Opinion: A well-intentioned bill could collapse NYC’s home care system

Imagine that you are a disabled New Yorker who relies on daily, 24-hour support to manage the basic tasks of life that others take for granted. Something as simple as brushing your teeth, using the restroom, preparing meals or repositioning in bed at night to prevent bedsores – the care you receive at home is more than a service; it is a lifeline, allowing you the dignity of remaining in your own home while still receiving the round-the-clock support you need and deserve.

Now imagine this stability, as well as the dignity and independence you are afforded by receiving care in your own home rather than in an institution, being completely suspended. A lifeline erased. This is the reality that nearly 14,000 disabled New Yorkers who receive 24-hour live-in care could soon face if the New York City Council moves forward with a fraught bill to upend the home healthcare system.

Intro. 303, while well-intentioned, seeks to ban 24-hour “live-in shifts” for home care workers by fining service providers for providing shifts exceeding 12 hours per day in New York City. While these 24-hour shifts can indeed be exploitative and should be reformed, Intro. 303, as currently written, is not the solution. The bill’s backers recently made some edits to the bill, but they do not meaningfully change the problems that exist in the original proposed legislation.

People who rely on split shifts really want every hour of every worker’s time to be compensated with a living wage, and they want every worker to choose how long and when they work. But the state Medicaid rules are challenging. If an insurance plan has only authorized sleep-in shifts, an agency cannot bill Medicaid for split shifts without committing fraud. Under the New York Labor Law, the home care worker working sleep-in shifts is paid for only 13 hours as a standard; however, if the worker does not get 8 hours of sleep (5 hours of which is uninterrupted), and three one-hour meal breaks in any shift, the worker must be paid for all 24 hours of the shift. In practice, these workers are often paid for only 13 hours even when they do not get enough sleep or break time and should get paid for all 24 hours.

Intro 303 tries to solve the problem of abuse of the current rules by throwing the baby out with the bathwater. The bill does not and cannot change the rules governing the insurance plans or regulate the conduct of the insurance plans. This is because home care in New York City is governed by state Medicaid rules and managed care plans, not city statute; Medicaid dictates how many hours a person receives. Replacing one 24-hour shift with two 12-hour shifts requires a higher level of care authorization and comes with a steep price tag. Given these limits on the city’s authority, this bill – by simply prohibiting agencies from assigning aides to the authorized 24-hour shifts – fails to replace those shifts with anything. If the bill is enacted, agencies will have to choose between not providing home care to people whose lives depend on it or violating the new law. The process is unworkable because if agencies are fined for not complying, no one wins and the entire industry that serves people who need these services could be destabilized.

The bill, which is fiscally ungrounded, attempts to mandate a fundamental restructuring of home care delivery without securing the hundreds of millions of dollars required to sustain it, relying instead on the unrealistic assumption that New York state will somehow fill the eliminated shifts with split shifts and will also fill a colossal funding gap. Because home care services are financed and regulated through Medicaid at the state level, the city cannot unilaterally impose a 12-hour cap without either depriving vulnerable people of the care they need or triggering massive cost increases that providers have no mechanism to absorb or recoup.

By advancing a mandate without the funding or authority to implement it, Intro. 303 does not solve the inequities in home care; it destabilizes the entire system and puts both workers and the New Yorkers who rely on them at risk. 

Care recipients, some of New York City’s most vulnerable residents, and home health care workers, who bring care, dedication, and professionalism to what is a tremendously demanding job, should not be pitted against one another. Rather than advancing a bill that risks destabilizing the system, the City Council and the Mamdani administration must work in partnership with Albany and key stakeholders on real solutions that both preserve the continuum of care and address the deplorable conditions many workers endure each day.

These reforms should include prohibiting retaliation against home care aides who refuse 24-hour shifts, ensuring workers can report all hours worked without fear of punishment, requiring agencies to promptly submit documentation supporting eligibility for split-shift coverage and enforcing meaningful penalties against those who violate labor protections. Crucially, Albany must also appropriate $460 million in funding to ensure sleep-in home care workers are fairly compensated without compromising the care that thousands of New Yorkers depend on. 

New Yorkers deserve better than false choices and unfunded mandates. We can and must build a home care system that protects workers from exploitation while preserving the dignity, independence and stability of those who rely on care to live in their communities. That means rejecting Intro. 303 and committing instead to thoughtful, coordinated reform that aligns city action with state authority and funding. The stakes are simply too high to get this wrong. For thousands of disabled New Yorkers and the workers who care for them, the path forward must be one of collaboration, investment and common purpose, not disruption and risk.