzed Veterans Association, such tenants have an average income of $15,000 a year.
SHIFTING COSTS TO THE MEDICAL SYSTEM
Services for the elderly are concentrated at the two extremes of health. For the healthy, there are group activities at senior centers. If you have a moderate income as well as good health, New York City is an ideal place to be over 65 and retired: you don't need to drive, restaurants deliver meals for no extra charge, and there are free cultural events nearly every day. For the very ill or frail, there are intensive medical care and nursing homes.
In general, people who are over 65 are healthy most of the time. They can usually recover from illness or injury, and go back to their homes, if they receive enough support. The help they need is largely what families and neighbors used to provide: keeping track of finances, cooking meals, buying groceries, and other tasks that require no medical training. A common pattern is for the needs of an elderly person to rise in gradual stages: every year, a few more hours of help might be needed each week.
People aged 85 and older form the fastest growing portion of New York's population of the elderly; they are also the age group needing the most assistance. For those who cannot be completely independent, yet don't need round-the-clock nursing home care, there are few affordable sources of assistance. Most of those are embedded in the Medicaid system, with financial and medical standards of need so arcane that it takes a specialist to fill out the application for services, which come in rigid packages not easily tailored to individual needs. For instance, in-home assistants may be authorized to only do certain tasks: helping with bathing, but not dishwashing; accompanying the client on errands, but not giving medicine. Aides generally work four-hour shifts, up to three days a week, even when clients might prefer an hour of help every day.
It is hard to determine how many people are winding up in hospitals or nursing homes for lack of simple help. Linda Leest, executive director of Services Now for Adult Persons, gives an example. "Transportation is key in eastern Queens," she says. Her agency's vans do more than a commercial car service would. "We'll not only walk people from the van to the door, but we also have an escort program. We'll send someone to go into the bank with them. It can make the whole difference as to whether a person can keep living at home."
SERVICES FOR THOSE WHO DON'T QUALIFY FOR MEDICAID
Assisted living facilities offer a combination of independent apartments with medical and social services. However, the only people who can use them are those who can afford to pay thousands of dollars a month, with no reimbursement from Medicare or Medicaid. Bobbie Sackman, of the Council of Senior Centers and Services, warns potential residents that "There's no legal definition of what they have to provide, no regulations, so people are getting ripped off. They don't know what their money is buying -- how long they can stay, what services they'll get.
"What's really needed is housing with services," she explains. This means funds for home-based care, like that mandated by state law under the Extended In-Home Services for the Elderly Program. This provides case management, housekeeping, personal care, shopping assistance, bill paying, medication management and other forms of assistance to older, frail clients who are not eligible for Medicaid. Governor Pataki has proposed changing state law to end this mandate, merge Extended In-Home Services with another program, and cut the funds for both. The program can't keep up with demand in its current incarnation: it has a waiting list of 6,000 applicants.
NOT GETTING WHAT THEY ARE ENTITLED TO
Like most social workers at senior centers, Edna Souels advises clients about how to get benefits that can solve their problems. "They don't always know they are eligible," she says. Almost half of the seniors who have disabilities making them eligible for Supplemental Security Insurance payments are not receiving them. Two-thirds of the elderly who are eligible for food stamps don't get them. Even the Senior Citizen Rent Increase Exemption is not claimed by two-thirds of low-income elderly tenants in rent-regulated buildings who could use it to avoid rent increases.
Reasons for this include not only lack of information about benefits, but also the stigma attached to programs for low-income people. In 1990, only nine percent of Latino seniors used senior centers, 12 percent used home care, and four percent used visiting nurse services. Only one-half of eligible Latino elderly receive Supplemental Security Income, and 41 percent use food stamps. They are more likely to use Medicaid --- 74 percent of those eligible do -- because there is less stigma attached to it, since family members often use public hospitals. This is much higher than the use of Medicaid by all eligible elders in the city, which is just 40 percent.
The 1996 welfare reform laws added a new complication: the need to prove citizenship or legal immigration status to qualify for most benefits. Older people born in the United States, as well as those who are naturalized citizens or legal immigrants, may not have the right kind of records and be unable to prove their status. Individual senior citizens may have lost vital papers over the years, or forgotten where they are stored.
OUT OF SIGHT, OUT OF THE BUDGET?
When the city proposes closing senior centers, most people think of lunchrooms and bingo games. These are the visible side of the centers' work; they also care for elders who cannot leave their homes to attend group activities. Meals on Wheels, a joint public-private effort, delivers food to the homes of 17,000 low-income seniors a year; most of its meals are cooked in the kitchens of senior centers. The New York Public Interest Group has estimated that for every two elderly clients receiving Meals on Wheels, another nine qualify for this service, but are not getting it. The waiting list consistently averages about 500 people.
Older people can easily become socially isolated. Edna Souels, of Crown Heights Senior Services, spends much of her time counseling troubled clients. "Some of them have family problems-; their children aren't so good to them. A lot of them have depression." They rely on Souels for the understanding that younger people might get from a psychotherapist. "They don't go to mental health services much," she says.
