New York State Assembly
Senate Standing Committee on Aging
Senate Standing Committee on Health
Senate Standing Committee on Labor
Chairs May, Rivera, and Ramos
July 27, 2021
Nursing Home, Assisted Living, and Home Care Workforce – Challenges and Solutions
Thank you Chairs May, Rivera, and Ramos for the opportunity to testify and highlight both the challenges and solutions in relation to supporting the homecare, nursing home, and assisted living workforce in New York State.
LiveOn NY represents the diverse network of nonprofit organizations that help older New Yorkers to thrive in their communities. Through advocacy, mobilization and coalition building, we advance systemic change to ensure that New York is an equitable and inclusive place to age regardless of wealth, racial disparities and other barriers.
With a base of more than 100 community-based organizations, LiveOn NY’s members provide core services throughout New York, including senior centers, congregate and home‐delivered meals, affordable senior housing, elder abuse prevention services, caregiver supports, transportation, NORCs, case management, and home care.
Today, we have an opportunity to discuss a key pillar in the continuum of care that enables thousands of older New Yorkers and people with disabilities to age in place: home care. In many ways home care, along with the entire continuum of community-based services, are the critical bulwarks to ensuring individuals can age in communities, rather than in institutional settings, as research has shown to be preferred.
Unfortunately, however, like much of the network of services that supports an individual's ability to age in place, our home care system relies on a workforce that is both underappreciated and underpaid. This is not an accident, it is a policy decision.
Currently, the median annual earnings of New York’s home care workers are only $22,000. To put that in perspective, the median salary for fast food workers in New York state has grown to $24,429. As fast food workers and others have earned laudable, hard fought wage increases, the gains only further demonstrate the work that needs to be done in other industries, namely home care, to ensure all workers receive a livable, competitive wage.
Without wage increases in the home care industry that are commensurate and simultaneous to gains in other industries, the subsequent wage compression will only serve to exacerbate an already strained industry. A recent study of home care associations found that on average 17% of home care positions went unfilled, likely due to low wages for an emotionally and physically demanding role. “As a result of these staff shortages, many individuals with unmet home care needs experience hospitalizations that might otherwise be unnecessary, and many enter nursing homes, a costly alternative to in-home care that became especially dangerous during the COVID-19 pandemic.”
Given the high cost associated with the alternatives to home care, it leads one to question if we are spending more on less desirable alternatives than we would be by appropriately funding the work of home care in itself. This hypothesis has recently been confirmed by CUNY research, which found that “wage increases and health insurance coverage for the State’s home care workers would require significant resources, but those costs would be more than offset by the resulting savings, tax revenues, and economic spillover effects.” Further, as articulated in the report, “improving compensation for home care workers would help to alleviate the existing shortages in the occupation, and also spur employment growth in other fields.”
The lack of investment in home care attendants is a striking example of the lack of a long-term strategy around care in our state. Given this, LiveOn shares our thanks to the legislature, and Senator May and Assembly Member Kelles in particular, for sponsoring and passing S4652 / A6590, a bill to Reimagine Long-Term Care in New York State. We encourage Governor Cuomo to sign this legislation upon delivery, so that New York can immediately get to work in creating a more caring and coordinated long-term care system.
This work is critical, not only in response to COVID-19, but also in advancing the State’s overall efforts to affirmatively promote equity.
Today, the vast majority of home care attendants, as well as unpaid caregivers on whose shoulders the burden of care often falls during shortages, are women. More specifically, more than 90% of the homecare workforce are women, one in four individuals are immigrants, and more than 60% are individuals of color. Should these demographic trends continue within this rapidly expanding job market, a State decision to continue to provide low-wages to home care attendants would only serve to further engrain our deepest societal inequities, all but ensuring the likelihood of home care attendant’s living and aging into poverty. Therefore in addressing the home care wages and resulting shortage, New York will also be making an overdue step towards addressing both racial and gender wealth gaps, and building a more caring economy.
To make strides towards this urgent need for equity and an improved system of long-term care, LiveOn NY’s offers the following recommendations:
Recommendations
First, enact and fund Fair Pay for Home Care, S5374 (May) / A6329 (Gottfried). The purpose of this legislation is to “establish a base wage for home care workers at 150% of the regional minimum wage,” thereby ensuring the role of home care workers remains competitive, at least in comparison to positions funded at minimum wage. Without such a mandate and corresponding funding from the government, wage compression will continue to diminish the viability of this demanding, highly emotional role, thereby exacerbating the existing home care attendant shortage.
Simply put, this legislation is good policy. It is caring: ensuring that older New Yorkers and individuals with disabilities will have access to the support of professionals who are paid appropriately for their work. It is equitable: immediately and directly lifting the wages of women, immigrants, and individuals of color who comprise this workforce. It is fiscally responsible: with research finding the potential to create 18,000 good paying jobs, with an associated economic impact of $3.6 billion. And it is what New Yorkers want: creating a system of care that betters the odds that we all can one day age in the communities we know and love, as is preferred.
In reality, we can’t afford not to institute fair pay.
Second, provide funding for New York State Office for the Aging’s (NYSOFA) Expanded In Home Services for the Elderly Program (EISEP). Currently, there are thousands of older New Yorkers on waiting lists for home care services and other supports, such as transportation and case management, through the EISEP program. While exacerbated by COVID-19, waiting lists for this program are not new. LiveOn NY has been tracking waiting lists for these programs for years, and given limited state funding, the waiting list for case management services in New York City alone have not dipped below 1,000 individuals waiting for services since 2016. Just last year, total waiting lists for EISEP services were as high as 11,000 individuals statewide.
In response, LiveOn NY was pleased to see the legislature fight for an allocation of $8 million in the FY22 budget towards addressing the waiting list, however, addressing the waiting list in full would have required a total investment of $27 million. While federal stimulus funds have helped address waiting lists in some cases, this need is not going away; particularly as our state's older adult population continues to rapidly grow, outpacing the occasional increase in funds allocated to NYSOFA to address point-in-time waiting lists.
As we look to the Fiscal Year 2023 budget, it is critical that the State provides the funding necessary to support the EISEP program in full, both by allocating enough funding to address existing waiting lists, and looking at historical waiting list data to project and allocate funding towards future need. This, in addition to the Fair Pay for Homecare legislation, will ensure both that home care workers are adequately supported, and that older New Yorkers living above the Medicaid threshold have access to home care and community-based supports, rather than languishing on waiting lists hoping for care.
Third, work with providers and consumers to determine a path to ending the State’s 24 hour rule, which mandates that workers tasked with 24-hour shifts be compensated for 13 hours. LiveOn NY’s members, such as the Chinese-American Planning Council, have been on the forefront of standing with their workers in advocating to the State to redress the inequitable pay experienced by workers under this rule. Given the legal complexities created and the pay disparities, it is critical that the state not only amend this rule, but provide the funding necessary to hold providers harmless while instituting any such changes determined to be appropriate.
Finally, expand investment in affordable senior housing with services. As we look to retool the long-term care system at-large, and in recognizing that the growth of the older adult population will require some level of congregate support to reach the scale of support that will be necessary. LiveOn NY recommends New York State prioritize investments in affordable housing with services for older New Yorkers. Once stably and affordably housed, the availability of a service coordinator in buildings’ has proven to lower hospitalization costs and delay or altogether negate the need for institutionalization. By investing in the light-touch supports that might be necessary to ensure individuals can age in communities, as is preferred, New York can preclude unnecessary nursing home utilization and support an individual’s ability to age in place.
Thank you for the opportunity to testify, and we look forward to continuing to work together to address the needs of home care attendants across our state.