Demand for home care is rising in New York, due to the large, rapidly aging Baby Boomer population and a cultural shift toward growing old in place rather than in group facilities. But recruiting home health aides to do the job has become increasingly difficult.
Home care staffing agencies and disabled New Yorkers who receive state assistance to hire their own aides report that they’re seeing higher turnover than in the past, and it’s taking longer to fill empty positions. A 2018-2019 survey of home care agencies statewide across the state found that about one in six positions were left unfilled due to staffing shortages, on average. The problem has gotten worse during the pandemic, according to a report issued by the Home Care Association of New York State in February.
For people who rely on home health aides for daily tasks such as bathing and eating, that’s a major problem.
“We've had situations where workers don't show up, and people have to stay in their bed and not get out of bed because they need help,” Heidi Siegfried, director of health policy at Center for Independence of the Disabled New York, said in an interview with Gothamist. “The people that use home care are really dependent on the worker to live their lives independently.”
A coalition of state lawmakers and advocates for home care employers and clients is bringing the issue to the fore during this year’s legislative session, pushing a bill that would raise the minimum wage for home care workers to 150% of the existing minimum wage in each region of the state. In New York City, that would mean a starting pay of $22.50 per hour – a significant increase over the $15 many home care workers currently earn. Raising home care wages statewide would cost an estimated $4 billion per year.
The bill, called the Fair Pay for Home Care Act, now has enough sponsors to pass in the state Assembly and the Senate. But Gov. Kathy Hochul hasn’t lent her support.
She did not include funding for the measure in her executive budget, released in mid-January, even though addressing the health care workforce shortage was a focal point of her State of the State speech earlier that month. The only funding she included for home care workers was a one-time bonus of up to $3,000 — but it would only be paid to employees who stay on the job for at least a year. Hochul budgeted $1.2 billion in fiscal year 2023 for the bonuses, which would also be available to other types of frontline health care workers.
A wage increase, in contrast, would guarantee longer term financial security for home care workers. Lawmakers grilled state health officials on the issue at a hearing on the health care budget in Albany on Tuesday.
“Can you honestly argue that bonuses will make any difference in recruiting the workers we need to fill our worst-in-the-nation shortage of home care workers?” State Senator Rachel May asked Brett Friedman, the state Medicaid director.
Friedman responded that he and other state officials “have looked at the bill from every angle” and found it unfeasible. But he didn’t cite a lack of funds. Rather, he said if the state sets aside enough money to fund the wage increase, it would be difficult to ensure that those dollars would actually trickle down to the workers.
Much of the home care in New York state is funded by the Medicaid program, which provides health insurance to people who are disabled or have low incomes. The money is supposed to flow from the state to individual Medicaid health plans and then to home care staffing agencies, which in turn pay their workers to go into people’s homes.
After New York raised the minimum wage in 2016, the state began paying Medicaid plans more to cover the increased costs. But home care employers say the Medicaid plans, which are run by private entities, haven’t always passed those funds on. And employers are still on the hook for higher wages.
“We struggle every day to ensure that the money for that prior minimum wage increase is adequate,” said Friedman.
Advocates say this is an issue they already took into account. The Fair Pay for Home Care Act would require the state health commissioner to set a minimum amount that Medicaid plans have to reimburse home care agencies for their services.
Researchers at CUNY who analyzed the proposal say it would help offset a greater home care crisis while sparking the economy by giving home health aides — most of whom are women of color — more spending power. They estimated that between recruiting new workers and replacing those who leave, the home care sector will need to fill an estimated 1 million positions in the 10-year period between 2018 and 2028.
Wages for home care workers have gone up over the years, but advocates say the ability to earn equal or higher pay in other sectors has made home care work less attractive. Because home care can be grueling work and is in high demand, it shouldn’t be a minimum-wage job, advocates argue. They add that it was easier to recruit workers in the early 2000s when home care workers typically earned more than the minimum wage.
Home health aides “have to do pretty intimate, hands-on care,” Siegfried said. “They're usually committed to the work, but it's hard work and flipping burgers might be a much easier job.”
During the budget hearing Tuesday, those advocating for higher pay for home care workers scoffed at the bonuses Hochul proposed — they would be less for part-time employees, which includes many home care workers.
“A bonus is not the same thing [as a higher wage],” said Helen Schaub, state policy and legislative director for the union 1199SEIU, which represents home care workers. “You pay your back-rent and then you’re still in the same situation.”
Schaub insisted that a bonus would be no easier to administer through the Medicaid program than a wage increase.
The state Senate and Assembly will release their own budget proposals in March, which will then be discussed before a final budget is released in April.
By: Caroline Lewis