New York City’s Department for the Aging (DFTA) needs to do more to ensure the meals it provides to homebound seniors are prepared in sanitary conditions and are nutritious, high-quality meals, according to an audit released today by New York State Comptroller Thomas P. DiNapoli. The agency’s failure to adequately monitor the vendors it hires to make and deliver the meals is a particular concern during the COVID-19 pandemic, which has increased isolation and food insecurity.
“There are nearly 2 million seniors in the city and many have trouble preparing their own meals. The city’s Department for the Aging is responsible for helping to ensure their well-being, but its lack of oversight and attention to customer feedback regarding this vital program raises serious questions about the quality of services,” DiNapoli said. “I’m pleased the agency has accepted most of our recommendations and urge it to implement them swiftly so it can better monitor providers and accomplish its mission of providing nutritious home-delivered meals to senior citizens who rely on this critical service.”
In fiscal year 2020, DFTA reported delivering more than 4.6 million meals to over 31,000 homebound seniors. DFTA does this by working with community-based organizations and paying them for each meal that is delivered successfully.
Food Safety and Nutrition
DFTA nutritionists make surprise visits to assess whether providers are preparing safe and nutritious meals. Providers that do not meet standards must submit a plan to DFTA to correct the problems. However, DFTA does not compare one year’s assessment to the next, so problems that repeat are not recognized as recurring deficiencies and there are no consequences for failing to fix them.
Auditors’ review of five providers found that 27 issues nutritionists flagged in 2019 were found again in 2020:
- 17 food safety or cleanliness issues, including roaches or vermin in kitchen and food not protected against contamination.
- Four nutrition issues, including high sodium levels in canned or frozen vegetables.
- Six administrative issues, including the failure of all providers to submit Department of Health inspection reports within 24 hours.
DFTA stated that in many cases the original problem was resolved but a new issue in the same category was found at the next assessment. For example, one provider had dead cockroaches in their basement food storage area in 2019 and resolved it by getting an exterminator. Two months later, at the 2020 assessment, DFTA found mice droppings in the same area. DFTA’s 2020 assessment recording evidence of mice did not reference the 2019 evidence of roaches.
DFTA handles client complaints about meal quality and delivery through various sources including 311 and its own hotline. Before it can respond, DFTA first must confirm if the complaint is from a registered client. However, the system that tracks DFTA’s clients does not interface with the systems that track their complaints, forcing DFTA to manually match the complainant’s name to the client list, which can delay response times.
A review of more than 600 complaints found DFTA often took longer to resolve them than it should, with nearly 30 percent of the complaints not resolved within its 14-day guideline. One 80-year-old client, who is severely handicapped, complained a provider did not deliver their meals. After four unsuccessful attempts to reach the client, DFTA closed the complaint. DFTA were unable to confirm whether they had contacted their case manager or the provider to ensure the client was okay. A month later, the client filed another complaint stating they had been wrongly removed from the at-home meals program. Records showed that DFTA closed that new complaint after one failed attempt to reach the client.
Clients can also file a complaint directly with their meal delivery person or the meal provider. However, DFTA does little to review these complaints, which are supposed to be reported to the agency and resolved in one week. DFTA’s lack of oversight in this area made it impossible for the agency to know if providers are reporting all complaints. Auditors looked at 2019 complaint logs from five providers and found one reported five complaints, another had just one complaint, and three recorded zero complaints, including a provider that got a failing grade on DFTA’s customer satisfaction survey for the year. It is possible providers are not collecting many complaints because clients are taking them directly to their case managers, but DFTA does not require case managers to share clients’ complaints.
English Only Client Surveys
Among the city’s senior population, 28% speak limited English, based on DFTA’s 2019 demographic report. In some areas, like Community Districts 1 through 6 in The Bronx, 50% rely on other languages. DFTA, however, did not take steps to make sure people with limited English-speaking skills were able to participate in its survey. Officials said that in 2018 and 2019, survey takers who encountered someone who did not speak English thanked the person for their time and excluded them from the survey. In 2020, DFTA amended this practice by excluding non-English speakers from their survey sample at the outset.
New Contracts for Poor Performing Providers
DFTA awarded new contracts to providers who performed poorly under previous contracts. DFTA officials stated that when scoring proposals, they are limited to only considering the content submitted in the provider’s proposals. However, the proposals ask explicitly that providers show success on past DFTA evaluations. Some providers who did not include their past negative evaluations in their proposals received high or perfect scores by DFTA in those categories. DFTA said it reviews its own evaluations to determine if a provider would be responsible to provide the services, but the audit found at least one instance where DFTA awarded a new contract to a provider in 2021 that it had previously given a poor rating the year before.
Paying for Undelivered Meals
To allow for human error, DFTA forgives 3% variance between the number of meals providers list on their route sheets and those it is invoiced for. This variance could allow payment for nearly 140,000 meals that were not delivered.
The audit found instances in which DFTA did not confirm whether meals on providers’ routes were delivered and did not review all providers’ route sheets. Out of the 14 providers that DFTA reviewed, eight billed the agency for more meals than they reported on their routes. In the sole month reviewed for fiscal years 2018 and 2019, the agency paid for 265 meals that were not delivered.
Meals are free, but seniors can voluntarily contribute to the program providers by check or cash in sealed envelopes through the mail or given to their delivery person. Seniors contributed $1.3 million in 2020, and $1.5 million in both 2018 and 2019. DFTA said it expects providers to put the donations back into the program, but it does not verify that takes place and providers are not required to report how they use the contributions. As a result, there is a risk that providers may be using the contributions for unrelated purposes.
DiNapoli recommended DFTA take urgent action to improve the home delivered meal services by:
- Identifying and addressing providers with recurring food safety and nutritional issues.
- Including seniors with limited or no English proficiency in its surveys.
- Ensuring complaints are resolved within 14 days.
- Developing policies to determine if meals were delivered to clients directly.
- Accounting for providers’ past performance when assigning contracts.
- Developing a system to track and verify client contributions and ensure they are used to benefit the Home Delivered Meals program.
In its response, DFTA officials generally agreed with the recommendations and indicated actions they would take to implement them.
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