This Budget Season, New York Should Tackle the Workforce Shortage in Home Care

Imagine you’re comfortably enjoying retirement in your own home when you unexpectedly face a health concern that creates physical limitations and requires assistance. You turn to Medicaid for support, which authorizes home care for you and your spouse.

That’s when you hit a roadblock — you can’t find any home care aides to hire.

Your daughter begins managing your care, yet she also can’t find an aide. She’s forced to give up her home and job to move in with you to provide care. You know this isn’t the best scenario for your daughter, but what other options do you have? This is not a hypothetical story; it happened to a family in Franklin County, New York.

As a policy analyst focused on the policy barriers facing direct care workers throughout New York, I frequently hear similar stories. Across New York, from rural upstate counties to New York City, we are facing a caregiving crisis. With the budget season approaching, Governor Cuomo and our state legislature can begin remedying this crisis.

In New York, the number of people aged 65 and older is projected to increase from approximately 2.6 million in 2010 to about 3.6 million in 2040. Meanwhile, the number of adults in the typical caregiving age — people between age 25 and 64 — will slightly decrease. PHI’s analysis found that, in 2010, there were about four people of caregiving age for every person over 65. In 2040, it’s projected to drop to approximately 2.8 people of caregiving age for every person over 65. This means that over the next few decades, as the young-old ratio shrinks, New York will have fewer workers to support a growing number of older adults. Unless something changes, the gap between the demand for care and the workforce supply will widen. This crisis will get much worse.

The growing shortage of home care workers isn’t surprising for people who work in my field. I can speak from personal experience when I say that home care jobs can be both physically and emotionally draining. During my time as a home health aide, I had bad days — for example, when I was slapped across the face by a woman with advanced dementia for trying to help her from the toilet to her wheelchair. But there were also good times – for example, when a client told me that my assistance and support always brightened her day. Despite the times I wanted to give up, I stayed because I could see the difference I was making in the lives of my clients and their families. I know many aides feel this way.

Working as a home care aide also gave me tremendous respect for people who choose this career. Despite the difficulty of the work, or the low wages and hours that leave one in five aides in poverty, almost 200,000 New Yorkers have become dedicated caregivers. But with vacancies growing and job quality remaining poor, how will we meet growing demand?

The New York State Assembly took a first step to addressing these problems by holding hearings on the home care workforce in February of this year. We heard from people around the state that this shortage is worsening. Consumers can’t find the workers they need. Workers want to stay in their jobs but can’t afford to with low wages and limited room for advancement. Home care agencies must turn away clients because they don’t have enough aides to meet demand.

It is now time for action.

As New York State’s legislators approach the next budget season, here are three concrete ideas to address the home care workforce shortage:

1. Establish a Home Care Jobs Innovation Fund to test innovative home care aide recruitment and retention strategies. Given high turnover in this sector, we know that finding and keeping home care workers in today’s economic climate is extremely challenging for both providers and families. As the state implements a training investment program for direct care workers (the Managed Long Term Care Workforce Investment Program), a corresponding program could also help support recruitment and retention. For example, challenges such as finding the right workers, preparing new hires for the job, creating a supportive work environment, and low compensation could be addressed through interventions that screen for the right applicants, new hire orientation strategies, supportive communication strategies through technology, or novel worker investments (e.g., transportation fund, scholarship program, or retention bonuses). But we need to test which strategies work best.
2. Create a home care “advocate” for New York State. A statewide home care “advocate” would support both workers and long-term care providers in navigating New York’s evolving wage and labor laws, such as minimum wage requirements and new developments in the Fair Labor Standards Act, among other laws. An advocate could also connect workers to training opportunities and help them access public benefits, which would allow these workers to live healthy lives and remain in this workforce.
3. Establish a workforce data monitoring system. Collecting and assessing data on the workforce allows our field to identify challenges before they become an emergency. A workforce data monitoring system that measures staffing statistics, hours worked, vacancies, and turnover rates, among other variables, would help understand where the shortage is worse—and how to address it.

The home care workforce shortage has become a crisis for consumers and workers. New York State can begin solving it this coming budget season.