Public Hearing - July 27, 2021

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 1      BEFORE THE NEW YORK STATE SENATE
        STANDING COMMITTEE ON AGING,
 2      STANDING COMMITTEE ON HEALTH,
        AND
 3      STANDING COMMITTEE ON LABOR
        ----------------------------------------------------
 4
                       JOINT PUBLIC HEARING:
 5
                NURSING HOME, ASSISTED LIVING, AND
 6        HOME CARE WORKFORCE – CHALLENGES AND SOLUTIONS

 7      ----------------------------------------------------

 8                                 Van Buren Hearing Room A
                     Legislative Office Building, 2nd Floor
 9
                                   Date:  July 27, 2021
10                                 Time:  9:00 a.m.

11

12      PRESIDING:

13         Senator Rachel May, Chair
           NYS Senate Standing Committee on Aging
14
           Senator Gustavo Rivera, Chair
15         NYS Senate Standing Committee on Health

16         Senator Jessica Ramos, Chair
           NYS Senate Standing Committee on Labor
17

18      PRESENT:

19         Senator Brian A. Benjamin

20         Senator George M. Borello

21         Senator Shelley B. Mayer

22         Senator Peter Oberacker

23         Senator Susan J. Serino

24

25







                                                             2
 1
        SPEAKERS:                               PAGE  QUESTIONS
 2
        Meghan Parker                             15      33
 3      Director of Advocacy
        New York Association on
 4        Independent Living

 5      Jim Clancy                                15      33
        Sr. Vice President for State Policy
 6
        Dora Fisher                               15      33
 7      Director of Post-Acute and
          Continuing Care Services
 8      Healthcare Association of
          New York State
 9
        Lisa Newman                               15      33
10      Executive Director
        Empire State Association of
11        Assisted Living

12      Stephen B. Hanse                          65      74
        President & CEO
13      Lisa Volk                                 65      74
        Director, Clinical & Quality Services
14      Tarrah Quinlan                            65      74
        Director, Education Program
15        Development & Member Operations
        NYS Health Facilities Assoc.,
16        and New York State Center for
          Assisted Living
17
        Eugene Hickey                             97     103
18      Secretary-Treasurer
        Francine Streich                          97     103
19      Field Direction
        UFCW, Local 2013 (Brooklyn, NY)
20
        Grace Bogdanove                          122     136
21      Vice President, Western New York
          Nursing Home Division
22      William Roe                              122     136
        Licensed Practical Nurse
23      Tonya Blackshear                         122     136
        Certified Nursing Assistant
24      1099 SEIU, United Healthcare
          Workers East
25







                                                             3
 1
        SPEAKERS (continued):                   PAGE  QUESTIONS
 2
        Sarah Daly                               163     178
 3      Government Relations Analyst
        LeadingAge New York
 4
        Michele O'Connor                         163     178
 5      Legislative & Policy Director
        Argentum/Argentum NY
 6
        Doug Wissman                             163     178
 7      Board Member
        Greater New York Health Care
 8        Facilities Association

 9      Dallas Nelson, MD                        187     196
        NY Medical Directors Association
10
        Diedre Gilkes, RN                        187     196
11      NY State Nurses Association

12      Hannah Diamond                           210     224
        State Policy Advocacy Specialist
13      PHI

14      Maria Alvarez                            210     224
        Executive Director
15      Statewide Senior Action Council

16      Lindsay Heckler, Esq.                    210     224
        Supervising Attorney  Center
17        for Elder Law & Justice

18      Agnes McCray                             248     259
        Board President of ARISE,
19      Human Rights Advocate, and
          Home Care Consumer
20
        Marcella Goheen                          248     259
21      Founder of EssentialCareVisitor.com

22      Rona Shapiro                             264     279
        Executive Vice President,
23        Home Care Division
        Lilieth Clacken                          264     279
24      Home Health Aide
        1199 SEIU, United Healthcare
25        Workers East







                                                             4
 1
        SPEAKERS (continued):                   PAGE  QUESTIONS
 2
        Jason B. Brooks                          264     279
 3      Personal Care Assistant
        Healthcare Workers Rising
 4
        Martha Davila                            264     279
 5      Home Care Attendant

 6      Ilana Berger                             296     314
        Coordinator
 7      New York Caring Majority

 8      A reader for Sandra Moore Giles          296     314
        Senior Home Care Consumer
 9
        Sandra Abramson                          296     314
10      Family Caregiver

11      Mildred Garcia Gallery                   296     314
        Ageless Companions
12
        Mary Lister                              320     330
13      Home Care Worker
        A Founding Member of the
14        Queens City Workers Center

15      Ignacia Reyes                            320     330
        Home Care Worker
16
        JoAnn Lum                                320     330
17      Mobilization Against Sweatshops
        Ain't I a Woman/! Campaign
18
        Carlyn Cowen                             343    350/366
19      Chinese-American Planning Council

20      Rebecca Preve                            353     366
        Executive Director
21      The Association on Aging in New York

22      Tara Klein                               353     366
        Senior Policy Analyst
23      United Neighborhood Houses

24      Melissa Wendland                         375
        Director of Strategic Initiatives
25      Common Ground Health







                                                             5
 1
        SPEAKERS (continued):                   PAGE  QUESTIONS
 2
        Claire Pendergrast, MPH                  375
 3      Syracuse University Lerner Center
          for Public Health Promotion
 4
        Bryan O'Malley                           384
 5      Consumer Directed Personal Assistance
          Association of NYS
 6
        Heidi Siegfried                          384
 7      Health Policy Director
        Center for Independence of
 8        the Disabled, NY

 9      Tania Anderson                           384
        CEO
10      ARISE

11      Jeanne Chirico                           400     414
        CEO and President
12      Hospice and Palliative Care
          Association of New York State
13
        Kathy Febraio                            400     414
14      President and CEO
        NYS Assoc of Health Care Providers
15
        Al Cardillo                              400     414
16      President & CEO
        Home Care Association of NYS
17
        Dana Arnone, RN                          417
18      Owner
        Reliance Home Senior Services
19
        Honorable Christine Pellegrino           417
20      All Things Home Care, Inc.

21      Faigie Horowitz                          417
        Caring Professionals, Inc.
22
        Jim Hurley  Home Instead Senior Care     417
23
        Christie Johnston                        437
24      NY Coalition of Downstate
          Homecare Agencies/Premier Home
25        Health Care







                                                             6
 1
        SPEAKERS (continued):                   PAGE  QUESTIONS
 2
        Matthew Hetterich                        437
 3      Administrator
        Gurwin Certified Home Health Agency
 4
        Veronica Charles                         437
 5      Director of Government Affairs
        Maxim Healthcare Services
 6

 7                            --oOo--

 8

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25







                                                             7
 1             SENATOR MAY:  Good morning.

 2             Hi, everybody.

 3             Welcome to our first in-person hearing in,

 4      what, like 18 months?

 5             It's amazing.

 6             So I am Senator Rachel May.  I am the chair

 7      of the Senate Aging Committee.

 8             And I am thrilled to welcome everybody here

 9      to this hearing on workforce challenges in

10      long-term care settings, including nursing homes,

11      assisted-living sites, and in-home care settings.

12             I am joined by my colleagues, Gustavo Rivera,

13      chair of Senate Health Committee; and Jessica Ramos,

14      the chair of the Senate Labor Committee; and as of

15      now, by two additional senators, Senator Borello and

16      Senator Serino, who are both on the Aging Committee

17      as well.

18             Today's hearing will be an opportunity for us

19      to provide -- to hear from providers of long-term

20      care, both institutions and the care workers

21      themselves, as well as many who have dedicated their

22      efforts to understanding, and improving, long-term

23      care in New York State.

24             Anyone with even a glancing familiarity with

25      this issue knows there is a crisis in our state.







                                                             8
 1             Critical shortages of workers plagued the

 2      home care and nursing care industries well before

 3      the pandemic.

 4             And the situation only got worse under the

 5      pressures of COVID-19, from the need for infection

 6      control, to the closing of childcare facilities, and

 7      the health care -- health toll the virus took on

 8      health-care workers themselves.

 9             At the same time, New York also dealt this

10      sector a blow by cutting Medicaid allocations; and

11      just this month, by raising the minimum wage upstate

12      for fast-food workers, but not for home care

13      workers.

14             We know there is a crisis.

15             We are deeply grateful to everyone coming

16      forward today who is trying to solve it.

17             We want to learn from you about anything you

18      have tried that works, any unnecessary barriers you

19      faced to providing excellent care, and about any

20      measures we can take to improve recruitment and

21      retention of this critical workforce.

22             Before I give my colleagues an opportunity to

23      say a few opening words, I'd like to go over some

24      housekeeping items; and, also, thank those who

25      helped to organize and coordinate this effort,







                                                             9
 1      including Senate event staff; and my staff,

 2      Zach Zeliff, Kristin Williams, and Eric Vandervort,

 3      and particularly my aging policy director,

 4      Ingrid Gonzalez-McCurdy, who just joined our team in

 5      March, and has jumped in with both feet to make this

 6      hearing a success.

