Who will care for Long Island's aging population? Home health aide shortages grow

After John Small, 96, injured his head in a fall in October, his wife, Patricia, struggled to care for her husband of 73 years.

The couple, with their daughter's help, decided to get help from a home care agency to assist with the retired salesman's daily needs.

They hired two aides, from Reliance Home Senior Services in Wantagh, who each work 12-hour shifts, seven days a week at the couple's East Meadow home. The aides help John Small with tasks, including showering, shaving and dressing.

They are “like angels,” said Patricia Small, 94, a retired teacher. Were it not for the "dedicated" aides, "we would really be in a muddle," she added.

Home health aides are state-certified health care professionals who play a central role in New York’s health care system as they provide care for people with disabilities and older adults like John Small who opt to remain in their homes rather than entering nursing care or assisted living facilities.

The Smalls have lived in their East Meadow home for nearly 20 years, a key reason they chose to pay for home aides.

"It is better for patients to be in their surroundings," Patricia Small said.

As Long Island’s population ages, demand for home health aides is surging — with the workforce projected to grow nearly 40% statewide by 2030, according to the Center for Health Workforce Studies at the University at Albany. But the industry is already struggling to keep up, constrained by low wages, limited public transportation and tightening immigration policies that experts say could leave thousands of seniors without the help they need to safely age at home.

“We have more people who need help [than] people who are available to provide the help that is needed," said Nicole Laborde, director and founder of Islandia-based Ideal Home Care Services. 

A backbone of long-term care

Home health aides and personal care aides require training and licensure from the New York State Department of Health.

Personal care aides assist with daily tasks such as bathing, dressing and meal prep, while home health aides can also provide limited health-related support, like distributing medication under a nurse’s supervision. 

Long Island employed   44  ,770 home health and personal care aides in 2024, and the occupation is projected to have about 9,500 openings a year through 2032, according to 10-year estimates from the state Labor Department.

Meanwhile, there are more Long Islanders 65 years or older today than a decade ago, Newsday reported. One in 5, or nearly 111,000 seniors, are now living alone while coping with the challenges of aging in the suburbs, according to 2023 U.S. Census Bureau data analyzed by Newsday.

According to state figures, seniors are projected to make up 25% to 30% of the population in most New York counties by 2030, but industry operators like Reliance Home Senior Services say they are finding it increasingly challenging to hire enough workers to meet the rising demand for home health aides on Long Island.

There are nearly 500 licensed home care agencies serving Long Island, according to state Health Department data. There are roughly 70 nursing homes on Long Island, according to the agency.  

The projected growth of home health aides and personal care aides outpaces the overall growth of all occupations on Long Island, said Shital Patel, a labor market analyst with the state’s Labor Department.

While annual openings in the field are estimated to be in the thousands, nearly 8,000 aides a year are projected to leave the field, Patel said. 

A shortage of health aides could mean many more seniors are placed in nursing homes instead of aging in place, Laborde said.

Currently, of patients referred to a home health agency following a hospitalization, 40% are not assigned an aide due to "capacity constraints and workforce shortages," according to data from the National Alliance for Home Care, based in Alexandria, Virginia.

"If they don’t have the care at home, they are going to end up going back into a nursing home or having family members become caregivers,” Laborde said. “That’s the consequence if we don’t have the manpower to take care of them.”

"The home care industry is increasingly important and one of the fastest growing industries," Mariano Torras, an economics professor at Adelphi University and chair of its Finance and Economics Department, said in an email.

"The demographic 'cliff,' that is, the inevitability of rapidly aging populations everywhere, only reinforces its importance. The worker shortage on Long Island will hurt the local economy, if nothing else, because fewer jobs translate to less income and spending. But the resulting higher cost of home care due to the labor scarcity is also likely to dampen spending in other areas," Torras said.

The U.S. home health care market, estimated at $162 billion in 2024, is projected to grow to $381 billion by 2033, according to Grand View Research, a San Francisco-based market research firm.

