Blog April 04, 2017

The Home Care Workforce Crisis in Our States: How New York Has Responded

Allison Cook, MPH
New York Policy Manager, PHI

What would you do if your loved one needed home care and you couldn’t find anyone to provide it? This is the difficult reality for a growing number of Americans. The U.S. is facing a growing home care workforce shortage, especially in rural areas.

Home care is a critical support that helps older adults and people with disabilities age in the community, rather than in facilities. Unfortunately, we have not ensured that home care aides have quality jobs, which enable them to provide quality care. Because of low wages, inadequate training, and limited career advancement opportunities, these jobs have become noncompetitive, failing to attract and retain the workers necessary to meet the needs of our aging population. Aging advocates and media outlets around the country are sounding the alarm – workforce shortages are growing – yet federal and state governments are struggling to identify effective solutions.


New York State is seeing the impact of the workforce shortage, especially in rural upstate. The state will need over 124,000 new home care aide jobs between 2014 and 2024, but doesn’t have sufficient workers to meet these needs. Testimony at a recent NYS Assembly hearing on the challenges facing the home care workforce illustrated how consumers are affected by the shortage. One person was stuck in a nursing home unnecessarily for months because they couldn’t find a home care worker. Many others told stories of routinely losing qualified aides because aides cannot make ends meet with such low wages.

Ahead of the curve, New York is addressing the workforce shortage by investing in home care aide job quality—a model that could also work for other states. Recent policy interventions include:

  1. Investing in quality employers: New York created a pool of funds available only to home care agencies that meet certain “quality” criteria, including providing comprehensive health benefits and additional training for their home care aides. (Learn more from the #60CaregiverIssues campaign, Issue #5).
  2. Increasing wages: The national average wage for home care aides is a little above $10 per hour. New York’s minimum wage will increase to $15 per hour in the coming years, increasing compensation for home care aides and other low-wage occupations.
  3. Creating opportunities for career advancement: Last year, New York passed a law that created an Advanced Home Health Aide occupation. This will provide home health aides with a next step in their career, and will fill a care gap by allowing Advanced Aides to administer certain medications.

Despite these advances, there is room for improvement. New York—and other states—need comprehensive plans to address the workforce shortage. Thus far, most state interventions are focused solely on increasing wages. Arizona increased Medicaid funding this year to cover a minimum wage increase. Maine legislators made home care worker wages more competitive in 2015, but in 2016 the public voted to increase the minimum wage, resulting in the minimum wage catching up to home care wages. Most significantly, last year Washington state negotiated a collective bargaining agreement for “independent” or “consumer-directed” aides that raised their wages to $4 above the current minimum wage and $1.50 above the state’s new minimum wage in 2020. While wages are an important factor, solely increasing wages will not solve the shortage.

To build on this momentum and identify a range of solutions, PHI launched a two-year, national campaign to identify 60 policy and practice issues related to the direct care workforce. PHI is committed to finding solutions that improve the quality of care for older people and people with disabilities by improving the quality of direct care jobs– including providing better wages and benefits, creating advanced roles and training opportunities, reconfiguring how we finance and structure the long-term care system, and much more. Learn more at

Allison Cook is the New York Policy Manager at PHI, a research and consulting organization widely recognized as the nation’s leading authority on the direct care workforce.