Christmas in Brooklyn for Older Adults

The home care industry in New York is at a turning point. On the one hand, the demand for home care is at an all time high. New York's aging population continues to grow and an increasing number of people prefer to get their care at home rather than in institutional settings. On the other hand, agencies in the home care industry are facing greater financial pressures than ever before, along with regulatory changes and a shrinking workforce that affects families' ability to secure services. In New York City, Long Island and Westchester, home care aides working for licensed home care services agencies were paid a minimum wage of $19.10 per hour, effective January 2025; in the rest of the state, minimum wages for these aides were $18.10 per hour. Minimum wage for these aides in NYC, LI and Westchester will rise to $20.00 per hour in January 2026, while minimum wages for home care aides in the rest of the state will be $18.50 per hour. These wage increases are part of the wage parity initiative to increase wages for this vital workforce. Identifying the Different Types of Home Care in NY Prior to discussing costs and rules related to home care in NY, let's clarify what we mean by "home care", since the nomenclature for home care can be very confusing. Licensed Home Care Services Agencies (LHCSAs) provide personal care services such as assistance with Activities of Daily Living (ADLs) such as bathing, dressing, meal preparation, and light housekeeping. LHCSAs employ home health aides and personal care aides that work under the direction of an employee of the agency. Certified Home Health Agencies (CHHAs) provide skilled nursing care and therapeutic services ordered by a physician. This includes registered nurses, physical therapists, occupational therapists, and speech therapists providing medical services at home. Consumer Directed Personal Assistance Program (CDPAP) allows eligible individuals to hire, train, and direct their own personal assistants, including family members. CDPAP has experienced explosive growth over the past several years, although it has also faced great scrutiny and regulatory changes. The type of care your loved one requires will determine which services are suitable. A person recovering from surgery may require a Certified Home Health Agency (CHHA) for wound care and physical therapy. A person with dementia requiring assistance with ADLs may be able to obtain services from a Licensed Home Care Services Agency (LHCSA). A person preferring to use a family member as their caregiver may wish to pursue a Consumer Directed Personal Assistance Program (CDPAP). How Much Does Home Care Cost? We'll start talking about costs, since this is usually the first thing families ask — and the answer can be quite surprising if you are not prepared. As of November 2025, the average hourly rate for home care in New York City was approximately $25.76. Based on a 40-hour workweek, this represents a weekly cost of $1,030.30. A monthly cost for full-time care would be approximately $3,349 for 130 hours of service. However, the reality is that those rates represent just the beginning for the basic personal care. Skilled nursing care will cost significantly more. A live-in care arrangement, 24-hour care, or a specialized service for a condition such as Alzheimer's can easily cost between $8,000 to $15,000 or more each month. Estimated Cost Ranges for 2026: Type of Service Range of Hourly Rate Estimated Monthly Cost (130 Hours) Personal Care Aide $23-28/hour $2,990-$3,640 Home Health Aide $25-32/hour $3,250-$4,160 Skilled Nursing (RN) $75-120/hour Variable (typically fewer hours) Live-in Care $350-500/day $10,500-$15,000 Costs will vary based upon where in New York State you reside, the level of care required, the reputation of the agency, and whether the care is provided on weekends, at night, or on holidays (all of which generally cost more). Navigating the Medicare and Medicaid System Families need to understand the payment systems because many families believe that Medicare will pay for home care, which is generally not true in the way families think. Medicare will pay for skilled home health care if the individual meets the following requirements: You are confined to your home You require skilled nursing care or therapy A doctor orders the services The agency providing the services is certified by Medicare Medicare DOES NOT pay for personal care services (the help with bathing, dressing, etc. that most people need the most); nor does Medicare pay for 24-hour care or long-term assistance. Medicaid pays for personal care for eligible individuals through programs such as Managed Long Term Care (MLTC). However, Medicaid eligibility requires the individual to meet both medical necessity standards AND financial standards. Application to Medicaid can take months and requires a significant amount of documentation. Approximately 250,000 Medicaid enrolled New Yorkers currently receive services from home care programs at a total annual cost of approximately $6 Billion. Programs such as CDPAP have seen enormous growth over the past couple of years, with more than double the number of participants as compared to a couple of years ago, while traditional agency-based care has seen declines in participation. Many families find themselves in what I refer to as the "middle gap," meaning that their loved one needs a great deal of help but does not qualify for Medicaid, while Medicare does not pay for the kind of services they really need. In this situation, the family will generally have to pay for the care privately at least initially. The Growing Workforce Shortage No One Is Talking About There is a harsh truth: Finding quality home care aides is becoming increasingly difficult, and it appears that things are only going to get worse. This problem stems from the fact that despite increases in wages, home care is a challenging job with a high turnover rate. The consequences for families are real. When you contact an agency to inquire about services, they may tell you that they cannot accept any new clients. Alternatively, you may experience a high degree of staff turnover as aides leave for better-paying jobs. Lastly, you may find it difficult to obtain weekend or overnight coverage due to a lack of available staff. Demand for home care is growing much faster than the supply of home care staff. Between 2019 and 2023, the number of skilled home health agencies serving Medicare patients declined or remained stable in over 94% of U.S. counties. That is an astonishing statistic -- and it means that fewer people will have access to care at a time when more people than ever before need it. This creates the following realities for families: Find home care earlier than later -- ideally before you desperately need to do so. Be flexible in terms of the hours you can accept -- particularly during peak times. Treat your home care aide with respect -- they have choices. Contact multiple agencies -- you may find that one agency has the availability of another. If possible, consider using CDPAP and employing your own family members as your home care aides. Protecting Your Family from Unscrupulous Providers Not all home care providers conduct business ethically. There have been numerous cases of provider fraud, wage theft, and quality issues in recent years. To protect your family, you should ask the right questions and look out for red flags. Before contracting with a home care provider, verify: That the agency is currently licensed with the New York State Department of Health How long the agency has been operating References from current clients Training and supervisory practices of the agency for its caregivers Agency response to missing caregivers or emergency situations Billing practices and payment policies of the agency Red flags to watch for: Pressure to enter into contract quickly Unclear responses regarding the agency's licensure or certification status Low rates for services (possible indication of wage theft or inadequate training for employees) Reluctance to provide references Communication difficulties or unavailability of supervisory personnel High employee turnover Keep in mind, the person you are allowing into your home to provide care for someone in a vulnerable position is a trusted individual. Therefore, it is not unreasonable to ask detailed questions about how the agency operates — it is prudent. Angel Care Agency, Inc. understands the overwhelming nature of making home care decisions for your family. We assist families in navigating the complex home care environment in New York and match you with quality, caring caregivers. We assist you in determining the best course of action for your family, regardless of your need for a few hours of assistance or comprehensive around-the-clock care. Contact us today to review your family's needs.