Punching Above Our Weight

An 1891 agency attached to a care campus

Syracuse Jewish Family Service has been working in Central New York since 1891. It is now the human services arm of the Menorah Park campus in Syracuse, a continuum of care that runs from a retirement community through to specialist dementia units, and Jay Sinclair's team sits on the human services side of it. The agency was set up to support the Jewish community of Central New York and has since widened out to serve residents of Onondaga County. Sinclair had been in the job about a year when this was recorded, and he opens by handing credit to the directors who came before him.

One detail he offers early on shows how that widening works in practice. The home-delivered meal service is fully kosher and complies with kosher requirements, which means a number of strictly halal clients can eat from it, because kosher food satisfies halal requirements. It does not work in the other direction. A kitchen built for one community ends up feeding more of the county than it was designed for.

The skunk works argument

Sinclair calls his team the skunk works of the organization, the people building the services everyone is going to need in five, ten or fifteen years. The case he makes for it is demographic, and he presents it as his own reading rather than as settled fact. Some of the baby boom generation are reaching 85, so in his account the wave of retirees has already arrived. He points to reports in the media that more people are now looking after elderly relatives than are looking after young children.

What follows from that, for him, is an operational problem. The shift is not going to reverse, and he says there are not enough people or resources to keep providing services the way they have always been provided. He is blunt about where the planning is happening: in his view nobody at the New York State Department of Health and nobody in Medicare and Medicaid services is thinking about it this way, and everybody should be. His team gets room to experiment because somebody has to work out how to deliver with less reimbursement before the answer is needed.

“I stand on the shoulders of others who have blazed the trail before me.”

Jay Sinclair · 2:30

The unofficial circle of support

His answer is not a larger professional workforce. He says the money and the people for that do not exist. What he calls the unofficial circle of support is neighbors, friends and family working alongside trained staff, and he thinks that is what will carry a growing elderly population.

He arrived at the idea partly through an argument he decided not to have. Visiting the UK the month before the recording, his father-in-law, a career diplomat, was complaining that Margaret Thatcher had destroyed community in Britain by elevating the individual above it. Sinclair wanted to argue and let it go, because he is only back for a few days a year. What he kept thinking about was Syracuse, where he knows people whose neighbors look out for them with nobody paying them to.

He ties the same point to isolation. His framing of the 2023 Surgeon General advisory is that loneliness is the largest killer of Americans, ahead of the causes usually named; that is his statement of it rather than a quotation from the advisory. He also thinks technology has a place in the response, and mentions that New York State is among the larger adopters of a conversational AI device that clients talk to and form a relationship with. A care home combined with a primary school somewhere in North America, whose name and location he does not know, is his example of an arrangement whose benefits run in every direction.

“There are reports out there in the media already that there are more people looking after elderly relatives than are looking after young children. And that demographic shift is not going to suddenly change. So providing services in the way that we have always provided them will not suffice.”

Jay Sinclair · 4:31

Why an elder shelter has to be its own building

The shelter began as a pilot under a director several before Sinclair, in partnership with an organization in downstate New York. He puts the start at 2018 or 2019. By the time the money and the approvals were in place, COVID arrived, which made the implementation hard, and the program has run continuously since.

His explanation for why a small agency runs the area's only one, when larger organizations in the region do not, comes down to fit. The local domestic violence network is mature, and he names Vera House as doing that job well. A person in their 20s escaping domestic violence and a person in their late 60s or early 70s escaping elder abuse cannot be housed in the same facility and managed the same way. The older person is likely to arrive with multiple medical conditions the younger one does not have, and the two cases have to be run separately. He reaches for Syracuse University as the parallel, which built dedicated space for students coming out of the armed forces, who have little in common with someone who has just graduated high school.

The categories of abuse were something he had to learn on the job, and the one he says people talk about most now is internet and IT abuse. Behind it sits a plainer question about access. Most of his own medical care runs through an online portal, from appointments to prescriptions, and he asks what happens to a person who has no internet at all. He grants that this is not abuse in itself. His rule of thumb is that around 80 percent of people will take up whatever the new arrangement is, and the 10 percent at either end need a more personal touch.

“You are not here to deliver meals. The meal is ancillary to the social contact and connection that our volunteers can make with some of our clients.”

Jay Sinclair · 21:34

Referrals and a three-day intake

Referrals reach the shelter from local hospitals, from Onondaga County Adult Protective Services, from Vera House, and from area medical centers, clinics and independent living facilities. Sinclair says admission takes about three days on average, and he is precise about the figure because he tracks this kind of thing.

The documentation side is medical records, any police report, and an account of the current situation. The interview happens twice. It starts on the phone, and the agency always asks the person to come into the facility afterwards so that staff can meet them face to face. His reason is that a phone call hides mannerisms and physical detail that are obvious in a room.

“I call us small but mighty. I say that we punch above our weight because of the service that we provide…”

Jay Sinclair · 25:10

The question asked before anyone is admitted

A stay runs up to three months, which puts the shelter between an emergency bed and long-term housing. The hardest decision, Sinclair says, comes before anyone is admitted, and it is working out where that person will be able to go safely and affordably when the three months are up. It is also the part that takes the most time.

Sometimes the answer is the person's own home, once an order of protection is in place or the abuser has been removed from the property. Where that is not available, independent living is usually the goal, and he is realistic about how hard housing is to find in Central New York and elsewhere in the country. He describes housing as the leading social determinant of health, with transportation second, on the grounds that a person who cannot get to a medical appointment is not going to get better.

What the meal route is really for

Sinclair came to the organization as a Meals on Wheels volunteer driver before he ran it, and the volunteer program is the part he talks about with the most conviction. He points out that the rotating roster has to be large, because volunteers come and go and are not employees. The first thing he tells them is that they are not there to deliver meals.

The meal is ancillary to the visit. For some clients the delivery is the only social contact they get in a day, sometimes in a week, which puts the route back in line with the isolation argument he makes earlier in the conversation. The instruction he gives volunteers is concrete: start a conversation and spend a little time, and expect to learn something, because the people on the route have long histories behind them. His claim is that a volunteer gets back more than they put in.

Advice to a director who thinks the organization is too small

Asked what he would say to an executive director who sees a gap like elder abuse services in their own community and assumes their agency is too small to take it on, Sinclair starts with the numbers. The headcount needed to run a service like the shelter is smaller than people expect, and he says the money needed is probably smaller too. His summary is not to walk into the work carrying assumptions.

The rest of the answer is about who to call. He had not worked in this sector before and expected the relationship between private and public bodies to be cool in both directions. What he found in the county was willing participants who wanted the same outcome for the same reasons, and his closing advice is to reach out to fellow executive directors and to public bodies, and to not be afraid to ask for help.