BY NOELLE RANGRAS
Private equity (PE) firms now control roughly half of the home care sector in New York State, Cornell University researchers said at a conference organised by the university’s Industrial Labor Relations on September 30th.
Researchers from Cornell’s school of Industrial & Labor Relations published a report this June about PE consolidating home care, home health, and hospice agencies. Home care is the largest occupational category in New York State. In 2023, NYS had 566,160 home health and personal care aides, of whom 87% were women, 81% people of color, and 66% immigrants or foreign-born.
Medicaid is the primary payer for home care services. New York State has higher Medicaid long-term-care enrollment and spending than most states, offering a steady revenue source for PE-owned home care agencies. ILR analysts suggest that PE-backed home care agencies in NYS derive most of their home care revenue from Medicaid, with a reported $2.32 billion in 2022, more than 7.6% of the Medicaid home care revenue reported by NYS home care providers that year.
The total amount of Medicaid revenue flowing to PE owned agencies in NYS is projected to rise sharply in 2026, as a PE-backed company has now taken over administration of the Consumer
Directed Personal Assistance Program (CDPAP). In 2025, CDPAP accounted for more than 50% of home care delivery in NYS.
ILR researchers and authors met to discuss the impact defined in the report. Anne Marie Brady, ILR’s Director of Research for Worker Rights and Equity, acknowledged the profit extracted by PE across services for aging and disabled individuals. Researchers, policymakers, and advocates are concerned about the potential negative impact these changes have on the quality of jobs, and the quality of care provided, she said. This included serious issues, such as caregivers who went without pay or were paid incorrectly, limited health coverage for workers, and procurement irregularities.
Kezia Scales, the vice-president of Policy, Research & Evaluation of Protected Health Information (PHI) says that women in home care ”are not treated like real professionals. This severely affects their wages.” Workers often face workplace discrimination as well, Scales said. Aditi Sen, the managing director of campaigns at Americans for Financial Reform Education Fund (AFREF), brought up ties to structural racism dating back centuries. “Conditions in this sector have been abhorrent, both for caregivers and patients.”
With PE acquisition, less funds are being dedicated to employee connection, which means little to no human support. Automation in customer service has led to reports of lack of information on patient conditions, as well as racism and bigotry through patient families, according to Scales. Workers have been unable to connect with support resources. Robin Rowe, the lead project researcher, says that many home care workers described “feeling isolated from the company, and that they were left on their own.”