 7             Those testifying today have been grouped on

 8      small panels, and are listed on the witness list,

 9      which is available at, the back table?  I'm not sure

10      where -- somewhere, you can find it in this room.

11             We will call witnesses down by panel.

12             We encourage them to keep their remarks

13      brief, with an absolute limit of five minutes, so

14      that we can have time for questions.

15             We have many people expecting to testify, and

16      expect a full day.

17             We will hear testimony from now until noon,

18      and then we'll take a break, and return for the

19      second part of the hearing.

20             Written testimony that has been shared to our

21      offices will be added to the archived hearing event

22      on the Senate website, and should be available for

23      public viewing soon after the hearing.

24             Today's hearing is also being live-streamed

25      on the nysenate.gov website.







                                                             10
 1             I will now turn it over to our Health chair,

 2      Senator Gustavo Rivera.

 3             While he does that, let me ask the first

 4      panel to come down and get start -- get settled.

 5             If you know who you are, that's

 6      Meghan Parker, Dora Fisher, Jim Clancy, and

 7      Lisa Newcomb.

 8             SENATOR RIVERA:  Thank you, Senator May.

 9             I will be very brief.

10             Thank you for being here.

11             It is a pleasure to actually see people in

12      person again.  And I'm hoping that this means that

13      we will be doing these going forward.

14             I'm looking forward to hearing from everyone

15      today.  We understand the great pressure that

16      workers in the health-care field, particularly in

17      these types of settings, have under normal

18      circumstances.  And the pandemic only made it worse.

19             So I'm certainly looking forward to all the

20      inputs that we will have today, and we have a long

21      one, since we have two hearings back to back.

22             I'm here to back up my two colleagues.

23             Very happy to be back here, and looking

24      forward to what the day will bring.

25             Thank you, Senator May.







                                                             11
 1             SENATOR RAMOS:  Good morning, everybody.

 2             (Speaking Spanish.)

 3             My name is Jessica Ramos.  I am the

 4      New York State senator representing District 13 in

 5      Queens.  I also have the honor of chairing the

 6      Labor Committee in the New York State Senate.

 7             I'm very excited about today's hearing

 8      because I think, by and large, there is a societal

 9      indifference to a workforce that is largely Black,

10      Latino, women, and who are often taken advantage of,

11      and are paid low wages, and, very often, lack

12      dignity on the job.

13             So I'm eager to hear stories from both the

14      industry, from workers, and from everyone who will

15      being testifying today, just about the lack of

16      investment that our state has made in long-term

17      care, in assisted living, in our nursing homes, for

18      certain.

19             I think we can all agree that the pandemic

20      really peeled back the onion, layer by layer,

21      showing us just how much work there is to do in this

22      sector so that everyone can be taken care of in a

23      better way.

24             You know, as probably one of the youngest

25      senators, I very much care about how my parents and







                                                             12
 1      the rest of their generation will be taken care of

 2      as more of our baby boomers age day by day.

 3             And, hopefully, establishing a better

 4      standard by the time we reach that stage.

 5             And that's, I think, what this is really

 6      about: making sure that New Yorkers, generation

 7      after generation, feel taken care of; and that the

 8      workforce, those who are caring for us, are paid

 9      living wages, and treated with dignity and respect

10      on the job.

11             I want to thank my colleagues for co-chairing

12      this hearing with me.

13             And I want to thank all of the Senate staff,

14      and my legislative director, Nathan Burger, who's

15      here with me today.

16             Thank you.

17             SENATOR MAY:  Thank you, Senator Ramos, for

18      making us baby boomers feel ourselves aging day by

19      day.

20                [Laughter.]

21             SENATOR RAMOS:  I love you so much.

22             SENATOR MAY:  We have the ranking member of

23      the Aging Committee here, Senator Serino, who would

24      like to say a few words.

25             SENATOR SERINO:  Thank you very much,







                                                             13
 1      Senator May.

 2             SENATOR BORELLO:  Oh, we're back to the

 3      microphones not necessarily working.

 4             SENATOR RIVERA:  Oh, memories.

 5             SENATOR SERINO:  This one is working.

 6             Okay.

 7             So I just want to say thank you, Senator May,

 8      and Senators, for having this hearing today.

 9             You know, as we all know, the workforce

10      shortage that we're seeing across the care continuum

11      is a public health emergency.  And we know it is

12      only getting worse as our population ages.

13             And I've heard from too many neighbors who

14      cannot access quality care simply because of a lack

15      of staff, both in home care and in residential

16      health-care settings.

17             So I'm really looking forward to hearing from

18      the witnesses today.  I think it's going to be a

19      great day.

20             And I just had a question.

21             I don't see the Department of Health on our

22      list.

23             Were they invited today?  Do you know?

24             SENATOR MAY:  I don't remember.  I don't

25      think they were invited.







                                                             14
 1             We decided that this was really about hearing

 2      solutions coming from outside the department, so

 3      that we could give a report to the department.

 4             SENATOR SERINO:  Oh.  Because they just have

 5      such a huge part to play in this.

 6             I'm just kind of surprised that they're not

 7      here with us today; a little disappointing.

 8             But, thank you.

 9             I look forward to hearing from everyone

10      today.

11             SENATOR MAY:  Senator Borello, do you want to

12      say a few words?

13             SENATOR BORELLO:  Sure.

14             First of all I want to say, thank you very

15      much for having this hearing.  I'd like to thank my

16      colleagues for this.

17             I think this is an incredibly important

18      issue.

19             Now, I represent some of the most rural areas

20      of New York State.

21             We already have staffing shortages.  And we

22      have an administration that has, for nine years in a

23      row, cut Medicaid reimbursements.

24             So we're asking for more pay for employees,

25      which they deserve, while we're cutting







                                                             15
 1      reimbursements.

 2             We have already seen the impact of that, and

 3      we are going to continue to see that if we don't

 4      address this issue, and understand the cause and

 5      effect.  Things don't happen in a vacuum.

 6             And I'm hopeful that this panel will shed

 7      some light on the real challenges: the people that

 8      are caring for our most vulnerable citizens need our

 9      support.

10             We saw cuts to Medicaid reimbursements, but

11      we had massive increases in a budget that was a

12      record-breaking $215 billion, and yet we cannot

13      support our most vulnerable citizens and the people

14      that care for them.

15             So I look forward to hearing from you, and

16      what solutions we may be able to come up with to

17      help you, rather than hinder you, because, right

18      now, the State's mostly in the hindering business,

19      and not in the helping business, when it comes to

20      caring for our most vulnerable citizens.

21             Thank you.

22             SENATOR MAY:  All right.  Thank you.

23             With that, we will start with our first

24      panel.  And I will let you introduce yourselves.

25             So, beginning with Meghan Parker.







                                                             16
 1             MEGHAN PARKER:  Is this on?

 2             SENATOR MAY:  Yes.

 3             MEGHAN PARKER:  Okay.  Great.

 4             Good morning.

 5             Hi.  My name is Meghan Parker.

 6             Thank you for the opportunity to testify here

 7      today on behalf of the New York Association on

 8      Independent Living, or "NYAIL."

 9             And thank you for squeezing me in at the

10      beginning of the hearing so I could testify.

11      I appreciate it.

12             NYAIL and our member independent living

13      centers provide and orient services that help people

14      to live as independently as possible in their

15      community, and to transition them from nursing

16      homes.

17             At the statewide level, NYAIL coordinates a

18      couple of programs, including the Money Follows the

19      Person-funded Open Doors program, which staffs a

20      team of transition specialists across the state that

21      actually go into nursing homes and help people

22      transition back into the community.

23             We also coordinate the Olmstead housing

24      subsidy and rapid transition program, two rental

25      subsidy programs that help people leave







                                                             17
 1      institutions, and provide them with supportive

 2      services and assistance with locating accessible

 3      housing.

 4             And what I keep hearing from people who run

 5      these programs, and people across the state, is,

 6      more and more, increasingly, they work with people,

 7      they line them up with all the necessary supports

 8      and services they need to transition.  They actually

 9      find them an accessible apartment in the community,

10      no easy feat; have a lease and everything.  And then

11      people are unable to leave because they cannot line

12      up home care.

13             So, you know, nurse -- independent living

14      centers have been helping people, for a long time,

15      transition from nursing homes.  And there has long

16      been a shortage in certain regions of the state in

17      getting home care.

18             But, in recent years, it has really increased

19      dramatically so that it's now an acute crisis, from

20      Long Island to Buffalo, with no regions in between,

21      really, avoiding this crisis.

22             This -- there are a number of ways in which

23      this is problematic, including the State having an

24      obligation under the Supreme Court's

25      1999 Olmstead v. L.C. decision, which affirmed







                                                             18
 1      that people with disabilities and seniors have the

 2      right to live and receive services in the most

 3      integrated setting, their home communities.  And, of

 4      course, being able to access home care is a

 5      necessary component of that.

