New York State Testimony on the Home Care Workforce: Challenges and Solutions

New York State Assembly
Senate Standing Committee on Aging
Senate Standing Committee on Health
 Senate Standing Committee on Labor
Chairs May, Rivera, and Ramos
July 27, 2021
Nursing Home, Assisted Living, and Home Care Workforce – Challenges and Solutions

Thank you Chairs May, Rivera, and Ramos for the opportunity to testify and highlight both the challenges and solutions in relation to supporting the homecare, nursing home, and assisted living workforce in New York State.

LiveOn NY represents the diverse network of nonprofit organizations that help older New Yorkers to thrive in their communities. Through advocacy, mobilization and coalition building, we advance systemic change to ensure that New York is an equitable and inclusive place to age regardless of wealth, racial disparities and other barriers.

With a base of more than 100 community-based organizations, LiveOn NY’s members provide core services throughout New York, including senior centers, congregate and home‐delivered meals, affordable senior housing, elder abuse prevention services, caregiver supports, transportation, NORCs, case management, and home care.

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, however, 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. This is not an accident, it is a policy decision.

Currently, the median annual earnings of New York’s home care workers are only $22,000. To put that in perspective, the median salary for fast food workers in New York state has grown to $24,429. As fast food workers and others have earned laudable, hard fought wage increases, the gains only further demonstrate the work that needs to be done in other industries, namely home care, to ensure all workers receive a livable, competitive wage.

Without wage increases in the home care industry that are commensurate and simultaneous to gains in other industries, the subsequent wage compression will only serve to exacerbate an already strained industry. A recent study of home care associations found that on average 17% of home care positions went unfilled, likely due to low wages for an emotionally and physically demanding role. “As a result of these staff shortages, many individuals with unmet home care needs experience hospitalizations that might otherwise be unnecessary, and many enter nursing homes, a costly alternative to in-home care that became especially dangerous during the COVID-19 pandemic.” 

Given the high cost associated with the alternatives to home care, it leads one to question if we are spending more on less desirable alternatives than we would be by appropriately funding the work of home care in itself. This hypothesis has recently been confirmed by CUNY research, which found that “wage increases and health insurance coverage for the State’s home care workers would require significant resources, but those costs would be more than offset by the resulting savings, tax revenues, and economic spillover effects.”  Further, as articulated in the report, “improving compensation for home care workers would help to alleviate the existing shortages in the occupation, and also spur employment growth in other fields.”

The lack of investment in home care attendants is a striking example of the lack of a long-term strategy around care in our state. Given this, LiveOn shares our thanks to the legislature, and Senator May and Assembly Member Kelles in particular, for sponsoring and passing S4652 / A6590, a bill to Reimagine Long-Term Care in New York State. We encourage Governor Cuomo to sign this legislation upon delivery, so that New York can immediately get to work in creating a more caring and coordinated long-term care system.

This work is critical, not only in response to COVID-19, but also in advancing the State’s overall efforts to affirmatively promote equity.

Today, the vast majority of home care attendants, as well as unpaid caregivers on whose shoulders the burden of care often falls during shortages, are women. More specifically, more than 90% of the homecare workforce are women, one in four individuals are immigrants, and more than 60% are individuals of color. Should these demographic trends continue within this rapidly expanding job market, a State decision to continue to provide low-wages to home care attendants would only serve to further engrain our deepest societal inequities, all but ensuring the likelihood of home care attendant’s living and aging into poverty. Therefore in addressing the home care wages and resulting shortage, New York will also be making an overdue step towards addressing both racial and gender wealth gaps, and building a more caring economy.

To make strides towards this urgent need for equity and an improved system of long-term care, LiveOn NY’s offers the following recommendations:

Recommendations

First, enact and fund Fair Pay for Home Care, S5374 (May) / A6329 (Gottfried). 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.

