Home health aides and their advocates are pushing the City Council to pass legislation that would restrict their hours — a move that is facing pushback from the union that represents them.
The bill, sponsored by Councilman Chris Marte, who represents Lower Manhattan, would limit a home care aide’s shift to 12 hours. It would also cap the total to 50 hours per week.
This would effectively end 24-hour shifts, a practice common in New York City, according to advocates.
Marte said his mother’s background working as a 24-hour home care attendant was a driving force behind the legislation.
“I've been able to, as a child, see the damage it does to someone who's working around the clock, and taking care of the most vulnerable people,” Marte said.
Workers assigned to 24-hour shifts are only paid for 13 hours, according to state law. It’s based on the idea that aides will get eight hours of sleep, at least five of which is uninterrupted, and three hours for meals.
But this is often not the case, according to home care aides and advocates who support the bill.
Leslie Palacio, who lives in the Bronx, has worked as a home health aide for the past 13 years.
She said she’s had to skip meals and often has not been able to sleep during the 24-hour shifts. She has sometimes worked these shifts four or five days in one week.
“You can't even bat an eye,” Palacio said in Spanish through a translator. “The patient is screaming their head off at night and you have to attend to their every need.”
The politically powerful union that represents home health aides, SEIU Local 1199, said in a statement that they support Marte’s efforts “to end this exploitative practice” of the 24-hour shift.
However, the union said they do not support the bill in its current iteration without additional funding through the state Medicaid program, which would pay for the increase in home health aides to fill the gap in care.
“Without funding, managed care plans and providers — the vast majority for-profit — will have a powerful financial incentive to abandon the highest need consumers, moving them to nursing homes where Medicaid pays fee for service,” Helen Schaub, interim political director of Local 1199, said in a statement.
It’s a concern that those receiving home care, such as T.K. Small, who has a neuromuscular condition called spinal muscular atrophy, also share.
Small requires 24-hour care and currently utilizes the “split shift” model of two aides working 12-hour shifts.
But he said the current iteration of the bill is too broad in its limitations and would create an undue burden on people requiring intensive care such as himself, particularly with the weekly cap of 50 hours.
For instance, one of his aides has recently requested to travel to Trinidad. To fill the gap, he’s scheduled another worker who will have to work more than 50 hours, he said.
“I can't tell my worker who’s going to Trinidad ‘you can't go,’ ” Small said. “If I did that, I'd be a bad guy.”
Small’s fear, including others who receive care and testified at a Committee on Civil Service and Labor hearing earlier this month, is that these limitations would effectively force them into nursing care facilities to get the care they need.
Opponents of the bill also argue that, in some cases, 24-hour live-in care is necessary for patients.
“There are often times that for both the attendant and the individual patient, the relationship for a live-in approach to care really works out the best,” Al Cardillo, president of the Home Care Association of New York State, said.
A patient may feel uncomfortable with more than one person in their home in a 24-hour period, such as when a person suffers from dementia and could become confused or fearful when new aides are introduced into the home. There’s also instances when patients require culturally or linguistically compatible aides in order to communicate effectively, which could again make it harder to find several people who fit the bill, Cardillo said.
He also said the bill would exacerbate a shortage of home health aides.
“If you need two individuals to provide for the needs that one individual would otherwise be able to do, you're greatly increasing the risk that some individuals will not be able to be served and that they will have to be referred for admission to facilities, which we are committed to trying to avoid really at all costs,” Cardillo said.
The hourly minimum wage for home care aides is $15 in New York City, Long Island and Westchester and $13.20 in other parts of the state. On October 1, the hourly minimum wage for home care aides will increase by $2.
Cardillo said he would like to see more competitive compensation and additional support for home health aides. He said legislation on the state level, such as the New York Home Care First Act, which his organization has lobbied for in the past, would reimburse people for transportation-related costs, child care assistance and peer support.
Creating a more robust workforce through these types of measures should be a priority to fix the issues plaguing the home care aide field, Cardillo said.
“If you only take one component like the number of hours that are worked or the wages that are worked, you're not really addressing the full body of the policy and the response that's necessary, really, to support the system,” Cardillo said. “You really have to respond in this more comprehensive way.”
But the New York Home Care First Act failed to pass in the last legislative session in Albany. Cardillo said his organization plans to lobby for the bill again in the next session, which begins in January.
Marte and other supporters of the City Council bill believe that if New York City takes action, it would help move Albany to pass further legislation protecting workers.
A vote has not been scheduled for the bill.
In the meantime, Marte said his office is continuing to discuss the bill with stakeholders, including the union. He also said there could be changes to the policy as it stands as a result of these conversations, including the 50-hour weekly cap.
“We want to make sure that people understand and have the right education of what this bill actually is going to do before we move forward,” Marte said.