 6             And so this crisis has only increased.

 7             And in my written testimony, I do go through

 8      various ways in which people who provide the

 9      services outlined, that they used to be able to use,

10      to help get the harder-to-serve people out of

11      institutions and access home care, including they

12      used to sometimes, for harder-to-serve people, be

13      able to access like an enhanced rate.

14             So, for example, if someone lived in a rural

15      area, and they had trouble getting home care workers

16      to come out, their MLTCs might approve an enhanced

17      rate to serve that person.  But that really no

18      longer exists, the problem is too widespread.

19             I don't have time to go into all the

20      barriers, but, you know, we're also seeing a much

21      heavier burden being put on family members, to be

22      backups, as there are no available home care workers

23      to show up in the inevitable event that someone

24      doesn't show up for their shift.

25             We're finding, more and more, that when







                                                             19
 1      people apply for traditional home care, they are

 2      told that they're either going to have to wait

 3      months and months to get home care, or go into the

 4      Consumer Directed Personal Assistance program

 5      (CDPA), you know, basically, shifting the

 6      responsibility to consumers to find and recruit

 7      their own aides.  And this is not an appropriate

 8      option for everybody.

 9             And the longer somebody is in an institution,

10      the more isolated they become.

11             And so they really don't have the same

12      community supports.

13             And, of course, CDPA really is a program that

14      kind of relies heavily on family members who are

15      willing to provide these services for the paltry

16      wages provided.  And so it becomes a barrier,

17      especially the longer someone is in, to them being

18      able to transition back out.

19             This wasn't always the case.

20             Back in 2006, home care workers earned about

21      150 percent of minimum wage.  And this is the time

22      when it was much easier to locate home care workers;

23      it was much more readily available.

24             But in recent years, as the minimum wage has

25      gone up, as has wages in other sectors, home care







                                                             20
 1      workers now make minimum wage.

 2             And as Senator May rightly pointed out at the

 3      beginning, as of this month, in all the counties

 4      north and west of Westchester, home care workers

 5      make $2.50 less an hour than they would make if they

 6      were working in a fast-food restaurant, which is

 7      only going to compound this crisis because, of

 8      course, providing home care is physically and

 9      emotionally demanding work.

10             And why would somebody keep doing it if they

11      could have a much less stressful job and make

12      significantly more an hour doing something else,

13      like working at a fast-food restaurant.

14             SENATOR MAY:  Sorry, but I need to interrupt

15      you because you're after your five-minute limit.

16             Can you close -- wrap up really quick?

17             MEGHAN PARKER:  Okay.  Let me just wrap up

18      real quick, and say:  That the answer to the crisis

19      is to enact the Fair Pay for Home Care Act, that

20      Senator May introduced earlier this year.

21             And thank you for your leadership on that.

22             It would increase wages to 150 percent of

23      minimum wage, and take care of the home care crisis

24      over the next few years.

25             My testimony does outline a recent CUNY







                                                             21
 1      report, that goes into the economic-development

 2      benefits of passing Fair Pay for Home Care, as well

 3      as how it would address the crisis.

 4             This is a desperate situation.

 5             People with disabilities are not able to

 6      access home care.

 7             And we just really implore you to take action

 8      in the upcoming budget, and pass Fair Pay for Home

 9      Care, so people are able to access home care in the

10      community.

11             So, thank you.

12             SENATOR MAY:  Thank you.

13             And just as one more housekeeping matter,

14      I believe the witnesses can -- there is a clock that

15      is [indiscernible] from this table, but we can't see

16      it.

17             So Zach will hold up his hand when

18      five minutes are up so that we can know as well.

19             But thank you so much for your testimony.

20             MEGHAN PARKER:  Thank you.

21             SENATOR MAY:  And we have Dora Fisher next.

22             JIM CLANCY:  Hi, good morning, Senator.

23             My name is Jim Clancy.  I work with

24      [inaudible].

25             SENATOR MAY:  Oh, okay.







                                                             22
 1             JIM CLANCY:  We both represent HANYS.  So if

 2      that's okay, I'll start.

 3             SENATOR MAY:  That's fine.

 4             JIM CLANCY:  The mic is on?

 5             SENATOR MAY:  Yes.

 6             JIM CLANCY:  The mic is on.

 7             Good morning, Chairs May, Rivera, Ramos, and

 8      the committee members.

 9             We appreciate this opportunity here this

10      morning.

11             I'm Jim Clancy, senior vice president for

12      state policy at the Healthcare Association of

13      New York State, representing not-for-profit

14      hospitals, health systems, and post-acute-care

15      providers across New York.

16             I'm joined with my colleague -- by my

17      colleague, Dora Fisher here, the director of

18      post-acute and continued care services for HANYS.

19             Again, thank you for this opportunity.

20             Recruiting and retaining a robust

21      long-term-care workforce in New York has been a

22      challenge for many years.

23             Those who come -- those who become

24      long-term-care providers desire to provide

25      compassionate, quality care; however, the physical







                                                             23
 1      and psychological demands, coupled with financial

 2      limitations, can inhibit career growth and drive

 3      high turnover.

 4             The COVID-19 pandemic has certainly

 5      exasperated that problem.

 6             Staff turnover in nursing homes had reached

 7      alarming heights long before the pandemic, with

 8      average turnover rates in 2017-18 nearing

 9      94 percent.

10             Earlier this year, the State enacted several

11      measures aimed at staffing in nursing homes.

12             These include, mandated that nursing homes

13      direct a minimum of 70 percent of their revenue

14      toward direct resident care, and maintain average of

15      at least 3.5 hours of nursing-care resident per day.

16             These new policies do not address the

17      underlying issue of chronic Medicaid underfunding,

18      which is the primary driver and root cause of

19      long-term-care workforce challenges, including

20      shortages and high turnover rates.

21             Over 70 percent of New York's nursing home

22      resident care is paid for through Medicaid, which

23      currently reimburses hospitals and their

24      long-term-care providers an average of 67 cents per

25      dollar spent on care.







                                                             24
 1             According to a recent analysis conducted by

 2      Hansen Hunter & Company, the nursing home Medicaid

 3      shortfall in New York State totals $64 per resident

 4      per day.

 5             When annualized, that Medicaid shortfall for

 6      New York's nursing homes total an estimated

 7      $1.5 billion in 2017.

 8             Roughly two-thirds of New York public and

 9      not-for-profit nursing homes deliver care on

10      negative operating margins.  The median operating

11      margin in these homes is negative 2.9 percent.

12             To make matters worse, the current fiscal

13      year's enacted state budget estimated 200 million

14      nursing home Medicaid rate reduction on top of a

15      1.5 percent across-the-board Medicaid cut the year

16      before.

17             HANYS is committed to working with state

18      government and all health-care stakeholders as we

19      pursue our common goal: ensuring nursing homes are

20      able to provide the highest quality of care, and

21      support the first-rate workforce.

22             Toward that aim, HANYS recommends the

23      following actions to ensure nursing homes are

24      equipped to address the state's long-term-care

25      workforce challenges, and maintain a continued







                                                             25
 1      access to high-quality, safe nursing home care:

 2             First:  Enhance Medicaid reimbursement paid

 3      to nursing homes to cover full cost of staffing.

 4             Delivering quality care, and maintaining

 5      adequate staffing levels, starts with ensuring

 6      nursing homes have the necessary resources to cover

 7      the full cost of recruiting, training, and retaining

 8      staff.

 9             Second:  Support workforce training programs

10      and career ladders.

11             Workforce training programs are critical to

12      increasing recruitment, ensuring staff can meet the

13      needs of the population, increasing the number of

14      individuals who are likely to pursue careers in

15      health care, and building skills for those who have

16      already begun work in health care.

17             The career ladder is an important piece of

18      building and retaining a quality long-term-care

19      workforce.

20             These pathways must be reinforced and

21      supported to enable staff to grow professionally,

22      and ensure nursing homes can retain their

23      high-quality staff.

24             Three:  Support apprenticeship programs and

25      other innovative workforce models.







                                                             26
 1             Apprenticeship programs have proven

 2      successful in New York State, where workers receive

 3      the combination of classroom and on-the-job

 4      training, as well as receiving college credits

 5      centered on nursing home life.

 6             HANYS recommends State support to enable

 7      development of additional apprenticeship

 8      opportunities across the state, through the 1115

 9      Medicaid waiver, the Department of Labor, or other

10      programs.

11             And, four:  Advance regulatory relief.

12             We encourage the Department of Health and the

13      legislature to make permanent key COVID-19 executive

14      order flexibilities, and to further streamline

15      regulatory requirements for long-term-care

16      providers, which would enable nursing home

17      administrators, clinical staff, and other members of

18      the care team to spend their time where it matters

19      most, delivering resident care.

20             In conclusion, HANYS, on behalf of all of our

21      members, thanks you for providing the opportunity to

22      address this urgent matter.

23             We appreciate the support of the legislature,

24      and look forward to continuing the progress we have

25      all made together.







                                                             27
 1             Thank you.