Simply put, this legislation is good policy. It is caring: ensuring that older New Yorkers and individuals with disabilities will have access to the support of professionals who are paid appropriately for their work. It is equitable: immediately and directly lifting the wages of women, immigrants, and individuals of color who comprise this workforce. It is fiscally responsible: with research finding the potential to create 18,000 good paying jobs, with an associated economic impact of $3.6 billion. And it is what New Yorkers want: creating a system of care that betters the odds that we all can one day age in the communities we know and love, as is preferred.

In reality, we can’t afford not to institute fair pay. 

Second, provide funding for New York State Office for the Aging’s (NYSOFA) Expanded In Home Services for the Elderly Program (EISEP). Currently, there are thousands of older New Yorkers on waiting lists for home care services and other supports, such as transportation and case management, through the EISEP program. While exacerbated by COVID-19, waiting lists for this program are not new. LiveOn NY has been tracking waiting lists for these programs for years, and given limited state funding, the waiting list for case management services in New York City alone have not dipped below 1,000 individuals waiting for services since 2016. Just last year, total waiting lists for EISEP services were as high as 11,000 individuals statewide. 

In response, LiveOn NY was pleased to see the legislature fight for an allocation of $8 million in the FY22 budget towards addressing the waiting list, however, addressing the waiting list in full would have required a total investment of $27 million. While federal stimulus funds have helped address waiting lists in some cases, this need is not going away; particularly as our state's older adult population continues to rapidly grow, outpacing the occasional increase in funds allocated to NYSOFA to address point-in-time waiting lists. 

As we look to the Fiscal Year 2023 budget, it is critical that the State provides the funding necessary to support the EISEP program in full, both by allocating enough funding to address existing waiting lists, and looking at historical waiting list data to project and allocate funding towards future need. This, in addition to the Fair Pay for Homecare legislation, will ensure both that home care workers are adequately supported, and that older New Yorkers living above the Medicaid threshold have access to home care and community-based supports, rather than languishing on waiting lists hoping for care.

Third, work with providers and consumers to determine a path to ending the State’s 24 hour rule, which mandates that workers tasked with 24-hour shifts be compensated for 13 hours. LiveOn NY’s members, such as the Chinese-American Planning Council, have been on the forefront of standing with their workers in advocating to the State to redress the inequitable pay experienced by workers under this rule. Given the legal complexities created and the pay disparities, it is critical that the state not only amend this rule, but provide the funding necessary to hold providers harmless while instituting any such changes determined to be appropriate.

Finally, expand investment in affordable senior housing with services. As we look to retool the long-term care system at-large, and in recognizing that the growth of the older adult population will require some level of congregate support to reach the scale of support that will be necessary. LiveOn NY recommends New York State prioritize investments in affordable housing with services for older New Yorkers. Once stably and affordably housed, the availability of a service coordinator in buildings’ has proven to lower hospitalization costs and delay or altogether negate the need for institutionalization. By investing in the light-touch supports that might be necessary to ensure individuals can age in communities, as is preferred, New York can preclude unnecessary nursing home utilization and support an individual’s ability to age in place. 

Thank you for the opportunity to testify, and we look forward to continuing to work together to address the needs of home care attendants across our state.

LiveOn NY Final Look at the 2021 New York State Legislative Session

New York, NY – LiveOn NY is proud to see several bills that we have supported pass the legislature prior to session ending on June 11th. From affordable housing, to investing in the care economy, to combatting elder abuse and food insecurity, each piece of legislation passed marks a meaningful step forward for all New Yorkers as we age.

“These legislative wins are a signal of progress as we move towards a state where New Yorkers of all ages can grow old with the necessary legislation that supports everyone across the lifespan,” said Allison Nickerson, Executive Director of LiveOn NY. “We hope to see these bills signed into law, and to then build on this progress to create a better New York for all ages.”

We at LiveOn NY are committed to continuing this momentum into next year’s legislative session, and we look forward to working with our legislative champions to realize more victories, both legislative and budgetary, for older New Yorkers.

