Gotham Gazette

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New York's Home Care System is on the Verge of Collapse; It Can Be Fixed in the State Budget

A rally for Fair Pay for Home Care (photo: @JFREJNYC)

For people with disabilities and older New Yorkers, home care is the lifeline that enables them to stay in their homes and lead independent lives. Right now, the home care sector faces an alarming workforce crisis, jeopardizing the availability of at-home assistance and community living that enable people with disabilities and older New Yorkers to live their lives with dignity.

We are facing a growing demand to increase the home care workforce. While agencies managed to continue essential in-home care throughout the pandemic, we now face a nearly insurmountable challenge, with nearly one in six home care jobs currently left unfilled. It is estimated that 26,510 new home care workers will be needed just to keep up with increasing demand in New York, and an additional 71,680 workers are required each year to address high annual turnover. If this issue is left unaddressed, vulnerable New Yorkers across the state will be left without needed care in their homes.

The remedy is clear: it’s imperative that advocates, providers, workers, consumers, families, and unions alike come together to support several new pieces of legislation that offer long-term, sustainable change in an industry that is vital to our nation’s most vulnerable populations. And that starts in the state budget deal being negotiated in Albany.

The Fair Pay for Home Care bill (S5374A May/A6329A Gottfried) would raise home care worker pay to 150% of the highest area minimum wage across the State. By increasing home care wages, the Fair Pay for Home Care bill would make home care compensation more attractive, with the goal of addressing worker burnout and incentivizing new people to join the workforce.

Currently, home care agencies face restrictive limitations on the compensation that workers receive because many are 100% funded by Medicaid. Importantly, the Fair Pay bill contains provisions designed to ensure Medicaid reimbursement supports fair pay. To carry out the bill’s purpose and support these improvements, New York State must enact a budget that fully funds these reimbursement provisions. Home care agencies acting alone cannot rectify the problem.

This session, the Legislature is also considering another home care bill (A3145A Epstein/S359A Persaud) that aims to address another flaw in the current system. If passed, this bill would split all 24-hour shifts for home care workers into two, separate 12-hour shifts. The bill would effectively end legacy practices that reimbursed Medicaid-funded nonprofit home care agencies for 13 hours of a given worker’s pay in a 24-hour shift, with the understanding that the other 11 hours were unpaid time for sleep and meals.

These antiquated government policies have, for far too long, placed an undue burden on New York’s home care workers. In order to make this bill work for agencies and ensure that it does not lead to a reduction in care for people who need care in their homes, the bill must change Medicaid reimbursement rules and managed care service authorization, helping to ensure there are sufficient workers to care for the most vulnerable. As with fair pay, home care agencies alone cannot solve these challenges.

In many ways, the Fair Pay for Home Care bill is a complement to the shift-rule bill, ensuring that Medicaid resources are made available to fund these structural and comprehensive reforms to home care compensation. Bills like these represent a timely and much-needed step in the right direction – but in order for these reforms to be successful, both bills must work in tandem.

If we hope to build an equitable and caring home care system to meet growing demand, one fact remains abundantly clear: we must pass systemic reforms which come from government leaders. Time is of the essence.

On Friday, March 18, home care agencies, workers, and consumers came together to rally in front of the governor’s office in New York City to fight for the Fair Pay for Home Care bill. Our coalition, which includes stakeholders from across the home care sector, called on our executive and legislators to invest in the future of the home care industry and our communities, empowering home care workers with the tools and resources required to provide the best care possible for people in need across New York State. We’ve relied on home care workers’ unconditional kindness, generosity, and passion for caretaking for too long. It’s time for Albany to equitably and fairly compensate home care workers. 

Wayne Ho is President and Chief Executive Officer of the Chinese-American Planning Council, Inc. Kathryn Haslanger is CEO of JASA.

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