Standing in a grocery store with a cart full of food, Diane Gotebiowski got a call from her 89-year-old father: “Your mother’s on the floor and she’s bleeding from her head. What should I do?”
Gotebiowski was 30 miles from her parent’s home in Catskill, New York, but she dispatched her husband who was nearby. Her mother turned out to be fine, but it was a reminder of how tenuous their home care arrangements are.
All day long, Gotebiowski checks her phone to monitor her 87-year-old mother through remote cameras and a bed sensor, just until she can get there after driving 42 miles from work. A shortage of home health aides in Greene County, New York, has left the family with few options. Hospice provides one hour of care a day. They help Gotebiowski’s mother get out of bed and get dressed, but that’s not enough.
“If she sat at a table and someone placed breakfast in front of her, it would not get eaten,” Gotebiowski said. As she continues to age, her care needs will increase, “and that frightens me.”
Addressing the caregiver workforce crisis is one of the priorities of the New York Master Plan for Agingcurrently under formation by the New York State Health Department in coordination with the Department of Aging. Other pillars of the plan will address housing, poverty, lack of access to services in rural and communities of color, technological services, elder abuse, social isolation and the financial instability of health care facilities.
California, Colorado, Texas, Minnesota and Massachusetts also have implemented master plans for aging. Nine other states are in the early stages of strategizing.
Instituted by an executive order from the governor’s office last year, New York’s master plan is a sign that the state, with a senior population of 3.2 million and growing, is planning for the surge in older citizens.
“In 10 years, one 1 out of every 4 New Yorkers will be over age 60,” said Adam Herbst, deputy commissioner for the Health Department’s Office of Aging and Long Term Care. “What that means is a tremendous shift in everything,” he said, "our communities, our economy, our budget, how we value our families, so many significant things.”
To obtain input from every region, the state is hosting town hall meetings, beginning with one last month in New York City, with others on July 11 in Albany and July 12 in Plattsburgh. Additional meetings are expected to take place in the western and northern parts of the state.
The need to plan is prescient, as the youngest baby boomers will be reaching retirement age in six years. By 2030, more than 20% of the U.S. population will be over age 65. While California launched the country’s first Master Plan for Aging in 2021, New York has been on the forefront of age-friendly policies for decades.
In 2010, the World Health Organization named New York City the first of more than 1,400 age-friendly cities.
“We started with small things, like putting benches near grocery stores and possibly giving the aging places to sit inside the store to rest, and slowing the time for crosswalk signals on some streets,” said architect Edward Mills, who served on the Age-Friendly New York City Commission organized by Mayor Michael Bloomberg’s office to meet the WHO’s age-friendly qualification.
WHO’s recommendations include accessibility improvements for buildings, transportation and housing. Its age-friendly cities are more likely to have clean, well-maintained green spaces with adequate toilet facilities; pedestrian-friendly walkways; outdoor seating; smooth, well-maintained pavements; sufficient pedestrian crossings; and street lighting.
Mills concedes that New York City already had a lot of those features, which might have helped it earn age-friendly status so quickly.
It was the pandemic, however, that pushed the state to take a hard look at what its agencies could be doing to make it easier for people to age in their communities. Of the nearly63,000 New Yorkers who have died from COVID-19, an alarming 87% were over the age of 60.
Gov. Kathy Hochul kicked off the master plan with an executive order in 2022. Stakeholders convened this year to draft the plan. A preliminary report will be made public later in July, with the final report due in January 2025.
In a June town hall meeting at Hunter College, Herbst presented an outline of the plan and took questions from the audience. Wendel Walters, policy advocate from the Osborne Center for Justice Across Generations, asked if it would include reentry support for older adults being released from correctional facilities, where aging can be accelerated. Greg Lynch from the Suffolk County Public Health Department asked how the plan would address the needs of the aging LGBTQ community, “and if so, where will you source the information for making those programs.” Charity Munson, director of Hospice & Home Care at Parker Jewish Institute for Health Care and Rehabilitation on Long Island, made a passionate plea for the plan to include educational grant programs like the one that allowed her to become a registered nurse.
“I was one of those kids who was on welfare, and I didn’t have the resources to enter the health care force,” she said. ”With stipends, I could eat and afford transportation to go to classes, and afterwards I had a job waiting for me.”
Programs to increase the number of nurses, nurses' aides and caregivers are a hallmark of California’s plan, which has been in effect since 2021. Many more such programs will be needed to address the demand for home care that already exists and will grow exponentially in the coming decades.
“As our diverse population continues to age, we’re aware of the physical and emotional demands placed on caregivers, compounded by the lack of training and opportunities for career advancement,” said Susan DeMarois, director of the California Department of Aging.
Home health aides are essential to helping people age at home, which is where most seniors would prefer to stay. But that workforce historically has been untrained and underpaid, leading to turnover. With aides in short supply, caregiving duties fall to family members — as Diane Gotebiowski has experienced in trying to juggle a full-time job and caring for her mother.
To increase the workforce, the California Legislature this year awarded more than $87 million to organizations training caregivers, and for stipends to offset pay while caregivers participate in training courses.
At a June stakeholders meeting for the New York plan, proposals to address the workforce crisis included establishing caregiver training programs for asylum seekers and offering tax relief for older adults who move to smaller homes.
The plan is a blueprint and does not come with funding or the muscle to enact policy. But Herbst pointed out that its initiatives benefit a population with political heft.
“The data will show that older populations are the ones who come out in large numbers to vote,” he said. “They're the ones who are the drivers of our state's economy.”
The Albany town hall meeting will be from 10 a.m. to noon Tuesday, July 11, at The College of St. Rose, St. Joseph Hall, 985 Madison Ave. The Plattsburgh meeting will be from noon to 2 p.m. Wednesday, July 12, at Clinton Community College, Stafford Center for Arts and Technology, Stafford Theater, 120 Clinton Point Drive. Both also will be streamed.
Ruth Dusseault is a writer with the Investigative Reporting Program at the UC Berkeley Graduate School of Journalism. She reported this story through a grant from The SCAN Foundation.