In the immediate, many of the legislative victories below require a signature from the Governor to be enacted, with this in mind, we encourage the Executive Branch to ensure these meaningful bills are swiftly signed into law.

Legislative Victories

• Investing in Care Act S4652 / A6590 (May/Kelles)

  • Directs the commissioner of economic development, in consultation with the commissioner of health, labor and OCFS to study, develop, and implement a long-term strategy to support the growth of the caregiving industry in New York state.

• Reimagining Long Term Care Task Force S598 / A3922 (May/Cruz)

  • Creates a task force to study the state of long-term care services in this state”

• Statewide SNAP Restaurant Meals Program S64 / A1524 (Persaud/Reyes)

  • Establishes a statewide restaurant meals program as part of the supplemental nutrition assistance program (SNAP)

• Elder Abuse Enhanced Multidisciplinary Team S6528 / A7634 (Persaud/Cruz)

  • Establishes an elder abuse enhanced multidisciplinary team program under the office for the aging consisting of professionals for complex cases of elder abuse, including financial exploitation, physical abuse, psychological abuse, sexual abuse, and neglect. This piece of legislation has been a priority for LiveOn NY, AARP NY, Lifespan of Greater Rochester and our partners.

• 5-Year Housing Capital Plan S2193 / A3807 (Kavanagh/Cymbrowitz)

  • Establishes a requirement for the state to create and fund a 5-year capital plan for the development, preservation, and capital improvement of affordable housing. A long term, sustained commitment to affordable housing from the state is necessary if we ever hope to meet our housing needs. The 5-Year Capital Plan bill has been a top priority for LiveOn NY, the New York Housing Conference and our partners.

• Affordable Housing Insurance S5231 / A5574 (Kavanagh/Cymbrowitz)

  • Requires the New York State Department of Financial Services (DFS) in coordination with the New York State Division of Housing and Community Renewal (HCR) to study and report on the recent significant increases in insurance premiums for housing units and to make recommendations to the Executive Chamber and the Legislature to address the causes for such increases.

• Allowing Compassionate Care-Giving Visitors S614 / A1052 (May/Bronson)

  • An act to create a standardized program to allow personal care and compassionate care visitors at nursing homes.

Work Still to Do

• LGBT Bill of Rights S85 / A7807 (Hoylman/Bronson)

  1. An act to establish the lesbian, gay, bisexual, and transgender long-term care facility residents' bill of rights.

• Elder Parole S15 / A3475 (Hoylman/De La Rosa)

  • An act related to parole eligibility for certain incarcerated persons age fifty-five.

• Fair and Timely Parole S1415 / A4231 (Rivera/Weprin)

  • An act related to findings of the state board of parole necessary for discretionary release of incarcerated persons on parole.

• Home Care Jobs Innovation Program S4222 / A7540 (May/Kim)

  • An act to establish the home care jobs innovation program and the home care jobs innovation fund.

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To learn more about LiveOn NY’s legislative priorities, contact Director of Public Policy, Katelyn Andrews, at kandrews@liveon-ny.org.

LiveOn NY Testifies at City Council Aging Hearing on Senior Residences and Communities During the Pandemic

New York City Council
Committee on Aging
Chair Council Member Chin
June 22, 2021
Oversight - Serving Seniors in Senior Residences and Communities During the Pandemic

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.

With our City on the road to recovery, we are presented with the opportunity to re-envision how we serve older adults in senior residences and throughout our community. The COVID-19 pandemic uncovered the growing need for aging services as well as shined a light on the visible inequities in supporting all New Yorkers as we age. 

Senior Residences 

While New Yorker’s have heard of the stark and heart wrenching realities that took place in nursing homes during the COVID-19 crisis, the dichotomous experiences of independent senior residences has been less explored to date. While loss was a reality across New York, HUD 202s and Senior Affordable Rental Assistance (SARA) buildings fared significantly better than one might have feared. The challenges in this relative success were significant, as providers were not only worried about safety, but of ensuring older residents remained fed and avoided social isolation during this time.

