In 2023, the population of New Yorkers 65 and older reached 1.43 million, increasing by 53% since 2000. This, combined with Medicaid cuts and immigration enforcement, has caused a strain in the state's healthcare and senior care industry.
WAMC's reporter Sajina Shrestha spoke with Stephen Hanse, the president of the New York State Health Facilities Association, to learn about the impact on the Empire State.
INTERVIEW TRANSCRIPT
Editor's note: This conversation has been lightly edited for clarity.
Stephen Hanse: This year in 2026, New York is entering the leading edge of the "silver tsunami," as the first wave of baby boomers turns 80. New York has the fourth oldest population in the country. When this population, back in 1960, was young, there were six working adults for every person over 65. Then in 2020, there were 3.6 working adults for every person over 65. Now the New York State's Master Plan for Aging is predicting that in 2030, just a few years from now, there will only be 2.8 working adults for every individual over 65. New York being fourth in the nation with oldest population, we are also facing a long-term care worker workforce crisis in New York. We don't have enough workers now to provide essential care to those who need skilled nursing services. This situation will only get worse as this tsunami really hits New York and the nation, for that matter.
Sajina Shrestha: Tell me more about that shortage. What's causing it, and what are some ways the New York State and workers are trying to fill that shortage?
Hanse: Prior to the onset of the COVID 19 pandemic, we had a workforce shortage. As we came out of the pandemic, we had a workforce crisis. We saw women and men leave long-term care, leave healthcare, you know, direct caregiving. Right now struggle to recruit and retain staff, and the reason for that really comes down to the Medicaid rate that nursing homes are provided in New York. Approximately 75% of all nursing home residents are supported by Medicaid. And what we see throughout the state of New York is that the state under funds the cost of care for a Medicaid resident by approximately $100 per resident per day. That underfunding causes real obstacles in being able to recruit and retain workers. When out in the labor force, they have other options if they don't have a passion for long-term care.
Shrestha: Long-term care workers using immigrant workers was one of the ways we were plugging that gap, right? What has happened now that there's so many things happening on the federal level of TPS getting cut or visas being revoked?
Hanse: Out of all the states, New York has the highest immigrant population working in healthcare. What we saw in long-term care nursing homes throughout New York, when the TPS status of Haitian workers was eliminated, was the loss of workers in many many nursing homes. These workers are long-term, long-time workers, they have relationships with our residents. They know the care they need, and then all of a sudden, at the end of July, they were unable to work. That has only exacerbated an existing long-term care workforce crisis.
Shrestha: Something that you touched on was Medicaid. Medicaid reminds me of how a lot of people right now, because of rising costs and inflation, are struggling with a bunch of different bills. On top of that, I wonder how the tsunami impacts New Yorkers who are hoping to make sure that their parents, their aging parents, are taken care of?
Hanse: They have to go to work, and ideally, folks want to be able to age in place. In many instances, you have younger generations providing care for those that that that silver tsunami, those baby boomers who are in their 80s now, and it's difficult, if not impossible.
They have one job, two jobs, multiple jobs that they have to attend to while providing care for their friends and loved ones. Secondly, many individuals get to the point where their clinical needs cannot be met at home,. They have to enter into a nursing home because their acuity is such that they cannot receive care at home. And then we run into the situation of what we talked about, in 2030 there are only going to be 2.8 working adults. For every individual in New York State over 65 years old, that really thins out. The older we get, it affects the ability to care for someone at home. It affects the ability to have a workforce in nursing homes to care for our elderly population. So these are issues that need to be addressed now, and we are working with Governor Hochul. We are working with the legislature to recognize these issues, to educate policymakers on the impacts that this tsunami is having on our aging population and the workforce that is needed and essential to provide care for this population.
Shrestha: The "senior tsunami" is not unique to United States. We've seen a growing aging population in Japan and South Korea. Could you talk more about what those countries are doing that you are seeing that we could possibly bring over to how we deal and how we manage our growing aging population?
Hanse: New York and Japan and South Korea are all experiencing significantly increasing populations over 65 years old. Right now, almost 20% of New York's population is over 65. South Korea, just over 20%, and in Japan, over 29% of the population is 65 or older.
That's actually the highest of any major economy in the world. New York, Japan, South Korea, we're all struggling with this this aging population, and what we we also all have in common is that you have the pool of working-age people shrinking.
So they're really looking at different dynamics. What can be done?
Many places are looking at the ability to age in place, the ability to provide care in the home, but what we see is the inability.
Japan is struggling with that, New York is struggling with that, and really those struggles come down to the clinical needs of the resident. We all want to be able to age at home, but sometimes it just doesn't get to the the clinical needs are such that they need to be in a skilled nursing facility. So we have this aging population in common, and are trying to get creative to to how to deal with this. But the common denominator in all three in New York, in Japan, and in South Korea, is investment in the long-term care apparatus, if you will. You know the services and supports provided to our aging population, and then really having the workforce, that is a tremendous struggle that that we're all facing. We don't have the workers. There's a declining population of working adults to provide care for our aging seniors.
