New York City is facing an impending healthcare crisis. Left unaddressed, it will eventually affect almost every New Yorker. First, the good news: Thanks to medical advances and access to nutritious food, more people than ever are living longer, fuller lives.
Now, the bad news: An imminent shortage of home care workers and supportive services threatens to erode the quality of life, safety, and health for this record number of older New Yorkers and their families.
In New York City, the number of people over age 65 has passed the one million mark for the first time in history and 462,000 of those are over 75 years old. By 2040, one in five city residents will be an older adult. As the ranks of older New Yorkers grow, so will the need for quality, affordable long-term care to help them age well, in their homes, and with a high quality of life.
Today, 187,000 home health aides work in New York, making it the single largest occupation in the city. The Bureau of Labor Statistics estimates that this occupation will grow 38 percent over the next six years – almost three times the rate of job growth for the economy overall. Amid this rapid increase in demand, agencies that employ home care workers are struggling to hire and retain enough skilled home health aides to keep up.
A key factor in this growing worker shortage is fact that home health aides struggle to earn enough to support themselves and their families. Although the majority of home health aides in New York City work full time, three-quarters earn less than $30,000 per year. Because Medicaid funding for home care is not adequate and Medicare does not cover home care services on a long-term basis, home care agencies cannot afford to pay workers a living wage, let alone provide training to ensure quality care for clients and career advancement for workers.
Around 62 percent of New York’s home health aides have no more than a high school diploma. Their demanding work schedules, combined with a dearth of education and training options, means that most have no way to improve their employment situation. Moreover, many workers lack the fundamental tools they need to improve the quality of care they can provide, such as knowledge about common health conditions like diabetes, heart disease, mental illness, or cognitive impairment.
Failure to support long-term care workers is driving many out of the profession entirely – exacerbating the worker shortages that already exist. This means that New York families increasingly find they must provide home care themselves, potentially forcing family members to sacrifice their own employment to serve as primary caregivers for older relatives. Additionally, worker shortages will increase pressure on families to institutionalize their older relatives sooner than they want or need to, denying them the ability to age in their own homes.
To meet the swelling demand for home health services we must attract more people to the profession and reduce turnover. Achieving this will require adequate funding for long-term care, more and better training opportunities for workers, and giving aides the respect and authority they deserve as key professionals within a care team. The Paraprofessionals Healthcare Institute, as well as Caring Majority, a coalition of workers, family members, and provider organizations, have called on Governor Cuomo to allocate a small portion of the funding in his $175 million proposed Workforce Development Agency to create a Home Care Jobs Innovation Fund. This investment would help support training and education, and identify cost-effective and innovative programs for older adult care that can be replicated statewide. In addition, provider agencies should train home health aides so they can be included in their clients’ care teams, and allow them broader participation in daily care decisions.
Nearly every New Yorker will eventually need care, either for ourselves or for an older loved one. While both the public and the private sectors share responsibility for addressing the crisis of long-term care, government should take the lead to ensure that families have affordable, quality options for protecting the health and safety of older adults. Failure to do so means consigning families to a heartbreaking burden, and endangering the lives of some of the most vulnerable New Yorkers.
Senator Liz Krueger represents District 28 in the New York State Senate, where she is the ranking member of the Senate Finance Committee. Christian González-Rivera is senior researcher at the nonprofit Center for an Urban Future, a New York City-based think tank focused on expanding economic opportunity.