New York City Council
Committee on Aging, Chair, Council Member Chin
November 19, 2021
Oversight - Home Care and Caregiving Strategy

Thank you for the opportunity to testify.

LiveOn NY’s members include more than 100 community-based nonprofits that provide core services which allow all New Yorkers to thrive in our communities as we age, including senior centers, home‐delivered meals, affordable senior housing, elder abuse prevention, caregiver support, NORCs, and case management. With our members, we work to make New York a better place to age.

Background

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, 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. Even further, waiting lists, due to inadequate government investment, limit the reach that our non-Medicaid funded home care program could have for older New Yorkers.

Historically, and even more so during the pandemic, the unmet need for home care for older New Yorkers and people living with disabilities was exacerbated by high turnover and staff shortages due to low wages. Further, COVID-19 disproportionately impacted older adults, and individuals of color, revealing existing inequities and the overburdened state of our long-term care system.

Evidence of the inequitable, underappreciated nature of care work — which is predominantly executed by women and Black, Indigenous, and People of Color (BIPOC) individuals — the median annual earnings of New York’s home care workers are only $22,000. In comparison to other industries, the home care industry will require significant resources and investments to ensure all workers receive a livable, competitive wage.

The high rates of turnover in the home care industry can greatly impact the quality of care for older adults and people living with disabilities. A 2019 qualitative study by BMC Health Services found that high turnover rates can be costly and negatively contribute to “both the quality of care for patients and staff- patient relationships.” Along with rapid turnover and low wages, the physical and emotional toll home care workers face creates a challenge to retain and recruit new workers.

Recommendations

Today, we have the opportunity to address the challenges that arose during the pandemic to provide improved and long-lasting care services for older adults. Many of whom prefer to age in place. It is crucial to stress the importance of improving and expanding our long-term care system in our City. In order to tackle these important issues, LiveOn NY recommends the following:

Full funding and an outyear plan to consistently eliminate home care and case management waiting lists. Waiting lists for home care and case management remain a chronic issue in New York City, with waiting lists for services existing for years, despite modest investments. Notably, the two programs are inextricably linked, with a waiting list for one service impacting the accessibility of the other, as case management is first required in order to assess an individual for home care eligibility. Together, these services enable older adults in all five boroughs to age safely and independently in their communities, avoiding unwanted moves to costlier institutional care settings. Further, given the exacerbated strain from the pandemic, the City must address unmet need for critical services with significant long-term investments and solutions. Finally, given the chronic nature of these waiting lists, the City must articulate a five year plan for increased investments based on historical and demographic data that make clear the likelihood of continued growth in demand.
The City should advocate to the State to pass and fund Fair Pay for Home Care. 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.
$48 Million Cost of Living Adjustment (COLA) for essential human services workers, including those that execute the DFTA caregiving, case management and home care programs. Throughout COVID-19, human services workers across sectors have stepped up to provide critical services in new ways, including to keep New Yorkers older New Yorkers fed, assist older adults in receiving vaccinations, and combating the life-threatening effects of social isolation. Despite this, the wages of these workers, the majority of whom are women and Black and brown individuals, are slated to remain stagnant in a City where costs are notoriously high.

Legislative Positions

LiveOn NY strongly supports Council Member Chin’s Resolution in support of Senate Bill 598B and Assembly Bill 3922 which seeks to create a task force to reimagine long term care and study the long run impacts of long-term care services in New York State. We join in echoing the Resolution’s call for the Governor to sign this important legislation into law. LiveOn NY has long advocated for the emergence of a Task Force to seize the opportunity to emphasize the cost-effective, community-based long term care models that already exist and could be further expanded. For example, one of LiveOn NY’s members, Selfhelp Community Services, have designed the Selfhelp Active Services for Aging Model (SHASAM) which provides a culturally competent social worker in affordable senior housing to serve their diverse residents. This model also provides other supportive services such as benefits and entitlement assistance and health programming. Additionally, Naturally Occurring Retirement Communities (NORCs) offer the NORC model which employs social workers, nurses, and in programming to encourage physical activity and combat social isolation. By mobilizing a dedicated Task Force to oversee the growth and expansion of these models and others alike, New York will contribute to the larger cause of enabling older adults to age in place with their care needs addressed.

LiveOn NY is actively reviewing Council Member Chin’s Resolution in support of Assembly Bill 3145A and Senate Bill 359, which would require non-sequential split shifts for care workers. Home care workers are essential in assisting older adults with daily responsibilities in their home. Having this service allows older adults to remain in their homes and have extra support. Currently, care workers are entitled “to eight hours of sleep and three hours for meals during a 24-hour shift under the ‘13-hour rule.” This state implemented rule creates significant challenges for both home care agencies and workers alike, as it does not accurately capture the extra hours that may be served should the client need services during the night or at another point in the unpaid working hours. Given this challenge, LiveOn NY looks forward to fully reviewing and determining a position on this potential legislative solution, and all other solutions that may be brought to light, to determine a path forward that ensures full compensation for hours worked across home care workers and full state reimbursement towards such wages.

Thank you for the opportunity to testify.