He was allegedly already out of the game for the last decade or less since he had progressive dementia or alzheimer or something like that. They also probably gave him last rites...

EP guys like DeBiase, the Cerone clan and Andriacchi were the main examples regarding their crew's close connection to the Grand Avenue crew and vice versa (Nicoletti, Salvatore, Lombardo, Eboli, Centracchio), same as the Cicero-Chinatown alliance or "brotherhood". Thats why until we receive some government/informant info regarding a current top admin, Ill continue speculating that the Outfit is possibly divided on two groups, obviously in close alliance, meaning history might repeat itself like it was a century ago with two separate families which still coexisted together in that same city and controlled certain (both) legit and illegal ops, mainly because there were already other powerful crime groups above them in "the food chain" at the time, same as today.