The stars in confronting these challenges were not only the non-profit organizations that stepped up to connect older residents with the City’s emergency feeding programs, or in other pop-up programs such as LiveOn NY’s work with World Central Kitchen, Citymeals, and others, but the Service Coordinators who remained a lifeline for tenants throughout the pandemic. It would not be an exaggeration to say that the availability of service coordinators in buildings saved lives during COVID-19.

Unfortunately, not all senior residences can afford to hire service coordinators or staff the building to the extent that would be ideal. As the City looks to become a leader in public health, this, creating a fund for senior residences to hire service coordinators to assist older New Yorkers in the enhanced needs that come with aging in place, is the empirically proven first step in that direction. Our member, Selfhelp Community Services, has research proving the effectiveness of this investment, as the presence of a service coordinator in buildings, even prior to COVID, meant reduced health care expenditures, namely: lower emergency room use, shorter stays per use, and increased use of primary care services.

Further, as the population ages, it is critical that increasing  investments be made by the City to meet demand to combat this crisis-level shortage of housing supply.

Many older New York rely on affordable senior housing with services to comfortably age in place. The need for affordable senior housing with services continues to rise with many older New Yorkers living on fixed incomes that cannot keep up with rising rent cost; experiencing mobility challenges that limit housing options within an aging rental-stock. In 2016, LiveOn NY found that an estimated 200,000 older adults were on waiting lists for housing through the HUD202 program in New York City. 

In addition, NYCHA developments also represent one of the few affordable housing options for older adults in our City. Just as the buildings are aging, so are the tenants that occupy them, making the need for quality, safe services in NYCHA paramount to the success of the community. 

• The City must work to continue to increase capital funding for public housing to support ventilation upgrades and other critical infrastructure improvements that will improve both residential and community space within NYCHA;

• Increase the supply of affordable housing by investing in the construction and preservation of 8,000 units of affordable housing annually, including 1,000 units with services to be set aside for older New Yorkers. This recommendation is included in the New York Housing Conference led United 4 Housing Coalition report which lays out numerous goals to equitably address our City’s affordable housing crisis.

• Restore and baseline all one-time funds for NYCHA Social Clubs. All funding for senior programming in NYCHA community spaces should not rely on one-shot funding from the Administration, but should be sustainably baselined and incorporated into the full scope of DFTA services;

Communities

While strides have been made, particularly with the reopening of senior centers, there is still more to be done. For years, the Department for the Aging (DFTA) remains critically under-resourced, receiving less than half of one percent of the overall City budget, in contrast to the rapidly increasing older adult population. 

New York City is entering a critical phase of the recovery, as we progress forward in building a New York for all ages. The City must continue to show its commitment to older adults with critical investments in senior services:  

The City should support essential services that include: 

• Restoring All City Council Aging Discretionary Funds To FY20 Levels 

• Restore and Baseline all Executive One-Time Funds, including funds for NYCHA Senior Centers. 

• Use FY21 accruals to cover costs associated with reopening in person senior services as well as $30 million for HVACs repairs, safety precautions, and Senior Center upgrades. 

• $48 Million Cost of Living Adjustment (COLA) for essential human services workers, who have been on the frontlines throughout the pandemic. 

• $16.6 million for Home-delivered Meals that would provide $13.6 million for weekday meals and $3 million for weekend and holiday meals, both to increase capacity to meet new demand and bring the per-meal rate to the national average. 

Thank you for the opportunity to testify.

LiveOn NY Testifies at City Council Finance Hearing on the FY22 City Budget

New York City Council
Committee on Finance
Chair Council Member Dromm
May 25, 2021
Oversight - Executive Budget Hearing

Thank you for the opportunity to testify at the executive budget hearing.

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.