 2             SENATOR MAY:  Thank you.

 3             And do you wish to testify in addition,

 4      Ms. Fisher?

 5             JIM CLANCY:  Did you want to say anything?

 6             DORA FISHER:  Yes, absolutely.

 7             As the director of long-term care for HANYS,

 8      I speak to our nursing home administrators daily.

 9             And I hear how passionately they care about

10      the work that they do, providing care to those who

11      society has forgotten: frail, vulnerable older

12      adults.

13             Our members provide care in both urban and

14      rural settings that -- with high levels of poverty.

15      Across the state, a third of older adults are at or

16      near the poverty level, which means that our members

17      rely on Medicaid reimbursement rates.

18             And, frankly, it is getting very hard for

19      them to maintain and retain staff.

20             And thank you very much for this opportunity

21      to speak.

22             SENATOR MAY:  Thank you.

23             And, finally, Lisa Newcomb.

24             LISA NEWCOMB:  Good morning, Senators, and

25      thank you for this opportunity.







                                                             28
 1             I'm Lisa Newcomb, executive director of the

 2      Empire State Association of Assisted Living, and we

 3      represent more than 300 licensed adult homes,

 4      enriched housing programs, assisted-living

 5      residences, and assisted-living programs across the

 6      state, serving more than 30,000 frail elderly

 7      seniors.

 8             Our members include self-pay, sometimes

 9      referred to in this industry as "private pay."  And

10      I'll have a note on that in a moment;

11             Others serve residents that have little or no

12      income by way of [indiscernible], supplemental

13      security income, or "SSI" payment;

14             And some also have served SSI, and also have

15      the assisted-living program, which is a Medicaid

16      daily rate;

17             And for licensed home care services.

18             Back to that note on self-pay, when it comes

19      to assisted living, I think that there's a

20      perception that the residents living in some of

21      these higher-end, you know, are extremely wealthy

22      with, you know, endless funds.

23             But the overwhelming majority of people that

24      are self-pay have limited incomes.  They are paying

25      from their pensions and from their life savings.







                                                             29
 1      And they are the most price sensitive, you know,

 2      when costs have to be passed along to them.

 3             So I just want to, you know, speak for those

 4      middle people because there's a lot of them out

 5      there.

 6             And in the last 10 years or more, both the

 7      SSI and the [indiscernible] rates have remained

 8      unchanged.

 9             I cite in my testimony report, from PHI,

10      titled "Federal Policy Priorities for the Direct

11      Care Workforce," just some quick stats:

12             From 2019 to 2029, there will be 7.4 million

13      job openings, 6.9 openings -- 6.9 million of those

14      are due to workers transferring to other occupations

15      or exiting the workforce entirely.

16             87 percent are women, 59 percent are people

17      of color, and 27 percent are immigrants.

18             It's fair to say that the recruitment and

19      retention strategies that worked in the past are

20      nowhere near as effective now.  Getting and keeping

21      staff is by far the biggest challenge in our

22      industry.

23             And it's important to note that assisted

24      livings can't close; we are a 24/7 business.

25             So strategies to close for a day or two to







                                                             30
 1      give staff a break are not ones that we can employ.

 2             I polled members, and got a very large return

 3      response, and asked one question:  What is the

 4      number-one most important action that government can

 5      take to increase workforce availability?

 6             The overwhelming majority of respondents said

 7      that, without additional financial resources, they

 8      cannot compete with the continued expanded

 9      unemployment benefits and other government subsidies

10      that incentivize workers to stay at home.

11             So some solutions to that problem:

12             Provide financial resources for wage

13      subsidies.

14             Use tax credits based on length of employment

15      to incentivize them to come and stay in assisted

16      living.

17             Offer loan forgiveness for nurses based on

18      length of employment.

19             Provide transportation incentives, such as

20      half-fare cards.

21             Better patrol the person collecting

22      unemployment, to -- and the point is to incentivize

23      people to work and not not to work.

24             The New York State spending plan for the

25      implementation of the American Rescue Plan of 2021,







                                                             31
 1      with regard to the HCBS funding, because the State's

 2      plan is directed at programs that are an MLTC

 3      benefit, no assisted livings, no ACS, not even our

 4      Medicaid funded out, are targeted to get one penny

 5      of that, and that includes 623 million directed to

 6      the long-term-care workforce for recruitment and

 7      retention, and even to pay for PPE.

 8             So we are completely shut out of all of that

 9      funding.  And we are a huge and growing part of the

10      long-term-care industry, and it's incredulous that

11      there is no funding proposed as part of that plan

12      for us.

13             So we ask, during the next, you know, set of

14      budget negotiations, to support and promote an

15      adjustment to our [indiscernible] rate, as well as

16      our SSI funding.  And we implore the department to

17      direct some of these ARP funds to our residents.

18             Just some other quick recommendations:

19             Immigration reform.

20             Again, 27 percent of direct-care workforce

21      are immigrants.

22             Federal legislation to develop a new visa

23      classification for non-seasonal, non-agricultural

24      workers for jobs that don't require a college

25      degree, any initiatives like this could







                                                             32
 1      significantly expand the pool.

 2             I don't know how much you can do of that at

 3      the state level, but to the extent that you can.

 4             Training reform.

 5             This is nuanced, but allow our enhanced

 6      assisted-living residences which provide aging in

 7      place to be able to operate home health aide

 8      training programs.

 9             It is extreme -- there is an extreme shortage

10      of training programs for certified home health aides

11      and personal care aides.

12             And those that do exist only really want to

13      train their own employees, because they have a hard

14      time, too, finding assistance.

15             So it makes it difficult for our enhanced

16      assisted-living residences to obtain training.

17             A couple of other little things:

18             Allow use of equal for staff benefits.

19             Right now, these approximately 6 million that

20      you provide to those ACFs that serve the indigent

21      cannot be used for staff -- for staffing.

22             Employee bonuses beyond their regular pay

23      should be an acceptable use of these funds.

24             And then, of course, in the long term, the

25      long-term-care educational track, very early on,







                                                             33
 1      in -- beginning in high school.

 2             Thank you.

 3             SENATOR MAY:  Okay.  Thank you.

 4             So the way this will work is, the chairs have

 5      10 minutes for questioning, and everyone else has

 6      five.  But I want to say we have a very long list of

 7      witnesses for the day, so we do not -- should not

 8      feel that we have to use all of that time.

 9             I would like to direct a few questions to

10      these providers, because I'm wondering what you have

11      experienced in the way of turnover rates in

12      staffing, and what that costs the providers, the

13      actual institutions, when staff turns over.

14             Do you have a sense of the cost of turnover?

15             JIM CLANCY:  I can just say, you know, in the

16      testimony, we have, based on numbers from 2017-2018,

17      about 94 percent turnover.

18             SENATOR MAY:  94 percent on...?

19             JIM CLANCY:  Turnover rate.

20             SENATOR MAY:  Every year?

21             JIM CLANCY:  In 2017-2018.  So it's a little

22      dated right now.  But I can't imagine that those

23      numbers are going to get better.

24             LISA NEWCOMB:  No, I mean, I think that we do

25      have some members that -- particularly those that







                                                             34
 1      serve SSI, that experience, that kind of turnover,

 2      as well.

 3             I think right now our bigger problem is

 4      actually recruiting and getting them hired.

 5             You know, retention is, you know, the

 6      responsibility of the employer.  And, you know, if

 7      you're a good employer, you know, you can,

 8      hopefully, not lose them to McDonald's.

 9             But the recruitment, just because they're --

10      you know, they're not there, or they're not willing

11      to do the work, that's the issue.

12             JIM CLANCY:  And we are losing them to

13      McDonald's.

14             SENATOR MAY:  Is there any effort to

15      determine what the main cause is for people to

16      leave?

17             Do you do exit interviews, or that kind of

18      thing?

19             DORA FISHER:  I can speak to this.

20             You know, ageism is endemic to our society.

21      And, these days, you can get a job at Walmart,

22      stocking shelves, for about the same price -- from

23      about the same wages that you can get at a nursing

24      home.

25             And nursing home work is incredibly grueling.







                                                             35
 1             Even if people are excited about aging,

 2      excited about older adults, it's still pretty hard

 3      to swallow, toileting, grooming, all of that kind of

 4      work, when you can just work at Walmart for the same

 5      amount of money, or Dunkin' Donuts.

 6             I think one of the things that Jim

 7      highlighted in his testimony is the need for

 8      apprenticeship and career-ladder programs, because

 9      the key difference between a job at McDonald's and

10      a job at a nursing home should be a career; that you

11      are beginning a career.

12             And so we believe that we need to build that

13      infrastructure.

14             LISA NEWCOMB:  And if I could add, at the

15      managerial level, I think lack of support from the

16      state Health Department really drives some of our

17      best administrators, executive directors, out of the

18      business.

19             SENATOR MAY:  I'm sorry.  Say that again.

20      What was the --

21             LISA NEWCOMB:  Lack of support from New York

22      State/from the Department of Health; from the

23      regulating agency.

