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It’s Time for New York to Invest in its Direct Care Workers

June 15, 2021

New York’s direct care workforce is critical to the state’s long-term services and supports sector, ensuring that older adults and people with disabilities can live and thrive in their homes, communities, and across congregate settings.

Yet as the COVID-19 crisis has reinforced, these workers remain undervalued and inadequately supported—and their jobs remain poor in quality. For example, New York’s direct care workers earn a median hourly wage of $14.24, and 45 percent live in or near poverty. Because of poor job conditions, direct care workers are increasingly leaving this sector for other fields (such as fast food and retail), which profoundly affects the individuals who rely on this support.

Did you know? PHI’s research shows that from 2018 to 2028, New York’s long-term care sector will need to fill over 1.1 million job openings in direct care, including almost 280,000 new jobs to meet rising demand and over 837,000 openings caused by workers who transfer to other occupations or exit the labor force altogether.

Yet, a sense of promise is in the air. A wave of new federal announcements—the American Rescue Plan and the American Jobs Plan, as two notable examples—signal a shift in how the federal government supports states to strengthen this workforce. Likewise, New York is continuing to identify the best ways to improve jobs for the state’s almost 530,000 home care workers, residential care aides, and nursing assistants—including through the Reimagining Long-Term Care Task Force.


Building on our long history of working to improve job quality for direct care workers in New York, PHI is adding New York to our Essential Jobs, Essential Care initiative—a multi-year advocacy initiative that we are implementing in several states across the country. In the coming year, PHI will work with a broad coalition of leaders in New York to co-create a roadmap that identifies shared advocacy priorities and strategies for success. Here are four pressing direct care workforce policy needs that have already been identified in New York.


New York’s home care workers deserve fair pay. With median annual earnings of only $19,200, almost half of New York’s home care workers—who constitute the majority of direct care workers in the state—live in or near poverty. The recent Fair Pay for Home Care Campaign sought to increase home care workers’ wages to 150 percent of the state minimum wage, which would have brought them up to a living wage. Although the campaign was not entirely successful this year, efforts are already underway to ensure that the raise is included in next year’s budget. Meanwhile, it will be important to advocate for a significant portion of the American Rescue Plan funding for home and community-based services (HCBS) to be allocated directly to home care workers.

New York’s direct care workforce needs enhanced training opportunities. Recognizing the need for enhanced training for direct care workers and other long-term care workers, New York established the Medicaid Managed Long Term Care Workforce Investment Program in 2017. However, this funding expired in March 2021 and no concrete plans have been released about what comes next. PHI has called on the state (read our “Discussion Paper April 2021″) to renew the Workforce Investment Program, with key improvements—to ensure that workers receive the training they need in a rapidly changing field. In the interim, until the “Workforce Investment Program 2.0” is up and running, a portion of the American Rescue Plan funding could go toward direct care training programs.

Direct care workforce innovation deserves funding. PHI worked in coalition with partners to successfully introduce a bill in the New York State Senate in 2021 to establish the Home Care Jobs Innovation Fund—a pool of money to fund pilot projects that seek to meaningfully improve workforce recruitment and retention. Although the Innovation Fund was not included in this year’s state budget, PHI will continue to work with other organizations and the legislature to pass the bill in the future—as a key step toward overcoming the state’s staggering workforce shortage. One-time federal funding opportunities, such as from the American Rescue Plan or the proposed American Jobs Plan, could be the perfect fit for a time-limited funding initiative like the Innovation Fund.

New York must establish a robust direct care workforce data system. Current direct care workforce data collection is inconsistent and insufficient, preventing the state from effectively tracking trends, identifying challenges, and assessing the impact of policy changes. The first step in establishing a more rigorous data collection system would be to survey all state agencies to identify workforce data sources and gaps. Going further, new federal funding could be leveraged to fund a statewide survey of direct care workers to better understand their job experiences and challenges, including with regards to COVID-19, and to develop more targeted and evidence-based workforce interventions.


For years, PHI has led critical advocacy on the direct care workforce. Yet we have never seen the type of widespread policy interest at the state and federal levels that we are witnessing in this moment. Together, we must capitalize on this moment, transforming jobs for direct care workers and care for older adults and people with disabilities.

PHI’s work in New York is made possible through generous support from the Altman Foundation and Gimbel Foundation.


Contributing Authors
Allison Cook

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