As New York City begins to emerge from a pandemic that took the lives of thousands of individuals, many of whom were older New Yorkers, and as this budget, built upon millions in new stimulus funds, will plant the seeds of recovery for our City at-large, the stakes have rarely been higher. As stated by the New York City Independent Budget Office, “the influx of stimulus funding makes this plan one of the most consequential city budgets produced in years. The priorities set forth and decisions made regarding the current financial plan, specifically with respect to how these stimulus funds are spent, are decisions whose effects will reverberate well into the next administration.” 

With this in mind, LiveOn NY is appreciative of the investments included in the Executive Budget to both better support older New Yorkers through programs such as Senior Centers, as well as to support the human services sector at large. More specifically, we are deeply appreciative of the decision to fully restore funding for the Indirect Cost Rate initiative; implement the $10 million of outstanding model Senior Center budget funding promises; and include $39.4 million towards Year 1 of the new Community Care Plan, which will expand and better support Senior Centers and NORCs. These initial investments are an important step towards bolstering a long-underfunded sector and a system that has been critical to supporting older New Yorkers through the historically difficult fight against COVID-19.

However, given that the Department for the Aging (DFTA) budget remains at less than ½ of 1% of the City budget despite older adults representing a rapidly increasing 20% of the population, the City must go farther in its Adopted Budget to truly set the trajectory for a recovery that leaves no New Yorker behind. Moreover, to wholly embrace this budget’s theme, “A Recovery for All of Us,” the City must do more to ensure that older New Yorkers, particularly low-income and Black and brown older New Yorkers, are included in that recovery.

Centered around the inequities made apparent during the pandemic, LiveOn NY first proposes three major investments to better address senior hunger, the digital divide, and wages for essential workers.

1. $16.6 million for Home-delivered Meals. Such funding would provide $13.6 million for weekday meals and $3 million for weekend and holiday meals, both to increase capacity to meet new demand and bring the per-meal rate to the national average. The home-delivered meals program, which is different from GetFood, serves older New Yorkers who, due to chronic illness, mobility limitation, or disability, will remain homebound long after COVID-19 fully subsides. For many meal recipients, this meal delivery represents not only a significant source of nutrients, but the only contact they will have with the outside world that day. Despite the lifeline that this program represents, it has been chronically underfunded for years, with funding lagging far behind the national average, putting the program and the non-profits that administer it, financially at risk year after year.

2. $4.4 Million to address the digital divide. $4.4 million of this funding would allow for improved technology and service access for older adults by investing in the technology infrastructure at Senior Centers, as well as creating mechanisms to directly support individual access to technology.

   1. As the City works to combat the digital divide, it must also invest an additional $5.89 million to leverage technology to better connect older adults to the services one might need to age in community. More specifically, this investment would broaden the ability for Senior Centers to market their services, and to create an online resource directory, similar to that of the Parks Department, where an older adult might more easily determine offerings from Senior Centers in their neighborhood.

3. $48 Million Cost of Living Adjustment (COLA) for essential human services workers. 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. It is critical that the FY22 budget rectify this, allocating $48 million in funding to ensure all human services workers can receive a 3% COLA that is not only necessary, but is deserved.

   1. Further, an additional $1.7 million is needed to ensure parity for NORC Directors to Senior Center staff of similar positions. Without such an investment, disparity, created as a direct result of City Contracts, will only continue to be exacerbated in the coming year.

In addition to these new investments, the City must look to restore and baseline all aging Executive one-time funds, including funding for Senior Centers located in NYCHA. 

The City must also prioritize hiring staff internally within the Department of Housing Preservation and Development (HPD) in order to continue the historic progress made within this Administration’s affordable housing development program. With new federal resources, HPD has an opportunity to fill vacancies and ensure a strong pipeline of affordable senior housing into the future.

Recognizing the significant role that City Council discretionary plays in meeting the hyper-local needs within districts, these funds must also be restored and bolstered as appropriate. Including by:

1. Restore Council aging discretionary funding to FY20 levels.

   1. A restoration of $2,040,000 that was previously made available through the “Healthy Aging” initiative, must be re-allocated, whether by restoring this initiative or adding the amount to a similar initiative such as Support Our Seniors.