Some senior centers send volunteers to visit clients who are unable to go out; others offer "telephone reassurance". Linda Leest, at Services Now for Adult Persons, is making innovative use of telephone conference calls for the homebound elderly. "We'll get eight to ten of them on the line, and they'll have a discussion group," she says. "We also have specialty groups: one is for bingo, and another is a choral group. They sing songs from when they were in high school."
This kind of activity doesn't lend itself to counting and evaluation; it's not tangible, like a bed in a nursing home. However, the lack of a rational system of in-home care is responsible for much of the huge cost of Medicaid today. If the few services that have taken root are cut off now, we will soon feel their absence in higher medical bills, not to mention the price that will be paid by those who end up in nursing homes.
Linda Ostreicher, a former budget analyst for the New York City Council, is a freelance writer and consultant to nonprofits. She is currently on the staff of Bronx Independent Living Services.
The budget proposed by George George Pataki for the state fiscal year that starts on April 1, 2003 is bad news for low-income New Yorkers.
The state predicts a 5.3 percent increase in the public assistance caseload; the increase may be much higher unless the State Legislature makes major changes to the governor's proposals.
Ron Deutsch, of the Statewide Emergency Network for Social and Economic Security, notes that the Pataki budget "eliminates a variety of initiatives that the governor has credited with helping people transition off of welfare and into the workforce."
KEEPING PEOPLE OUT OF JOBS
The shortage of affordable child care discourages parents from working, results in lost jobs due to child-care emergencies, and prepares the next generation for failure in school and the job market. The governor's budget maintains the current number of subsidized slots -- 183,400 -- but does nothing for the 29,000 families on waiting lists for child care placements. Day care subsidies for students at city and state public colleges would be eliminated, giving low-income parents a strong incentive not to continue their studies.
It costs an average of over $8,000 a year to send a four-year-old to a day care center. A parent working 40 hours a week at minimum wage can earn $10,712 a year. Without subsidized care, children in low-wage families miss out on the educational experiences that give their richer peers a head start in school.
Even for adults, basic education has become a controversial topic. Studies show that half of the adults on welfare have no high school diploma, and that this limits their ability to earn a living wage. Last year, the New York State legislature passed a bill allowing public assistance recipients to spend 16 hours a week in basic educational activities, while counting that time toward their 35-hour weekly work requirement. In December 2002, the governor vetoed this bill, in part because Mayor Michael Bloomberg lobbied against it. On March 13, 2003, the mayor vetoed a similar bill, Intro 93-A, offering education and training activities to welfare recipients.
With New York City's unemployment rate at 8.6 percent in January 2003, more local residents are competing for low-paying positions, increasing the need for affordable day care, and raising the bar for jobhunters' qualifications. Unemployment is not a major concern in Albany: last year, 97 percent of the net statewide job loss occurred within the five boroughs of New York City.
For city teenagers, unemployment is much higher, preventing most from getting work experience during and after high school. Last year, the Summer Youth Employment Program paid the salaries of 36,000 young workers. The governor has eliminated all funds for summer jobs from his proposed budget.
DARING THE STATE LEGISLATURE TO FIND DOLLARS FOR EMPLOYMENT AND TRAINING SERVICES
Every year, the legislature adds money to the governor's proposed budget to pay for programs it considers particularly important. A year later, the governor proposes a new budget that cuts out much of what was added by the legislature. This exercise contributes to the perennial lateness of the adopted budget.
Governor Pataki would prefer to give money for employment and training directly to local officials, without requiring them to fund any specific programs. In recent years, the legislature has diverted some of the governor's lump-sum proposals into specific employment-related programs which, once again, the Pataki budget proposal eliminates. They include transportation assistance, screening and services for domestic violence victims, wage subsidies, training in technology and English as a Second Language, basic education and literacy programs, and job training for people with AIDS/HIV infection.
According to Margaret Stix of the New York Education and Training Coalition, over the past three years, the city's share of the New York State block grant for employment and transitional services has dropped from $68.7 million to $2 million. The city has been slow to spend this money, first because the Giuliani administration preferred not to use it, and now because city contracts with nonprofit service providers require long-term goals to be met before providers are paid.
Stix points to wage subsidies, which have dropped from $45 million three years ago, to $5 million last year. The governor's budget cuts them out entirely. "This is a great program," she says. "How else are you going to get people like ex-offenders hired in this job market?" Subsidies pay 80 percent of an employee's salary for the first three to six months on the job. It has been shown that, after the initial period, two-thirds of the people hired under the program remain at their jobs without a subsidy.
MANUFACTURING HOMELESSNESS
People on public assistance receive a "shelter allowance," which has been stuck at $312 a month for a family of four since 1988. This amount falls far short of the "fair market rent" of $993 per month for a two-bedroom apartment, as calculated by the federal Department of Housing and Urban Development, and even well below the median Bronx rent of $620 per month found by the Census of 2000. So many families were being evicted because of this shortfall that a 1987 lawsuit, Jiggetts versus Dowling, produced a stopgap solution of court-ordered subsidies, known as "Jiggetts" payments.
