Invest in Women, Invest in Care
Over the past year, political momentum has caught up with reality. From the grassroots to
congressional candidates, people are finally staking out positions in favor of single-payer health
care, often referred to as Medicare for All. We believe that one crucial element that will make or
break any universal healthcare system is a thoughtful strategy for long-term care. Anyone
serious about alleviating poverty, creating gender equality, and fighting for racial justice must
confront our state’s changing demographics, the changing nature of work and the
workforce, and the changing demands and constraints on families, and plan for a new
long-term care system that truly serves individuals, family caregivers, and care workers alike.
The proposed New York State Health Act would create a single-payer program that provides
universal, comprehensive health care to all New Yorkers, putting an end to co-pays, deductibles,
and limited provider networks. To be truly universal, that system must also include a new
long-term care benefit that meets the needs of older adults and people with disabilities.
The time has come for New York to invest in a new care infrastructure that:
1. Provides single-payer health care that guarantees long-term care to aging New Yorkers
and people with disabilities by increasing access to services in their own homes and
communities.
2. Addresses the economic hardship and gender inequality created when working adults,
mostly women, also become unpaid family caregivers, by making professional care more
affordable
3. Creates economic opportunity while improving care, by investing in the direct care
workforce — an industry the robots won’t replace any time soon — through a living wage
for home care workers, access to training, and the opportunity for workers to come
together as advocates within the home care system.

Planning for Changing Demographics
If the changing demographics and aging trends are any indication, the immediate need for a
universal long-term care benefit is clear. Life expectancy is on the rise; today, men who retire at
65 can expect to live 17 more years while women who retire at 65 today can expect to live on
average until 86.6 years. According to the U.S. Department of Health and Human Services,
seven out of 10 people over the age of 65 will require some form of long-term care
support.
Yet most New Yorkers cannot afford to privately pay for long-term services and supports for very
long. The average cost for a private room in a nursing home is $140,416, the cost for an
around-the-clock aide is more than $100,000, and the cost for an adult day healthcare center is
$20,800.
Medicaid, not Medicare, is the primary payer of long-term services and supports in New York
and in our current system, aging adults and people with disabilities are forced to
impoverish themselves by spending down their assets in order to qualify for the supports

 and services that allow them to remain in their homes and communities. Long-term care
insurance on the private market is simply unaffordable for most individuals and families.
Dignity for Seniors and People with Disabilities
If you are a family living in New York in need of care, it can be confusing and difficult to
determine which health plans and options are available: When can you enroll? Are there special
enrollment periods? What determines whether you should have private coverage, job-based
coverage, Medicare, Medicaid, Child Health Plus, TRICARE or state coverage? When can you
receive care and how you will pay for it? We need a streamlined system for Long Term Care
delivery that builds on existing infrastructure and creates a “No Wrong Door” approach to
access.
Most people prefer to get the care they need in their homes and communities rather than
being forced to live in hospitals, nursing homes, or other institutions. New York has made
progress in developing programs that support family caregivers while allowing loved ones to
access the services and supports they need to live at home. We must invest and strengthen
models of community-based care, including senior centers, and we must continue to support
and grow programs like the Expanded In-home Services for the Elderly (EISEP) program, which
offers non-medical in-home services and respite for individuals and families who are not eligible
for Medicaid. The NYConnects program offers free information on resources available to
families with long-term needs, and we should continue to invest in “No Wrong Door” programs
like this that streamline access to care.
In addition to those programs, families should also be supported in selecting a qualified
caregiver by creating a registry of licensed care workers. Rather than simply relying upon
social networks and word-of-mouth, families should be able to access a database or registry of
caregivers to identify and hire the caregiving help they need.

Invest in Women by Investing in Care
Including long-term care within a single-payer healthcare system from day one
represents a forward-thinking women’s economic agenda. Today, women take on the lion’s
share of the caregiving responsibilities while at the same time working outside the home to
provide for their families. The majority of unpaid family caregivers are women (as are the
majority of direct care workers). These realities perpetuate wage inequality and economic
insecurity for women. Investment in care—a living wage for workers and relief for unpaid family
caregivers—will go far to bolster women’s economic security.
As our senior population grows, family caregivers’ services spare the state the cost of various
long-term facilities and nursing homes, a cost normally borne by taxpayer-funded programs
such a Medicaid. But those families are the ones paying, through the loss of income of the
care recipient, loss of the caregiver’s income if they reduce work hours or leave their jobs, loss
of employer-based medical benefits, and shrinking savings as money is used to pay caregiving
costs. There are approximately 2.58 million unpaid family caregivers in New York, who

 provide over 2.4 billion hours of care annually, worth an estimated $31.3 billion in economic
value.
It is estimated that the impact of caregiving on lost wages and Social Security benefits for family
caregivers can cost individuals up to $274,044 over a lifetime. The cost for families is even
more alarming when race is considered. On average, African-American caregivers spent
34% of their annual income on providing caregiving services; Hispanic/Latino family caregivers
spent 44% of their annual income.
Creating a universal long-term care benefit within a single payer health care act would provide
critical help and financial relief to unpaid family caregivers and could possibly save families an
estimated $11 billion through the elimination of out-of-pocket costs. It would at the same time go
a long way to reduce economic inequality especially among some of our most vulnerable
populations.

Recognition for Paid Care Workers
New York City is home to one of the largest home care workforces in the country. Over
300,000 homecare workers provide hands-on care to their clients, assisting with activities of
daily living such as bathing, dressing and eating; help with housekeeping, errands and
appointments, and performing clinical tasks. These workers are responsible for the safety and
care of their clients in their homes or in community-based settings.
More than one in seven low-wage workers in New York City is a home care worker.
According to the New York Department of Labor, the annual salary for home care aides is
$24,810 while the cost of living in New York is 20 percent above the national average. We must
invest in the homecare workforce by improving job quality, providing wage parity; and enforcing
workforce protections so workers can also also be equipped to adequately take care of
themselves and their own families.
It’s time to invest in the workforce that cares for New York
New York has been facing ongoing shortages in the direct care workforce, especially in rural
communities where weather issues, longer distances, and transportation can be a
hindrance for care workers. Medicaid reimbursement rates for home care workers are lower
today than they were in 2006, causing significant turnover and contributing to acute
shortages. There is also a lack of sufficient training, uncompensated hours and few benefits for
these workers.
New York state is at a crucial point where it can turn the current inadequate long-term care
system into one that provides real long-term care options for all, insures fair wages and working
conditions for those providing care and includes long-term care for families across New York
State. Long-term care that complies with the Olmstead mandate of the Americans with
Disabilities Act means ensuring people have access to LTSS.

 Building Care Infrastructure for the 21st
Century
In the realm of long-term support and services, the issue at hand is not whether or not to
provide needed care and support for aging adults and people with disabilities. The only choice is
between meeting those needs with a strategic investment in New York families and caregivers,
or asking those families and caregivers to continue to shoulder the cost of care on their own.
New Yorkers are already paying for this care, and this program offers the opportunity to invest in
care that is cost-effective and meets the stated needs of families across the state.
New York will see a 33 percent growth in need for home health aides and face a shortage of
some 23,000 within the next ten years. We should use our state’s economic development funds
to invest in the recruitment and retention of a qualified home care workforce, including paid
family and friends acting as caregivers. We must look creatively at our economic development
dollars and invest in jobs that will lift women and people of color while improving the quality of
life for older adults and people with disabilities.