   2. Beyond re-allocating funds that were reduced in FY21, due to budgetary constraints, it is critical that City Council maintain funding for the long-important initiatives such as: NORCs, Immigrant Senior Centers, Support Our Seniors, and all aging discretionary initiatives.

2. Bolster Council discretionary funding to meet rising needs

   1. Invest an additional $950,000, for a total of $2.86 million, in the Geriatric Mental Health Initiative to better equip providers to respond to the rising mental health concerns that have resulted from isolation experienced during extended periods of stay at home orders experienced by older New Yorkers throughout COVID-19.

New York’s more than 1.8 million older adults are counting on these investments to demonstrate meaningful action for aging in response to COVID-19.

But we know that this action can’t wait. The Administration must also immediately authorize the Department for the Aging (DFTA) to spend the $30 million in currently projected ‘cost-savings’ accrued by the agency over the course of FY21. Rather than having one of the smallest City agencies shoulder the burden of returning cost-savings to the City to balance the current budget, it should instead be invested in ensuring that Senior Centers and services are safe into the future. That would mean purchasing improved ventilation and HVAC systems for all Senior Centers in need to ensure high quality air standards for the population most at-risk to COVID-19. The funds could also go towards one-time technology upgrades, PPE purchases, cleaning supplies, kitchen upgrades for Centers with outdated equipment, and other purchases that, if made now, will promote the safety and sustainability of senior services into the future.

While the needs are vast, the City is poised to meet the unique needs of older adults by strategically using new stimulus investments, state investments, and improved City tax receipts to push the Department for the Aging budget above the ½ of 1% mark once and for all.

Thank you for the opportunity to testify.

City Council Candidates Share Their Stance on the Future of Aging in New York City Ahead of the 2021 Election

May 14, 2021 (New York, NY) – New York City is home to a growing aging population with over 1.8 million older adults living across the five boroughs. As we age, and as demographics predict a growing aging population across districts, LiveOn NY**, a senior advocacy and membership organization, is proud to release the responses to a ten question survey posed to all City Council candidates.

The candidate responses are critical points of education in advance of what will be an historic election, beyond just the number of seats open, this will be the first New York City election to utilize Rank Choice Voting (RCV). This new experience will represent a significant opportunity and change for older voters, and one that furthers the need for extensive educational opportunities such as this questionnaire.

Having received responses from more than 80 candidates across 27 districts, New Yorker’s can now read these in-depth responses to questions that matter to all New Yorkers. Examples of topics addressed in the questionnaire include:

• Affordable senior housing

• Technology

• Community based services such as Senior Centers

• City Budgeting

• Equity across the lifespan

In addition to other questions, these areas represent just a few of the many concerns we heard directly from older constituents as needing to be addressed by future leaders. The ability for candidates to address these issues will be an important factor in the upcoming election, as AARP New York has found that 3 out of every 4 voters were over the age of 50 during the last open Mayoral primary, which coincides with the City Council primary.

“To further our commitment to civic engagement, we’re pleased to have published more than 80 candidate responses to issues of importance to all New Yorkers as we age,” said Allison Nickerson, Executive Director of LiveOn NY. “We at LiveOn NY are committed to making New York a better place to age, and look forward to continuing to educate all New Yorkers on issues of importance to older New Yorkers.”  

Press Contact: Katelyn Andrews, Director of Public Policy, kandrews@liveon-ny.org

** LiveOn NY is a 501(c)3 non-partisan organization and does not endorse, support, or oppose any political parties or candidates at any time, including through their participation in or responses to this non-partisan City Council Candidate Questionnaire.

 **All candidates across all districts were given the opportunity to submit responses. Districts not represented were those that LiveOn NY did not receive responses to release.

About LiveOn NY

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 supports, NORCs and case management. With our members, we work to make New York a better place to age. For more information, please visit our website, https://www.liveon-ny.org/

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