Health on the Margins is a limited investigative series from Radio Catskill exploring the Catskills region’s fragile healthcare deserts.

Daycares are a lifeline for families: they provide parents and children structure, help build kids’ social skills, and offer weekly support for working families.But Sullivan County’s childcare assistance program has been on pause since July 2025. The program currently serves about 650 children. Radio Catskill's Kimberly Izar reports on the future of rural childcare.

Daycares are a lifeline for families: they provide parents and children structure, help build kids’ social skills, and offer weekly support for working families.
But Sullivan County’s childcare assistance program has been on pause since July 2025. The program currently serves about 650 children. Radio Catskill's Kimberly Izar reports on the future of rural childcare.

Rural Families Still Without Child Care Assistance 7 Months Later, Despite Hochul’s Child Care Push

In Episode 4 of Radio Catskill’s Health on the Margins, Patricio Robayo looks at what “aging in place” really takes—and why winter can turn small warning signs into emergencies. Winter in the Catskills can be cold—and it can be hard. Long distances, icy roads, and limited services can make everyday tasks more difficult, especially for older adults. Getting to the grocery store, the doctor, or even just leaving the house can become a real challenge.But aging doesn’t always arrive all at once. Sometimes it starts quietly: a missed bill, a forgotten appointment, a check that never makes it to the mailbox. And for families—especially working families—the question becomes: what help actually exists, and how do you access it before things reach a crisis point?For Radio Catskill’s Patricio Robayo, this episode is personal.Over the last few years, he’s helped care for his father as his memory declined. At first, it wasn’t dramatic. Bills slipped. Taxes were missed. Checks went missing—or were written and never sent. Things that used to be automatic suddenly required constant follow-up.And then mobility changed everything.“When my father lost the ability to walk safely—and eventually the ability to drive—everything became harder all at once,” Robayo says in the episode. Getting to appointments, picking up prescriptions, and handling basic errands became logistical puzzles that had to be solved around workdays, distance, and availability.Like many families, they found themselves in a gray area: not qualifying for Medicaid, but unable to afford consistent private care. That’s when Robayo began learning more about the services designed for this moment—before it turns into an emergency.A “one-stop” entry pointRobayo spoke with Lise-Anne Deoul, who leads the Sullivan County Office for the Aging, about what the office is actually built to do.Their mission, Deoul explains, is keeping people home, engaged, and safe for as long as possible—and that can mean connecting residents to a wide range of supports many don’t know exist until they feel overwhelmed.That includes help navigating Medicare supplemental plans, home-delivered meals, congregate meal sites for social connection, referrals to home care, and coordination through New York Connects, which Deoul describes as a “one stop shopping” entry point for long-term supports.The office is also part of a broader food security network. Deoul says they help facilitate a biweekly distribution that supports food pantries across the county—and when possible, those items can also help homebound residents and congregate sites.Transportation as dignity—and a lifelineIn rural communities, transportation can be the difference between staying healthy at home and falling into preventable decline.“I think we can all agree that driving is one of the biggest dignity and accessibility tools that we have throughout our lifetime,” Deoul says in the episode. When someone loses that ability—or never had it—getting to regular medical appointments becomes a major barrier.The Office for the Aging provides medical transportation for routine appointments, and for some residents, even life-sustaining treatments like dialysis and chemotherapy.The math of keeping people homeOne of the clearest moments in the episode comes when Deoul lays out the cost comparison of home-based support versus institutional care.She says a person supported through the office’s ISEP program—Expanded In-Home Services for the Elderly Program—can often be kept home safely for an average of about $6,500 a year. By contrast, she notes that nursing home care can cost around $122,000 annually.Beyond dollars, the program helps with task-oriented needs such as bathing, dressing, hygiene, laundry, light housekeeping, and errands—plus connections to vetted resources and agencies for additional support.But even when help exists, it doesn’t always reach people soon enough.“People are self-directing… self-determining,” Deoul says. “It’s kind of hard sometimes to watch people make some really bad decisions… but we keep reminding them we’re here.”Caregivers need care, tooThe episode also highlights the reality that family caregivers can burn out—and that support exists for them as well.Deoul points to caregiver resources offered through a local caregiver resource center, including support groups and a caregiver café, and notes that scheduling and resource information is available online and through the office’s outreach.Planning stops being optionalAs Robayo explains, planning ahead isn’t just paperwork—it’s protection.As his father’s condition worsened, once finances and mobility started slipping, their family had to move from reacting to preparing. Deoul says the Office for the Aging can connect residents to help with simple wills, estate planning, and advance directives, and can provide healthcare proxy forms.Having those tools in place can reduce emergency decision-making—and make it possible to step in legally and safely when someone can no longer make decisions for themselves.“Don’t wait for a crisis”If there’s one takeaway from Episode 4, it’s this: don’t wait.If you’re worried about a parent, a neighbor, or your future self, reaching out early can mean the difference between staying safely at home—or losing that option entirely.For Sullivan County residents, a first call can be the Sullivan County Office for the Aging or New York Connects. Outside Sullivan County, your local Office for the Aging can guide you to similar services in your area.

In Episode 4 of Radio Catskill’s Health on the Margins, Patricio Robayo looks at what “aging in place” really takes—and why winter can turn small warning signs into emergencies.


