While the debate rages on Medicaid, Social Security, and the changing demographic makeup of this country, the real day-to-day needs of seniors continue to be ignored. While Democrats and Republicans in Washington argue about what we already know – the current system is ill-equipped, structurally and financially to meet the needs of the “baby boomer” population – seniors and their families continue to make wrenching decisions about their lifestyle and future.

During my years in elected office I have heard from seniors throughout our communities, and one thing is very clear: older people want to age at home with dignity and independence. It’s a simple request and one that government can and should support.

It costs Medicaid over $100,000 a year to keep a senior in a nursing home in New York City; for a small fraction of that we can help keep seniors safe and healthy at home. To do this I have developed an “aging at home” plan. Highlights of my plan include: Strengthening community-based organizations that serve New York City seniors. Four out of five seniors are ineligible for Medicaid and this is the only support network they have.

These programs provide the services that keep older adults in their homes by providing the necessary supports – yet they struggle to survive. Without them, we have little chance of reining in Medicaid expenses and of successfully meeting the growing needs of seniors.

Creating a comprehensive plan to foster the development of safe and affordable senior housing to promote dignity and independence by providing those who need it with a healthy living environment. Currently, New York City relies predominantly on federal dollars to provide funding for elderly housing development. Limits on funding and other federal requirements coupled with increased demand have led to waiting lists of up to 10 years for available apartments. I believe this is unacceptable and that the city must establish a plan for the development for senior housing.

Nearly 80% of all care for the elderly is provided by families and other informal caregivers, saving the government billions of dollars a year in long term care costs, often at a detriment to the health and financial stability of the family caregiver.

As part of my plan, I will work to implement a tax credit for out of pocket expenses incurred by family caregivers. In addition I will expand social adult day programs. These programs provide individuals with Alzheimer’s and other dementias safe, stimulating environments while providing respite for caregivers. These programs are effective and cost only a fraction of the medical model programs that are funded under Medicaid.

The aging of the population and the exploding cost of long term care has highlighted the need for flexibility in programs and services. The time has come for us to create, develop and fund flexible, innovative programs that bring services to seniors where they need them most – in their homes and communities.

Dignity, independence and the freedom of choice is something we all desire, regardless of age or disability. By investing resources in programs such as these we can save dollars while promoting a society where aging is viewed with pride, dignity and respect.

Ms. Fields is president of Manhattan.