Immigration policy's toll on industry

There are several factors impacting the home health workforce, which has long relied on immigrant labor, but industry groups and employers cite recent changes to the nation’s immigration policy as an emerging factor contributing to labor shortages.

The nation's current immigration enforcement efforts have left local agencies with fewer pools of potential workers, experts say.

"It’s a serious concern that has exacerbated the workforce shortage crisis," said William Van Slyke, spokesperson for the Home Care Association of New York State, a trade group representing agencies and workers in the field. "We have received reports, largely from downstate providers, of significant losses of staff due to terminations of work authorizations and discontinuance of automatically extending certain categories of authorizations,” Van Slyke said in an email.

Since July, Dana Arnone, owner of Reliance Home Senior Services, said she has terminated 70 of her more than 700 employees because of revoked temporary protections that allowed some of her foreign-born workers to live and work in the United States legally, putting a strain on her operations and her ability to pair aides with patients in need. 

While the state does not track the percentage of foreign-born workers in the industry, U.S. Census Bureau data shows that 35.2% of home care industry workers in 2024 were Black or African American, 22.9% were Hispanic or Latino and 12.3% were Asian. 

Since March, the federal government has "terminated or announced its intent to terminate" the temporary protective status for more than 1 million of the 1.3 million individuals with the status, including more than 50,000 Hondurans, 330,000 Haitians and 600,000 Venezuelans, according to the American Immigration Council, a Washington, D.C.-nonprofit that advocates for immigrant rights.

The Department of Homeland Security has said ending TPS status for countries like Venezuela and Haiti is part of President Donald Trump's "promise to rescind policies that were magnets for illegal immigration and inconsistent with the law."

Katia Guillaume, vice president of 1199SEIU, a union that represents 75,000 home care workers in New York State, said the federal administration's efforts to end TPS has had a major impact on staffing.

On Feb. 3, the TPS status for workers from Haiti, from where many aides on Long Island hail, is set to end.

“In an industry that already has a shortage, this is going to basically devastate the health care industry, home care in particular,” Guillaume said.

When the immigration status of an aide who has spent years with a patient is revoked, both the aide and patients suffer, Arnone said. "They grow attached to the patients," she said.

Low wages, other factors hamper job recruitment

Wages for home health workers have for years fallen far below other health care professions and also hamper recruitment efforts, experts say.

In January, the state raised the minimum wage for home health aides on Long Island, New York City and Westchester to $19.65 an hour as part of a multiyear plan to increase the industry's pay. The plan initially began with an increase to $17 in 2022, $2 above the normal minimum wage at the time.

Still, advocacy groups say that’s not enough to keep up with increases in housing, transportation and other living expenses, and closing the wage gap will require more than modest increases to the minimum wage.

"Historically, many home care agencies pay above the minimum wage," Van Slyke said in a statement. But "while small incremental wage increases can be helpful to some extent, they have not had a meaningful impact on the workforce shortage crisis."

Guillaume said the increases in wages have not kept up with the rising cost of goods and transportation.

“Every stride that you make is countered by a cost-of-living increase,” Guillaume said. “It seems as if they will never be ahead.”

Arnone said the state’s efforts to draw more people to the industry through higher-mandated minimum wages haven’t moved the needle much.

One of the largest barriers, she said, is the role that managed long-term care insurance companies play in reimbursing home health aide operators.

In New York, responsibility for reimbursing home health aide operators through Medicaid shifted in 2012 from the state Department of Health and counties' Department of Social Services offices to outside insurance companies. Those companies determine the rates at which agencies providing the care will be reimbursed through Medicaid.

Nationwide, Medicaid is the primary funding source for long-term care, covering the cost for more than 9 million Americans each year, according to a March 2025 report from Georgetown University.

Arnone said the move toward outside insurers has meant that reimbursement rates offered to operators aren't enough to cover the cost of care, leaving little wiggle room to raise wages above state mandates.