Winter in the Catskills can be cold—and it can be hard. Long distances, icy roads, and limited services can make everyday tasks more difficult, especially for older adults. Getting to the grocery store, the doctor, or even just leaving the house can become a real challenge.
But aging doesn’t always arrive all at once. Sometimes it starts quietly: a missed bill, a forgotten appointment, a check that never makes it to the mailbox. And for families—especially working families—the question becomes: what help actually exists, and how do you access it before things reach a crisis point?
For Radio Catskill’s Patricio Robayo, this episode is personal.
Over the last few years, he’s helped care for his father as his memory declined. At first, it wasn’t dramatic. Bills slipped. Taxes were missed. Checks went missing—or were written and never sent. Things that used to be automatic suddenly required constant follow-up.
And then mobility changed everything.
“When my father lost the ability to walk safely—and eventually the ability to drive—everything became harder all at once,” Robayo says in the episode. Getting to appointments, picking up prescriptions, and handling basic errands became logistical puzzles that had to be solved around workdays, distance, and availability.
Like many families, they found themselves in a gray area: not qualifying for Medicaid, but unable to afford consistent private care. That’s when Robayo began learning more about the services designed for this moment—before it turns into an emergency.
A “one-stop” entry point
Robayo spoke with Lise-Anne Deoul, who leads the Sullivan County Office for the Aging, about what the office is actually built to do.
Their mission, Deoul explains, is keeping people home, engaged, and safe for as long as possible—and that can mean connecting residents to a wide range of supports many don’t know exist until they feel overwhelmed.
That includes help navigating Medicare supplemental plans, home-delivered meals, congregate meal sites for social connection, referrals to home care, and coordination through New York Connects, which Deoul describes as a “one stop shopping” entry point for long-term supports.
The office is also part of a broader food security network. Deoul says they help facilitate a biweekly distribution that supports food pantries across the county—and when possible, those items can also help homebound residents and congregate sites.
Transportation as dignity—and a lifeline
In rural communities, transportation can be the difference between staying healthy at home and falling into preventable decline.
“I think we can all agree that driving is one of the biggest dignity and accessibility tools that we have throughout our lifetime,” Deoul says in the episode. When someone loses that ability—or never had it—getting to regular medical appointments becomes a major barrier.
The Office for the Aging provides medical transportation for routine appointments, and for some residents, even life-sustaining treatments like dialysis and chemotherapy.
The math of keeping people home
One of the clearest moments in the episode comes when Deoul lays out the cost comparison of home-based support versus institutional care.
She says a person supported through the office’s ISEP program—Expanded In-Home Services for the Elderly Program—can often be kept home safely for an average of about $6,500 a year. By contrast, she notes that nursing home care can cost around $122,000 annually.
Beyond dollars, the program helps with task-oriented needs such as bathing, dressing, hygiene, laundry, light housekeeping, and errands—plus connections to vetted resources and agencies for additional support.
But even when help exists, it doesn’t always reach people soon enough.
“People are self-directing… self-determining,” Deoul says. “It’s kind of hard sometimes to watch people make some really bad decisions… but we keep reminding them we’re here.”
Caregivers need care, too
The episode also highlights the reality that family caregivers can burn out—and that support exists for them as well.
Deoul points to caregiver resources offered through a local caregiver resource center, including support groups and a caregiver café, and notes that scheduling and resource information is available online and through the office’s outreach.
Planning stops being optional
As Robayo explains, planning ahead isn’t just paperwork—it’s protection.
As his father’s condition worsened, once finances and mobility started slipping, their family had to move from reacting to preparing. Deoul says the Office for the Aging can connect residents to help with simple wills, estate planning, and advance directives, and can provide healthcare proxy forms.
Having those tools in place can reduce emergency decision-making—and make it possible to step in legally and safely when someone can no longer make decisions for themselves.
“Don’t wait for a crisis”
If there’s one takeaway from Episode 4, it’s this: don’t wait.
If you’re worried about a parent, a neighbor, or your future self, reaching out early can mean the difference between staying safely at home—or losing that option entirely.
For Sullivan County residents, a first call can be the Sullivan County Office for the Aging or New York Connects. Outside Sullivan County, your local Office for the Aging can guide you to similar services in your area.

Aging in Place: Senior Care, Caregivers, and the Rural Safety Net

In 2020, Sullivan County lost its only Planned Parenthood clinic. The next nearest Planned Parenthood clinic in Goshen closed four years later, along with three other upstate locations. Now, under President Trump’s changes to Medicaid eligibility, healthcare providers worry access to women’s health services will grow even farther from home.

In 2020, Sullivan County lost its only Planned Parenthood clinic. The next nearest Planned Parenthood clinic in Goshen closed four years later, along with three other upstate locations. Now, under President Trump’s changes to Medicaid eligibility, healthcare providers worry access to women’s health services will grow even farther from home.

Women’s Health Services Are Growing Farther Away. So Where Are Patients Turning?

New York has secured over $2.5 billion in opioid settlement funds that it says will be distributed over the next 18 years. But how much of those dollars has actually improved rural communities most affected by the opioid overdose crisis? That remains relatively unknown.

New York has secured over $2.5 billion in opioid settlement funds that it says will be distributed over the next 18 years. But how much of those dollars has actually improved rural communities most affected by the opioid overdose crisis? That remains relatively unknown.

Advocates Say Opioid Settlement Funds in New York Are Still Too Slow to Arrive – and Hard to Track

Opioid overdose deaths are down in New York state. But for many families still grieving or struggling, the fight is far from over. As the state enters a new phase in its fight against substance use, the question remains: what will it take to move people from surviving an overdose to living a dignified life?A listener's note: this episode discusses substance use and addiction and may be difficult to listen to.

Opioid overdose deaths are down in New York state. But for many families still grieving or struggling, the fight is far from over. As the state enters a new phase in its fight against substance use, the question remains: what will it take to move people from surviving an overdose to living a dignified life?
A listener's note: this episode discusses substance use and addiction and may be difficult to listen to.