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A Home Care System In Crisis: The High Cost of Low Wages

Executive Summary

Home and community-based services (HCBS) in New York’s Medicaid program have been dramatically underfunded for over a decade. These services, which include home health care, personal care, and consumer directed personal assistance (CDPA), are a critical lifeline for seniors and disabilities who wish to avoid costly institutions and instead live quality, independent lives at home, in their communities.

For years, the Consumer Directed Personal Assistance Association of New York State (CDPAANYS) has been sounding alarm bells about the worsening state of this industry, primarily focusing on how the systemic underfunding of this sector has led to poverty-level wages for workers. To determine the impact these low wages have on the industry, and in particular the consumers who rely on these workers to live independently in the community.

In 2016 and again in 2019, CDPAANYS surveyed consumers to determine the impact low wages were having. In each subsequent report, we have found that these wages were creating a sector in crisis. Consumers reported having difficulty hiring staff, difficulty keeping staff when they could hire, and needing to supplement wages out of their own pocket in order to maintain services.

In the third iteration of this survey, a stark picture came to light. While previous surveys found an industry in crisis, the 2021 version of the survey identified a system in collapse. By every measure, the situation for consumers trying to remain independent has dramatically worsened.

Key Takeaway: A Home Care System in Crisis. 74% of seniors and people with disabilities are unable to retain home care workers in 2021.

A Growing Shortage: Across every single measure, the real-world situations of seniors and disabled New Yorkers trying to avoid institutionalization is not only worse today than it was just three to five years ago, it is dramatically so:

  • 9% of consumers reported that it took them over a year to hire new staff, nearly eight times the statewide rate from 2016.
  • Over half of respondents statewide said that when recruiting, the most time consuming portion was “awaiting responses to advertisements or finding a potential candidate who would not turn down the job.” Previously, “awaiting fulfillment of medical requirements” far exceeded the length of every other category.
  • 20% of consumers reported that all five of their past five PAs quit. Three years ago, this number was just under 4%, while five years ago it was just over 2%.

The Root Cause — Low Pay: The wages people can pay their workers, which are entirely dependent on government funding through the Medicaid program, are insufficient to attract a pool of workers:

  • Over half of the workers who quit identified low wages as the reason they did so.
  • A quarter of consumers – seniors and disabled people poor enough to live on Medicaid – feel the need to supplement worker wages out of their own pocket to try to keep their staff.

Despite multiple warnings from advocates, the Legislature, and providers over the past several years, the previous administration chose to ignore, and even actively deny, these facts, instead continuing with cuts and failing to meaningfully invest in community-based long-term supports and services.

Link to Full Report