The state recently proposed a revised schedule of shelter allowances, with modest increases such as raising the allowance for a family of four to $450 a month. "The new allowance would be a good thing for New York City," says Susan Bahn of the Legal Aid Society. "It's not enough to be adequate, but it's a step in the right direction. It would help those families who might be evicted because their rent is only a hundred dollars more than the allowance they're getting now."
The governor's 2003-04 budget proposes that the new shelter allowances should become a state law, and implies that this would end the need for Jiggetts payments to prevent renters from being evicted.
Bahn recognizes the pattern: "Every year, back to Cuomo, they propose this, and every year the Assembly stops them from doing it," she explains. "There's no need to do anything as far as the statute, as long as we have the Jiggetts process." Bahn expects the Jiggetts case to continue for at least two more budget cycles.
"It's a cynical move on the governor's part," says Jonathan Hafetz, staff attorney at the Partnership for the Homeless. "Jiggetts has helped to redress the state's failure to increase the shelter allowance to reflect the true cost of housing." As of December 2002, Jiggetts payments of up to $775 a month were keeping about 14,500 families in their homes. The governor's proposed budget legislation would permit local governments to create their own supplements to the shelter allowance, suggesting that the Pataki administration recognizes the inadequacy of the new schedule.
Housing advocates admit that the Jiggetts mechanism has many flaws: families must be on public assistance, include children, be legally facing eviction, and apply for assistance through a few specific non-profit agencies.
However, Bahn credits the process with benefits beyond preventing homelessness. "We see many people whose lives have been stabilized by the subsidy," she says. "It allows the crises to stop, and I've seen moms get jobs because they were able to stop running to court all the time."
TAKING MONEY FROM THOSE LEAST ABLE TO WORK
Elderly and disabled New Yorkers were expecting to get $13 more each month in federal Supplemental Security Insurance starting next year, but Pataki has proposed keeping that increase for state expenses to administer the Social Security program. Supplemental Security Insurance recipients with disabilities were supposed to be allowed to maintain their Medicaid coverage if they went back to work; this change has been indefinitely delayed by the state's inability to finish adapting its computer system to accommodate the new policy.
PUSHING THE ELDERLY INTO NURSING HOMES
Senior citizens have not been exempt from additional cuts. Naturally Occurring Retirement Communities would lose the state funding that supports critical services keeping elderly apartment dwellers out of nursing homes. Subsidies for adult day care and for respite care would also be eliminated.
UNDERFUNDING THE ADULT HOME IMPROVEMENT INITIATIVE
In response to a New York Times expose of the appalling conditions in adult homes, the governor appointed an Adult Homes Work Group, which recommended both short-term measures to correct the worst abuses in the homes, and long-term expansion of the housing supply to enable residents to return to the community. Pataki has proposed spending $8 million on the short-term measures -- far short of the $58 million needed, according to the New York State branch of the National Alliance for the Mentally Ill.
The Work Group called for 6,000 new community housing beds for residents leaving the adult homes. Pataki's 2003-04 budget offers 1,000 new beds, to be split among adult home residents, patients leaving state psychiatric hospitals, and homeless people. The new beds require a $52 million match from local government, at a time when the city is calling on the state for help with its own budget gap. The governor's budget fails to fund new scattered-site placements, in regular apartments where tenants receive case management services, as a faster, cheaper way to expand the supply of community housing.
MORE CUTS FOR THE MENTALLY ILL
For years community-based mental health services were expanded using the money saved by closing beds at state psychiatric centers. Pataki has recognized the value of the Community Reinvestment Act, which guided this activity, by proposing a new reinvestment bill. However, he wants to delay the bill's implementation until 2004; meanwhile, the savings from six more facility closings would go toward the general fund.
The new Mental Health Court in Brooklyn depends on a variety of supportive services to divert mentally ill, non-violent criminals from prison. Without new community-based housing for people with psychiatric disabilities, New Yorkers will continue to pay more than is necessary to keep these individuals in prison, the least appropriate setting.
JOB-KILLING SERVICE CUTS
The proposed 2003-04 budget uses familiar tactics: It shifts some costs from state-funded programs -- like state mental health facilities -- to areas with more federal and local financial support, like homeless services. It delays other costs, such as nursing home bills for seniors who can remain independent for months or years after community-based supports are taken from them. It transforms the price of subsidized day care centers into costs that never take financial form, such as single mothers worrying about what happens after they leave their children with an untrained babysitter.
In this period of economic stagnation, social service is one of the few industries for which demand is growing. Unfortunately, by choosing not to fill that demand, Pataki is closing down existing and potential jobs, and preventing thousands of welfare recipients from qualifying for the jobs that are left.
If he gets what he is asking for, Pataki's third term will be the worst yet for low-income New Yorkers.
Linda Ostreicher, a former budget analyst for the New York City Council, is a freelance writer and consultant to nonprofits. She is currently on the staff of Bronx Independent Living Services.