Opinion: Cut out the home care middlemen

As a nurse and the proud daughter of a home health care worker, I know how crucial these workers are. I will always remember the impact my mother had on the people she cared for, like Bella, a woman in her late 80s with severe mobility issues. Her family wasn't there for her and she couldn't care for herself. By the time my mom started caring for her, Bella had completely stopped speaking, and it had been months since she had even bathed. My mom took one look at her and said, “Nah, this won't do. We're getting you in that bath.” She picked her up, put her in the tub and gently washed her all over, until Bella was like a new person again. As my mom was lifting her out of the tub, Bella spoke. “Thank you,” she whispered. “Thank you. You're so good.” 

The work of home care is essential. It is also chronically underpaid. That’s why I cosponsored the Fair Pay for Home Care Act, which would raise home care wages to 150% of minimum wage, and why I supported the $3/hour raise we won for New York’s home care workers as an interim measure until we get the bill passed. 

But when home care workers started getting their raises in 2022, another problem with our state’s healthcare payment system became disturbingly clear: private insurance companies were pocketing millions of the dollars that had been allocated to pay for the raises – $722 million in 2021 alone. That left home care agencies, most of them already operating on perilously thin margins, struggling to pay their workers what they were legally entitled to. As a result, respondents to a recent survey of agencies reported that most were limiting the type of clients they can serve, declining new clients or even seriously considering closing their doors. Many were forced to cut back on overtime pay, making it even harder for workers to earn a living wage. This, in a state where many people already can’t get the home care they need, partly because the care they applied for was denied and partly because there simply are not enough workers to supply it. New York has the worst shortage of home care workers in the nation.

Ever since the state put private insurance companies in charge of distributing most of our Medicaid home care funding in 2011, these so-called “managed long term care” plans have diverted billions of taxpayer dollars meant for care. According to an analysis by 1199SEIU, managed long term care plans spent $3.1 billion of the state’s money on administrative costs and pocketed another $2.4 billion in profits over three years. Where did they get that money? By denying needed care and medical equipment to home care recipients – and now, by refusing to pay for mandated raises for home care workers.

That’s why I am co-sponsoring the Home Care Savings & Reinvestment Act, a bill to remove these ineffective middlemen. Returning home care management directly to the state would free up billions of dollars to be spent on additional care and wages. 

While the managed long term care companies’ CEOs make hundreds of thousands, even millions, of dollars each year, home care workers struggle to get by. More than two in five New York’s home care workers live at or near poverty. As a child, I saw the pride my mother took in her work and the difference she made in the lives of so many people. I also saw the hard economic choices that my parents had to make every day for our family. This failure to pay a living wage for a life-sustaining form of “women’s work,” which is done in our state mainly by women of color, is a classic example of the racial and gender economic injustice that I took office to fight against.

We need more money, not less, to pay for home care and the hardworking people who provide it. Making sure that every dollar of the taxpayer funds earmarked for home care goes to home care rather than disappearing into the pockets of private insurers would be a good start. I promise to do all I can to pass the Home Care Savings & Reinvestment Act, and I call on Gov. Kathy Hochul, my colleagues in the state Legislature, and all of New York state to join me in this fight. It’s the least we can do to support the millions of elderly or disabled New Yorkers who need home care, the millions who provide that care, the millions more who rely on those caregivers and the millions more of us who will one day need care.