Starting a home care agency can cost anywhere between $50,000 and $100,000 in startup funds, in addition to licensing fees, and it can take between six to 12 months to complete the licensing process, according to ShiftCare, a software company geared toward home health agencies. The average cost per hour of home care for an agency, covering wages, payroll expenses, benefits, overhead and profit, is $27.91 per hour, according to 2024 report from the Fiscal Policy Institute, a nonprofit economic researcher in Albany.

'I feel happy helping people'

Home health aides face significant burnout from their jobs, researchers say.

A June 2024 study on the mental well-being of home health aides published in JAMA Network Open by Weill Cornell Medicine researchers found that caregivers experienced significant stress, loneliness and mood challenges tied to their jobs.

“Despite their integral role in patient care, home health aides themselves are a vulnerable workforce,” the authors wrote.

Destiny Padilla, 27, of Brentwood, a home health aide who works for Ideal in Islandia, cares for two elderly patients. She said her job can be emotionally and physically taxing.

“If you don’t have patience, you can’t do this line of work,” she said. “You have to be compassionate.”

Padilla also said low compensation is a major problem in the industry.

While she feels appreciated by her agency, she said, “Our hard work has to match our payrate.”

Some Long Island families say aides help them balance their work and caregiving responsibilities.

“It means the world,” said Louise Gatti, 63, of North Bellmore, whose mother Carmela Gatti, 93, has dementia and gets 24/7 home care.

Gatti, who works full-time, said without the help of the four aides who assist her mom, she’d be put in an “impossible” situation.

“I could not work at all. I would have to be full-time taking care of my mom,” said Gatti, whose mother lives with her. “There’s just no way one person can do it.”

Gatti said the work of one of her mother's aides, Margarita Esperanza Hernandez, 49, of Reliance Home Senior Services, has been so important to her ailing mother that Gatti sees her as "part of the family."

Hernandez, who also works as a hair stylist in Bay Shore, said she deeply cares about Gatti's mother and wants the best for her.

“I love her,” she said. “It’s not because she’s a patient or because of the money.”

As a Catholic who has been a home health aide for eight years, Hernandez, a practicing Catholic and a home health aide for eight years, said she feels compelled to offer help to those who need it.

  “If I did this job only for the money, I wouldn’t be happy,” she said.

Mildred Garcia-Gallery, 56, a home health aide consultant and activist from Massapequa Park, said many people fail to understand the challenges of the job. Everything from handling emotional outbursts from patients with declining mental faculties, to physically moving clients with limited mobility, to facing the reality of death head on can take a toll on the body and mind, she said. 

“This is a career for most," said Garcia-Gallery, who has worked in home care for 30 years and consults with agencies through her Lynbrook firm Ageless Companions LLC. “People start out here, some become nurses, but most stay because they like it or love it.”

“Dog walkers make $25 an hour, but our home care workers don’t?” Garcia-Gallery said. “I don’t get it.”

Many workers also lack access to public transportation, adding to the stress and burnout.

“Why is someone going to get into home care if they can make more money at Home Depot or Target, where they can take one bus to get to work?” Arnone said.

“It makes it much harder for recruitment if we’re saying, ‘You have to go to this family’s home,’ and transportation is not provided,” she said.

For nearly 30 years, Muriel Varnes, 63, a home health aide from Rosedale, Queens, has made the more than two-hour trek to her patients’ homes on Long Island.

Varnes takes three buses and walks 20 minutes to reach her clients.

She said she earns $19.65 an hour — the state’s mandated minimum for aides in the region.

As a result, Varnes, who lives alone, said she cannot afford to buy health care through her employer, and “lives paycheck-to-paycheck,” paying only for necessities.

“Some of these cases are very difficult,” said Varnes, who also cares for patients with Alzheimer’s disease or dementia.

Still, Varnes said, she loves her job.

“I feel happy helping people," she said. "I have the compassion for people who are elderly, sick and who need help.”