Health/Medicaid Joint Legislative Hearing on 2022 Executive Budget

Testimony of Bobbie Sackman

Leader, NY Caring Majority and Jews for Racial & Economic Justice

Tuesday, February 8, 2022

My name is Bobbie Sackman, Campaign Leader, NY Caring Majority/Jews for Racial and Economic Justice. I was formerly the Director of Public Policy for LiveOn NY for 28 years. I can attest that Fair Pay for Home Care is the most transformational change to providing a living wage for home care workers across the board, confronting the severe shortage of home care workers, providing critical home care to millions of New Yorkers and supporting family caregivers, the state has seen in decades.

New York’s population is aging rapidly and becoming more disabled — between 2021-2040, NYS is projected to grow by 3% —but the 65+ population will grow by 25%. The number of adults over age 85 will grow by 75%. [CUNY]

Meanwhile, according to the Center for Disease Control and Prevention, one-quarter of the state’s population has a disability, and when we look at the state’s sixty-five plus population, that number becomes almost 50%. And the need will only get worse, with some studies indicating that the rate of long-term disability among COVID-19 survivors, even those who had mild cases or who were asymptomatic, could be as high as 20-30%.

Even before COVID, the vast majority of us preferred to live and age in our own communities. The loss of over 15,000 nursing home residents to COVID-19 only made it clearer why home based support is preferential, and led many families to opt for home care over nursing homes for their loved ones [Times Union] In a recent poll, 90% of Americans preferred home care over nursing homes. [SEIU] Additionally, based on several recent studies, staying out of institutions is healthier too - recent research has found recovering COVID patients fared far better after discharge to home care than nursing homes [VSNY] and even before Covid, the median life expectancy of an individual in a nursing home was just five months [Geriatric Society]

Home care is what allows many of us who need care and support in our homes to do so - but New York currently faces the worst home care workforce shortage in the nation. [Mercer] This means we don’t have enough home care workers to care for older adults and disabled people. And the shortage is only growing worse as our population keeps aging, and older adults increasingly search for nursing home alternatives. This shortage is dangerous: without anyone to care for older adults and disabled people, our family members are vulnerable.

• 25% of home care consumers reported they were unable to find home care workers • Nearly 20% of state home care positions are currently unfilled due to staff shortages. • 42% of New York’s home care agencies reported high turnover [HCA]

We need more home care workers to care for the state’s older adults and disabled community, but the state pays home care workers poverty wages — as little as $13.20 an hour in many counties — and prioritizes institutional settings. So, home care workers who love their job are leaving the sector in droves to find better paying jobs. Poverty wages drive workers away:

• Over 40% of New York’s homecare workers live in or near poverty due to chronically low wages — an average of $13.20 an hour in most regions [PHI]

• 57% of NY home care workers rely on public assistance and 49% lack affordable housing [PHI]

• In the Hudson Valley, for e.g., 5,100 home health aides in the Hudson Valley leave the job each year because of low pay and inadequate benefits [HIH]

• 60% aides reported leaving due to an inability to earn enough money [CPDAANYS] • Seven out of every ten consumers Upstate and three out of every five on Long Island and Westchester reported low wages as the reason their workers quit. [CDPAANYS]

We need to combat the state’s dangerous home care shortage to keep older adults and disabled people safe — and the way to do it is by including Fair Pay for Home Care (A06329/S05374) in the budget which would raise home care wages to at least $35,000 a year on average.