24             SENATOR MAY:  Okay.

25             So I know, I've heard from many nursing home







                                                             36
 1      administrators that there were a lot of regulatory

 2      requirements as a result of the pandemic, of

 3      counting PPE on a daily basis, and a lot of

 4      reporting requirements.

 5             Have any of those been eased, or do you still

 6      have major staffing requirements for reporting?

 7             LISA NEWCOMB:  Well, I can't speak to nursing

 8      homes.

 9             JIM CLANCY:  I would just say that there have

10      been some incremental reduction in mandated

11      reporting from -- for the nursing homes and

12      hospitals, but not enough.

13             We need to do more, working with the State

14      every day, to try and get that reduced.

15             SENATOR MAY:  Are there specific things you

16      want to ask us to help with?

17             JIM CLANCY:  Sure.

18             We would like to have HERDS reporting.

19             Right now, the hospitals and nursing homes

20      have to report to HERDS on a daily basis.

21             I'm not sure that that's needed.  And maybe

22      have that reduced to a few days a week.

23             SENATOR MAY:  Okay.

24             JIM CLANCY:  But happy to talk about

25      specifics after this, Senator.







                                                             37
 1             SENATOR MAY:  And then my last question is

 2      about staffing agencies.

 3             So I know that there are a lot of kind of

 4      temp nurses and temp health-care staff in hospitals.

 5             Do nursing homes make use of that?  And

 6      what -- how does that -- what kind of wages do they

 7      command?

 8             Like, how does that affect your bottom line,

 9      and the quality of care?

10             JIM CLANCY:  Expensive.  Very expensive.

11             And depending on where you are, there's

12      either little access in rural areas, or tremendous

13      competition in more populated areas, for that same

14      staff person.

15             So prices fluctuate for that reason.

16             SENATOR MAY:  Okay.

17             I guess that's all I have right now.

18             Senator Rivera?

19             Senator Ramos?

20             He's deferring to you.

21             SENATOR RAMOS:  Okay.  Well, thank you,

22      Senator Rivera.

23             Well, my notes are all over the place, to be

24      honest with you, so bear with me, because it's

25      really unconscionable how high the turnover rate,







                                                             38
 1      how big the shortage, is in this industry.

 2             And so I'm wondering what type of support for

 3      workforce training exists now, perhaps provided by

 4      your organizations, perhaps provided by the state

 5      Health Department.

 6             What's out there now, if anything?

 7             LISA NEWCOMB:  Nothing directly for assisted

 8      living.

 9             SENATOR RAMOS:  Nothing directly for assisted

10      living, or for nursing home care?

11             LISA NEWCOMB:  Well, I can't speak for

12      nursing homes.  I represent only assisted-living

13      facilities.

14             SENATOR RAMOS:  Right.

15             I'm also wondering how many of your member

16      homes, or the agencies that are members of your

17      organizations, are -- have workforces that are

18      represented by a union?

19             What is the union density among your member

20      organizations or nursing homes or assisted-living

21      homes?

22             LISA NEWCOMB:  In assisted living, it's a

23      small percentage, mostly in New York City.  But

24      there are some upstate as well.

25             But most of the industry is not unionized.







                                                             39
 1             SENATOR RAMOS:  Well, I, of course, would

 2      argue that that's also a big reason why wages aren't

 3      very high.

 4             It's not only the State's duty and

 5      responsibility to raise the minimum wage, in my

 6      humble opinion, pegging it to inflation.

 7             But, of course, collective bargaining

 8      agreements actually allow for workers to seek

 9      incremental wages, and, hopefully, improvements in

10      terms of health and safety as well.

11             LISA NEWCOMB:  I would say two things to

12      that:

13             When it comes to SSI, they don't really --

14      they're not interested, because there's no funding

15      there for them to get for their workers, because it

16      is so underfunded that there's no real opportunity

17      there.

18             On the higher end of assisted living, they --

19      you know, many of them do pay, you know, very, very

20      fair wages.  And some have, you know -- there -- you

21      know, there have been discussions of unions, and the

22      workers have voted no.

23             That's not to say, you know, there are some,

24      you know, that have unions, and they work well,

25      and -- but I -- you know, on the -- for the







                                                             40
 1      indigent, there's no -- there's no money in it for

 2      anyone.

 3             SENATOR RAMOS:  Well, do any of the employers

 4      hold captive-audience meetings in order to dissuade

 5      the workers from organizing into a union?

 6             LISA NEWCOMB:  I -- not that I have ever

 7      heard.

 8             It's been -- the unions are just not actively

 9      pursuing.

10             SENATOR RAMOS:  Uh-huh.

11             JIM CLANCY:  Senator, just real quick, to go

12      back to your first question about other programs.

13             Right now -- again, it's in our full

14      testimony.  I did mention it in my comments. -- but

15      there are apprenticeship programs now in the state,

16      run through the district program, and also through

17      the Staten Island Performing Provider System, that

18      I mentioned that the mentoring and the college

19      credits.

20             So there are models out there that work.

21             SENATOR RAMOS:  That work.

22             JIM CLANCY:  Yeah.

23             SENATOR RAMOS:  That was going to be my

24      follow-up:  Well, how successful actually are they?

25             JIM CLANCY:  They work, but we need to expand







                                                             41
 1      on them.  We need --

 2             SENATOR RAMOS:  Not that they're not --

 3             JIM CLANCY:  -- to make sure a lot of

 4      resources get into those programs so that we can

 5      expand them.

 6             SENATOR RAMOS:  -- sure, yeah.

 7             You know, I keep thinking, and I said this in

 8      my opening remarks, by and large, this workforce is

 9      comprised of women of color, more often than not,

10      single moms, like myself.  And the rising cost of

11      living in New York State is pretty astronomical,

12      starting with just childcare alone.

13             You know, on average, we spend around $16,000

14      in childcare every year.  And if you put that up

15      against the wages that these workers are paid,

16      they're really left with nothing.

17             I honestly don't know how they make ends

18      meet, and I can't wait to hear from the workers

19      themselves.

20             But I'm very interested in the workforce

21      training and apprenticeship program development.

22      And I'll probably be reaching out to all of you,

23      after, to see how we can work together on that.

24             Thank you.

25             JIM CLANCY:  Thank you, Senator.







                                                             42
 1             SENATOR RIVERA:  I'm good.

 2             SENATOR MAY:  Senator Benjamin -- oh, before

 3      you go, actually, I should welcome,

 4      Senator Oberacker, Senator Benjamin, and

 5      Senator Mayer who have joined us.

 6             SENATOR BENJAMIN:  Thank you.

 7             Can you hear me?

 8             One more time?

 9             I actually want to pick up on my colleague

10      Senator Ramos's point about childcare.

11             Being that, you know, you're a living

12      facility, has there been some creative thoughts

13      around possibly helping some of your staff with

14      childcare within your space, so that that becomes an

15      attractive feature, compared to a McDonald's or a

16      Walmart, et cetera?

17             Because, I can tell you, childcare is very

18      expensive, in New York, in the country.

19             So has there been thoughts around that?

20             DORA FISHER:  A few of our members have

21      piloted some creative solutions to support their

22      workforce with childcare, eldercare, and among other

23      issues that are barriers to maintaining employment,

24      such as, you know, incentives to get your car fixed,

25      things like that.  And there have been a lot of







                                                             43
 1      creative solutions.

 2             I think getting back to Senator May's point

 3      about staffing agencies, a lot of our members

 4      believe that if they provide these kinds of support

 5      for their staff, they're more likely to retain

 6      staff, and not have to rely on agency as much.

 7             So these are some creative ideas that have

 8      been piloted, and I think some of them have been

 9      shown to work.

10             And I would be happy to discuss later.

11             SENATOR BENJAMIN:  Yeah, I think that that

12      would be something that can be a very obvious thing,

13      that given the industry that you're in, that you can

14      actually be a leader on providing, and be very

15      compelling, to people who want to sort of work in

16      this space, and know that their children are going

17      to be taken care of at the same time, I think it

18      would be very powerful.

19             And their children would not be very far from

20      them because they would be in a location that

21      they're near to.

22             So that's something that I think I would love

23      to hear more about.

24             The second question I have is about the issue

25      of the career advancement.







                                                             44
 1             To your point, this is very hard work.

 2             And I do think, to the extent that there is

 3      some obvious sort of process to which they can

 4      become a registered nurse, for example, et cetera,

 5      that is very transparent and clear, I wonder if that

 6      also, in addition to some of the personal issues,

 7      would help with the process of retaining workers.

 8             Any thoughts on that?

 9             JIM CLANCY:  Yeah, I just would like to say,

10      I would very much like to continue that conversation

11      as we start to get into the next legislative

12      session.

13             I think we have, as an industry, as a

14      provider, and as providers have -- want to work with

15      the State, particularly state Education Department,

16      with respect to licensure, scope of practice.  You

17      know, we have professionals that we want to make

18      sure, and I know the State wants, too, everyone

19      [indiscernible] their license.