Fair Pay for Home Care would raise home care wages to 150% of the minimum wage ⎯ allowing home care workers to make at least $35,000 a year on average. According to a study by the CUNY School of Labor and Urban Studies [CUNY] would wipe out the home care workforce shortage in less than five years, keep older adults and disabled people safe and out of nursing homes, and bring 200,000 new home care workers into the field. In all, the state would see increased revenue totaling $5.4 billion through job creation and moving home care workers off of social assistance — putting the Act on track to be one of the most successful economic development programs in the state’s history. And the home care sector is overwhelmingly women and people of color — so fair wages would create new jobs for historically underpaid communities. More and more New Yorkers are joining together to say: It’s time for New York to care for older adults and disabled people — by investing in home care that will keep them safe and at home. Fair Pay for Home Care would also:

Lift workers out of poverty: Currently, 42% of the state’s home care workers live in or near poverty. Fair Pay for Home Care would lift over 200,000 home care workers out of poverty wages. [PHI]

Jobs for women & people of color: Fair Pay for Home Care will overwhelmingly improve existing jobs and create new jobs for women and people of color: currently, New York’s care sector is 91% female and 77% people of color. As the country and state wrestle with historic racial injustice, along with the disproportionate impact of COVID on communities of color, Fair Pay for Home Care is an investment in equity, lifting up a historically underpaid workforce. [PHI]

Job creation during Covid: As New York faces widespread unemployment, Fair Pay for Home Care would bring 200,000 new home care workers into the field over the next decade and additionally create 180,000 jobs in other sectors and industries via increased spending and economic activity. [CUNY]

Economic generation: Fair Pay for Home Care would pay for itself and generate $5.4 billion for New York's state economy through new income and sales tax revenue, economic spillover, and reductions in Medicaid and social assistance. [CUNY]

Fair Pay for Home Care is also a smart investment for New York. A consortium of unionized Licensed Home Care Agencies and home and community based long term care associations projected that Fair Pay, when fully implemented, would cost New York $2.47 billion, and even less in the short-term while the state is receiving higher Federal Medicaid funding because of COVID-19. (This cost includes wage increases for home care workers AND all the costs associated with those raises for providers, to ensure this isn’t an unfunded mandate for providers. We can provide a more detailed breakdown of these costs if needed.)

Because Fair Pay would be implemented Jan 1, 2023, it is only 1/4 of the fiscal year 2023 - therefore in the budget about to be passed, it would cost the state approximately $618 million — this is slightly only 3/4 of the $860 million of funds available from the American Rescue Plan.

Given the projections by CUNY School of Labor and Urban Studies that Fair Pay would result in cost savings and revenue larger than the investment, the initial investment, fully funded by the Federal government, would begin to pay for itself by the time it was fully effective in fiscal year 2024. Since the state can use ARPA funds until March 31, 2024, any savings or increased revenue predicted by CUNY that had not yet materialized could be funded by the $285 million in remaining ARPA funds.

In a time when NYS Budget Director Robert Mujica said that NY is in a strong financial position, with billions in a ‘rainy day fund’ it is unconscionable for the State to NOT invest in the essential home care workforce and end NY’s worst in the nation home care workforce shortage.

NY Caring Majority members, RNs, PWD, family caregivers, developed the “Comprehensive Skills Table” which is pasted at the bottom of my testimony, and spells out in detail the myriad of health care skills home care workers provide and the ramifications when that care isn’t available. I will quickly go through some of them.

Keep in mind that home care workers earn poverty level wages at $13.20/hour upstate for this skilled health care work - including preventing death:

• Decreased falls - Toileting, bathing, transferring, ambulation, mobility, stabilization of the person’s body all prevent falls. 34,000 older adults died in 2019, due to falls. 300,000 were hospitalized, many debilitated for life due to hip fractures.

• Wound care - Changing of dressings, assessing the wound, lack of care could lead to a system infection such as sepsis, which is deadly.

• Respiratory care - Monitoring of respiration, cleaning of ventilators & other equipment, respond to ventilator alarms, assist with suctioning of tracheostomies, monitoring oxygen tanks & more. Respiratory support is a life saving measure. Without it individuals suffer to breathe and death is inevitable.

There is much more in the whole table, but, hopefully, the point has been made. Home care is health care. Investing funding for Fair Pay for Home Care provides critical health care for millions of New Yorkers while creating good paying jobs. Can we all agree that it’s time to end New York’s policy of neglect and poverty level wages?

Download the full testimony, including the Comprehensive Skills Table.