20             So if we can have conversation with that as

21      we kind of round the end of 2021, to '22, I think

22      we've got some creative ideas we would like to

23      share.

24             SENATOR BENJAMIN:  Sure.

25             Last question, and I know I missed the







                                                             45
 1      beginning, so I apologize:  What are the learning

 2      lessons that you have seen from COVID thus far?

 3             Obviously, we are not out of COVID yet, but

 4      learning lessons that you've seen thus far?

 5             I know in every sector there have been -- you

 6      know, obviously, COVID has been devastation.

 7             But there have been some things that we have

 8      learned and picked up, that we will continue, going

 9      forward, even as we get past COVID.

10             Are there -- what are some of those things

11      that you have seen in the industry that you think

12      can help, you know, guide the future of what

13      assisted living looks like, going forward?

14             LISA NEWCOMB:  Well, you know, I have polled

15      our members on that, and I've gotten a lot of

16      different types of responses.

17             Certainly, one overarching theme is just the

18      whole infection control.

19             I mean, that was always a thing before COVID,

20      but this, you know, has certainly, I think, you

21      know, sensitized them.  And, you know, that is not

22      going away.

23             COVID was a major shock to the

24      assisted-living network because it is such a social

25      environment.







                                                             46
 1             You know, our residents, while they're

 2      elderly, they -- you know, they are not, you know,

 3      bed-bound.  They're active.  They come and they go,

 4      you know, all the time.  People are coming into the

 5      assisted-living community all the time.

 6             And the isolation, you know, that they

 7      experienced, because, you know, they couldn't have

 8      visitors, I think that, you know, our members say

 9      that it just brought their staff closer to the

10      residents.  Because they, you know, were filling in

11      for that -- that family member that couldn't be

12      there, as best as they could.

13             You know, lots of other lessons learned, to

14      just, you know, kind of trust your instincts when

15      you're in the middle of -- you know, of a major

16      calamity, and there's no answers that anybody, you

17      know, no solutions that people, are providing, that

18      you go with your gut.

19             And, you know, I think our members have done

20      a tremendous job.

21             You know, any death is too many.  But, you

22      know, the number of residents that passed away is,

23      you know, certainly, significantly smaller than

24      nursing homes, because our residents, frankly, are

25      just not quite as frail.







                                                             47
 1             JIM CLANCY:  And I would just add, to state

 2      the obvious, the professional and heroic actions of

 3      first responders, providers, everyone in the

 4      health-care community, regardless of where they

 5      were.

 6             But I would say, also, the flexibility -- and

 7      this goes back to the point, your previous question,

 8      talking about licensure -- the flexibility that the

 9      providers were given in the last 18 months, to make

10      sure that they got the job done for their

11      communities, was a lesson I hope that we can build

12      on, moving forward.

13             SENATOR BENJAMIN:  Thank you.

14             SENATOR MAY:  Thank you.

15             I guess Senator Serino has a question?

16             SENATOR SERINO:  Thank you, Senator May.

17             And I just want to say, thank you so much.

18             You know, you are all so passionate and

19      caring for our most vulnerable.  And I really

20      appreciate your testimony today.

21             I'm a huge supporter of the apprenticeship

22      programs, but they only work if students know about

23      them.

24             So I just wanted to ask you, like, do you

25      think the State is doing enough to inform people







                                                             48
 1      about that?

 2             Like, what could we do better so that we can

 3      make sure that these opportunities happen?

 4             JIM CLANCY:  I would say this:

 5             I think we now, with the spotlight, after

 6      what has happened in the last 18 months -- right? --

 7      the spotlight is on health care.

 8             SENATOR SERINO:  Yes.

 9             JIM CLANCY:  And the opportunities that will

10      exist, and do exist, in health care is going to be

11      the responsibility of everybody in this room, and

12      part of, you know, the government, to ensure that

13      it's trumpeted, that there are opportunities.

14             SENATOR SERINO:  Okay.  Great.

15             We need to work on that.

16             And, Lisa, I just have a question, with the

17      assisted living.

18             You know, I've been -- I'm always talking

19      about SSI.  It's so frustrating, it's

20      unconscionable, you know, what we pay is really

21      horrible.

22             And I actually have legislation to raise that

23      rate.

24             And I will work with any legislator to get

25      that passed, so we do that pay rate they need so







                                                             49
 1      desperately.

 2             So thank you so much.

 3             Appreciate all your testimony.

 4             LISA NEWCOMB:  Thank you.

 5             You've always been so supportive, as have

 6      many of you.

 7             And the legislature actually did pass an

 8      increase a few years back, and it was,

 9      unfortunately, vetoed by the governor.

10             You know, the cost is $100 million.  And

11      I guess, you know, the 50,000, you know, seniors in

12      assisted living, I guess -- you know, I guess it

13      just wasn't a priority at that time.

14             SENATOR SERINO:  Our seniors get left in the

15      dust.  Right?  It's not fair.

16             LISA NEWCOMB:  And many have closed since.

17             SENATOR SERINO:  Yeah, absolutely.

18             He is becoming a senior very quickly himself.

19             SENATOR MAY:  Senator Borello.

20             SENATOR BORELLO:  Thank you, Madam Chair.

21             Again, I would like to give my thanks for

22      you-all being here to discuss this issue.

23             You had mentioned initially -- well, first of

24      all, you mentioned the -- a daily loss of

25      approximately $64 per patient per day in nursing







                                                             50
 1      homes.

 2             And then when it comes to assisted living,

 3      you mentioned that, according to all of your

 4      members, or I believe you said all of your members,

 5      that the enhanced unemployment benefit has created a

 6      crisis in employment.

 7             I was wondering if could you speak to that?

 8             I mean, essentially, what you're saying is,

 9      is that, so far, our government hasn't done anything

10      to help you, and has done a lot to hurt you.  And

11      that is certainly having an impact on the folks that

12      you care for.

13             But I would like to speak a little bit more

14      to those outside forces created by government that

15      is having a negative impact on your ability to

16      deliver services.

17             LISA NEWCOMB:  So, are you out Buffalo way?

18             SENATOR BORELLO:  Yeah.  Western New York,

19      yes.

20             LISA NEWCOMB:  Because it's my

21      understanding -- okay.

22             So we have members there, when the minimum

23      wage went up, and they're Medicaid providers that

24      have the assisted-living program, they were already

25      paying over the minimum wage at that time.







                                                             51
 1             So they did not get a Medicaid add-on.  So

 2      they were, kind of, sort of, punished for, you know,

 3      having done the right thing.

 4             So they do -- you know, they are paying well

 5      because they have to and -- and they want to, and

 6      they have to.

 7             But they, you know, have gotten, you know, no

 8      support.

 9             And, right now, the benefits that are coming

10      in from government, you know, exceed what they can

11      afford to pay in some cases.

12             And, you know, just as an anecdotal story,

13      but a member told me that, in the North Country,

14      like Plattsburgh way, somebody actually told them

15      that, you know, to leave her house, that she needs

16      $23 an hour.

17             And they just cannot -- they just cannot

18      afford that.

19             Remember that, you know, for most facilities,

20      that that means that you're passing it on along to

21      the resident who has a fixed income.

22             You know, and so something's got to give at

23      some point.

24             SENATOR BORELLO:  Well, in New York State, we

25      took out $100 million out of -- during COVID, with a







                                                             52
 1      1.5 percent cut to reimbursements.

 2             So I would imagine that's had a negative

 3      impact.

 4             Now, if you can speak a little bit to that,

 5      that, during COVID, when we were trying to do our

 6      best to take care of our most vulnerable citizens,

 7      the governor decided to cut $100 million out of

 8      reimbursements.

 9             JIM CLANCY:  Yeah, and, you know, I did

10      highlight that.  That was part of the previous

11      year's budget negotiations.

12             So, sure, that hurts.  Right?

13             And understand how we are where we are, why

14      we are where we are, today with Medicaid spending.

15             It's -- it's -- the program becomes more and

16      more robust, it's broader services to be covered,

17      which is a good thing.  Right?  We want as many

18      services, and as many people to receive those

19      services, as possible.

20             But those increased services have not been

21      coming with an increased dollar attached to it.

22             So that's the conversation that I hope we

23      will all be having with the administration, and with

24      your colleagues in the other House, to start to

25      right that ship.







                                                             53
 1             SENATOR BORELLO:  I don't know how much time

 2      I have left here, I can't see the clock, but, you

 3      know, we saw mandates for you to have to do testing,

 4      that were not reimbursed; PPE that was not provided;

 5      and all the other mandates during the pandemic.

 6             Can you just speak to the overall damage that

 7      has done to your industry?

 8             JIM CLANCY:  "Damage" is a good word,

 9      I guess.

10             I would just say, the stresses -- everyone

11      just stepped up and did what they had to do.  Right?

12             Put the checkbook aside, put the accounting

13      ledger aside, and did what they had to do, and said,

14      We will figure this out.

15             And now we're at that "We have to figure this

16      out" stage.  Right?

17             Nursing homes, let's be very clear --

18      right? -- as I also said in my testimony, you know,

19      before the pandemic, nursing homes were working at a

20      negative margin.  Right?

21             So anything to hit that bottom line certainly

22      exasperated that.

23             "Unfunded mandates," I mean, that's a word

24      that you hear.  You must hear that so many times in

25      a year -- right? -- from not just us, but from







                                                             54
 1      everybody else in other hearings.  Right?

 2             They're hard.

 3             They're hard.

 4             And that's why we're -- we have hearings like

 5      this, so that we can bring that to light, and ensure

 6      that we're having those conversations.

 7             SENATOR BORELLO:  Well, we already have loss

 8      of beds in Western New York, particularly in rural

 9      areas of New York State.

10             So do you, I guess, foresee more closures?

11             I believe there were two more closures

12      recently, and a third bankruptcy somewhere on

13      Long Island.

14             So do you see more loss of beds?

15             Because it's going to be a critical issue for

16      us, as we continue to have people aging and needing

17      more services, but there's a lack of beds, at least

18      in our area.

19             JIM CLANCY:  I do.

20             SENATOR BORELLO:  Okay.

21             Thank you.

22             SENATOR MAY:  And Senator Oberacker.

23             SENATOR OBERACKER:  It's kind of weird when

24      you talk and you don't hear yourself coming back.

25             So, thank you, Madam Chair.







                                                             55
 1             And I want to thank each and every one of

 2      you, too, for your testimony, to help educate this

 3      senator on the issues that are out there.

 4             You know, as a businessman -- and our

 5      business is a lot with product development and, you

 6      know, the creative ideas that have come out -- and

 7      one of the things that just struck me is that this

 8      business is so heavily reliant upon people --

 9      right? -- to do the jobs that are out there.

10             And so just one of the ideas that I had is,

11      is there any chance, or has there been any thought

12      given, to potentially, automation, that would help

13      in some of the mundane type of tasks that are out

14      there now?

15             I don't want this to sound insensitive, or

16      anything, because I think the business that we're in

17      is very personable, and that personable touch is so

18      important.

19             I'm just trying to think, out of, you know,

20      again, the creative side of things, you know, if you

21      were to have some sort of -- look at the box stores,

22      look at Walmart.  I mean, they're doing their

23      self-checkouts, and things of that nature.

24             So they've kind of, you know, taken some of

25      that automation idea to help out with this.







                                                             56
 1             So I just throw that out as kind of a

 2      question:  Is there, or could there be, some thought

 3      process given to that, to kind of help with the

 4      shortage?

 5             LISA NEWCOMB:  I was approached by a company

 6      just last month, that has, basically, robots that

 7      can deliver meals.

 8             You know, so I, you know, don't have an

 9      opinion about that quite yet, one way or the other.

10             But I -- you know, I told them I wanted to

11      look at it.

12             So we are, you know, scheduled to do that.

13             We automate as much as we can, but, like you

14      said, it is a people industry.

15             My daughter, when she was in college, worked

16      in dining in assisted living, and she really became

17      very attached.

18             And she would come home and she would say,

19      "There's this boy, and he likes this girl."  And I'm

20      thinking she's talking about the staff, "boy and

21      girl."

22             And she's talking about the residents.

23             So, you know, it really is a people thing,

24      but we do what we can when it comes to automating.

25             SENATOR OBERACKER:  And, again, it was kind







                                                             57
 1      interesting that, my mother-in-law, who was in an

 2      assisted living, and I remember them coming around

 3      and having a sheet of paper for her meals.  And it

 4      was more difficult for her to work off of a sheet of

 5      paper than if there was a picture of the actual meal

 6      that could be, you know, given, if you will.

 7             So just something along those lines.

 8             And the other thing I bring up, as an EMS

 9      provider in my local emergency squad, and we are

10      running through the same issues I think that you

11      are, where we don't have enough members, you know,

12      right now we are looking at getting a -- literally,

13      a machine that will perform mechanical CPR.

14             It's a whole nother individual for any of

15      these, you know, calls that we're on.

16             So I just throw that out, again.

17             I think it's something, as we move forward,

18      it would be really worth looking at.

19             DORA FISHER:  Several of our members have

20      utilized smart technology to, you know, monitor

21      patients remotely.

22             And it is really fantastic to see these

23      creative innovations.  And it also highlights why

24      nursing homes need that kind of flexibility to be

25      able to pay for things like this.







                                                             58
 1             But I do want to emphasize that this is still

 2      a high-touch human field.  And there are limits to

 3      what technology can replace in this field.

 4             SENATOR OBERACKER:  Thank you.

 5             DORA FISHER:  Thanks.

 6             SENATOR MAY:  All right.

 7             I think that's everyone.

 8             I just wanted to come back and say one --

 9             Oh, Senator Mayer.  Sorry.

10             SENATOR MAYER:  Thank you.

11             And, first of all, thank you, to you and your

12      staffs, and your institutions, for what you did

13      during the last 18 months.

14             And I think for all of us here, we dealt with

15      family members of folks that were in your places, as

16      well as family members and staff that work there.

17             So one question I had, and I don't think you

18      dealt with this:  For each of these sectors, the

19      number of workers who either died from COVID or

20      became seriously ill, do you know that number?

21             JIM CLANCY:  I don't.

22             LISA NEWCOMB:  I do not.

23             I don't think -- you know, I don't know that

24      that's publicly available, to my knowledge.

25             SENATOR MAYER:  But have you --







                                                             59
 1             LISA NEWCOMB:  I mean, it would be -- it

 2      would have been reported to the department, I think.

 3             SENATOR MAYER:  I just wondered, as -- as

 4      organizations, whether you know the scope of death

 5      or serious illness of workers in your facilities

 6      during the last 18 months?

 7             LISA NEWCOMB:  I have only heard of a few.

 8             JIM CLANCY:  Yeah, I wouldn't have that data,

 9      Senator.  But can I certainly go back, check, find

10      out, if we have that, and let you know.

11             SENATOR MAYER:  Well, I just think for us, as

12      we represent both, as I say, the families of these

13      patients, and the families of these workers.

14             And I know for me, and I would think for many

15      of my colleagues, the workers in these places are

16      largely the women in our districts, who are taking

17      the bus, and/or don't have a car, and may not have

18      health insurance, and also have childcare

19      responsibilities, as my colleagues mentioned.

20             And I think it would be helpful to know the

21      burden that was placed on them, either by death or

22      serious illness as a result of COVID, because they

23      made an extraordinary sacrifice.

24             So I think that would be helpful.

25             Second is, for those that work in your







                                                             60
 1      facilities, I know it depends on whether the union,

 2      how many facilities provide health insurance to the

 3      employees, either in assisted living or in nursing

 4      homes?

 5             LISA NEWCOMB:  I don't know that.  I don't --

 6      I'm sorry.  I don't have the answer for assisted

 7      living.

 8             JIM CLANCY:  No.  Senator, again, I don't

 9      have that information with me.  But, again, we

10      will --

11             SENATOR MAYER:  Well, again, I think for --

12      from at least my point of view, for these workers,

13      the ability to have health insurance, particularly

14      given what we've been through, this is the moment to

15      reevaluate the failure to provide health insurance.

16             I understand the finances of it, but we're

17      asking people to make extraordinary and personal

18      sacrifice.  And I think that ought to be part of the

19      conversation.

20             I would urge you to make sure, as we go

21      forward next year, that those -- both the pain that

22      they suffered, as well as their health insurance

23      needs, going forward, are part of the conversation,

24      as well as in your advocacy, because I think they

25      deserve that.







                                                             61
 1             So I would just urge that you do that.

 2             JIM CLANCY:  Thank you, Senator.

 3             SENATOR MAYER:  Thank you.

 4             SENATOR MAY:  All right.  I'm going to take

 5      my privilege as chair, and ask just a couple of

 6      follow-up questions, because -- especially after

 7      what Senator Mayer asked.

 8             I know we've heard a lot about enhanced

 9      unemployment benefits as a reason people aren't

10      going back to work.

11             But the evidence seems to be that it's lack

12      of childcare, lack of other kinds of supports, and

13      fear of infection.

14             And so the question about, vaccination,

15      I know vaccination rates are low among staff at a

16      lot of your facilities.

17             And we're hearing, around the country, there

18      are efforts to require vaccination, or regular

19      testing of employees.

20             What are you thinking on that score?

21             LISA NEWCOMB:  So for assisted living,

22      74 percent of our staff, currently.  I mean, you

23      know, it is inching up.  You know, I want it to be

24      100.

25             Some of our companies, very early on, did







                                                             62
 1      mandate it.  And I think more are considering it at

 2      this point, especially because, you know, when you

 3      have unvaccinated staff, you know, the community

 4      can't open up the way that it could if everyone were

 5      vaccinated.

 6             But, of course, there's also that fear that,

 7      if you mandate it, that you're losing people when

 8      you really can't, you know, afford to lose one other

 9      worker.

10             So, you know, I certainly, you know, support

11      any -- any of our members that mandate it; but, you

12      know, there's that risk.

13             JIM CLANCY:  And almost identical, I would

14      say, we do spend a lot of time working with our

15      members to help combat the hesitancy within their

16      workforce; to ensure that they really feel that it's

17      safe, and the right thing to do.

18             But those that will mandate it, we will

19      support their membership, and help them to do that.

20             But those that don't, for the obvious reasons

21      outlined, the flexibility needs to be -- you know,

22      needs to be part of that conversation as well.

23             SENATOR MAY:  Okay.  Thank you.

24             Meghan, I don't know if you wanted to say

25      anything about this, too, with vaccination with







                                                             63
 1      home care workers.

 2             I apologize that you've sort of been left out

 3      of the conversation here.  But the morning is mostly

 4      devoted to nursing care, so that was why.

 5             MEGHAN PARKER:  Yeah, I know, I understand.

 6             And I'm sure my colleagues will all get to

 7      answer questions on the topic I spoke on earlier.

 8             So we advocate for consumers.  And I know

 9      that there are many people with, you know, serious

10      conditions.  People who are, have suppressed immune

11      systems, who, you know, don't feel safe, having home

12      care workers come into their homes if they're not

13      vaccinated.

14             And so I think that, on the consumer side,

15      which is where, you know, I fall, that, you know,

16      mandating vaccines would make people feel much more

17      comfortable and make people much safer.

18             SENATOR MAY:  Thanks.

19             And then my last comment:  I want to come

20      back to this 94 percent turnover rate.

21             Only 6 percent of your employees actually

22      stay more than a year?

23             Is that what you're saying?  Because that --

24             JIM CLANCY:  That was, again, [simultaneous

25      talking; indiscernible] --







                                                             64
 1             SENATOR MAY:  -- was a shocking number.

 2             JIM CLANCY:  -- based on 2017-2018 numbers,

 3      that was the turnover rate.

 4             SENATOR RAMOS:  But the retention was more

 5      than a year?

 6             JIM CLANCY:  You know what?  That's a good

 7      question.  And let me find that out.

 8             I'm not sure I highlight that in my

 9      testimony.  But I will let you know over what that

10      time period is.  Okay?

11             SENATOR MAY:  That would be helpful, because

12      that is a shocking number, and an indication of a

13      totally failed business model, an employment model,

14      that absolutely needs to be rethought from the

15      bottom up.

16             DORA FISHER:  And to clarify on the

17      statistic, it includes -- it's an average.  Right?

18      So it includes turnover rates that exceed

19      100 percent.  You know, when you have -- and it

20      includes staff people that turn over three or

21      four times in a year.

22             So it's not to say that 6 percent of the

23      staff stays on every year.  It's about -- it's

24      about, especially at the lower level, the people who

25      come in and out every three or four months.







                                                             65
 1             SENATOR MAY:  Okay.

 2             Well, it would be nice to get a little more

 3      granular detail about where that number comes from.

 4             JIM CLANCY:  Absolutely.

 5             SENATOR MAY:  Thank you.

 6             Thank you, all.

 7             JIM CLANCY:  Thank you.

 8             LISA NEWCOMB:  Thank you.

 9             SENATOR MAY:  I really appreciate your work,

10      and your testimony today.

11             And we'll move on to the next panel, which is

12      Stephen Hanse, Tarrah Quinlan, and Lisa Volk.

13             All right, Mr. Hanse.

14             STEPHEN B. HANSE:  Good morning.

15             My name is Stephen Hanse, and I have the

16      privilege of serving as president and CEO of the

17      New York State Health Facility Association, and the

18      New York State Center for Assisted Living, a

19      statewide organization representing over 450 skilled

20      nursing and assisted-living facilities throughout

21      the state, who are both proprietary, not-for-profit,

22      and government-sponsored facilities.

23             Prior to the onset of the COVID pandemic,

24      New York was experiencing a significant

25      long-term-care workforce crisis.







                                                             66
 1             We were meeting with the commissioner of

 2      health, folks on the second floor, to address this

 3      issue.

 4             Then we had the onset of the COVID-19

 5      pandemic which only exacerbated this workforce

 6      shortage.

 7             We saw our workers become ill.

 8             We saw workers, for the first time ever, have

 9      to leave work, to stay home and care for their

10      children as a consequence of schools closing.

11             Now we continue to fight through this

12      pandemic, and we are sitting here discussing the

13      workforce issue.

14             And as we heard during the first panel,

15      I think it's clear that the issues of workforce and

16      reimbursement, more particularly Medicaid

17      reimbursement, are inextricably linked.

18             You heard that New York has a

19      $56-per-patient-per-day shortfall, and what that is

20      is the statewide data.  It costs $265 per patient

21      per day to provide care for a Medicaid patient.

22             About 77 percent of all nursing home

23      residents in the state of New York are Medicaid

24      patients.

25             So when you back out that $64, you're left







                                                             67
 1      with $8.37 per hour paid by the state of New York

 2      for Medicaid care for our most vulnerable men and

 3      women in nursing homes.

 4             So as we look at the issue of staffing, and

 5      we have staffing mandates, we all would love to hire

 6      as much staff as we could.

 7             I was recently speaking to an administrator

 8      of one of our buildings, who said, "If a bus full of

 9      nurses showed up tomorrow, I would hire them sight

10      unseen; just, we would hire them all."

11             So we need to address the workforce crisis,

12      we need to address the reimbursement, and make them

13      work together.  We can't deal with these issues in

14      silos.

15             It's been over 12 years since Medicaid has

16      been increased for the cost of living in the state

17      of New York.

18             So we need to address that.

19             In this past budget, it looks like

20      $64 million was allocated for workforce.  And my

21      understanding, that $64 million was for the fourth

22      quarter of this fiscal year.

23             And I just want to get some clarity on that

24      because, if that's the State's share, and that

25      becomes $128 million, then there seems to be a level







                                                             68
 1      of commitment to addressing workforce.

 2             And we would stand here today, to say, any

 3      increase in the Medicaid rate for long-term care in

 4      New York, you can allocate 100 percent of that

 5      increase to staff.

 6             We would fully support that.  We would work

 7      with our partners and organized labor to bring that

 8      to you.

 9             And when management and labor supports

10      something, it makes your life easier.

11             So we would fully support that.

12             So with those issues, there are issues that

13      we need to do to recruit and retain workers, and

14      stop losing our workers, the limited workers we do,

15      to hospital systems and other providers on the

16      health-care continuum who can continue to pay more.

17             So with that, we would like to present to

18      you, in addition to the real need to increase the

19      Medicaid rate, real concrete proposals that can be

20      implemented now with the legislature, and working

21      with the state agencies in regulatory capacity, to

22      recruit and retain workers.

23             And with that, I would like to introduce my

24      colleague Lisa Volk.

25             LISA VOLK:  Good morning, everyone.







                                                             69
 1             So my name is Lisa Volk.  I am the director

 2      of clinical and quality services for NYSHFA.

 3             My background:  I'm an RN, and a licensed

 4      nursing home administrator.  So I've been many years

 5      in operations of facilities.

 6             There's a couple of key areas that we are

 7      looking at when we talk about workforce.

 8             Number one being the TNA program/the

 9      temporary nurse aide training program that was

10      utilized throughout the state to help supplement the

11      nursing home staff.

12             Currently, the Department of Health just did

13      a survey that indicated 1,322 temporary nurse aides

14      are being utilized in the facility.

15             This is a big program that they're using.

16             What we would like to do is extend the waiver

17      on that program.

18             We also are currently working with the

19      Department of Health to develop a bridge program

20      that will accept some of the hours worked by the

21      temporary nurse aide employees as their clinical

22      hours for the 100-hour course.

23             We also would like to align with the federal

24      guidelines as far as the hours of 75, versus 100 in

25      New York State.







                                                             70
 1             So those are some really big, key issues that

 2      we believe -- I mean, these are your frontline

 3      staff.

 4             This is very, very much so needed.

 5             Before I turn it over to Tarrah, my

 6      colleague, I had one other thing I wanted to talk to

 7      you about, is the nursing home administrators.

 8             And Dora said earlier, she's on the phone a

 9      lot with the nursing home administrators, as am I,

10      and certainly can empathize with where they're at.

11             But there's a lot of these nursing home

12      administrators leaving the industry, by way of

13      retirement, by way of leaving the industry

14      completely, by leaving the state, and that's very

15      concerning to me.

16             And I think there's a way that we can work

17      with the Board of Nursing Home Examiners, to see if

18      we can open up more of the qualifying field

19      experience.

20             Stephen and I have worked with nursing home

21      administrators some years ago, that actually had

22      some awesome experience, and was very qualified.

23      But because they were not an administrator on

24      record, their experience was not taken into account.

25      They were more of a regional.







                                                             71
 1             And this is an administrator that had control

 2      kind of over a special focus facility.

 3             So I think there's things that we can do.

 4             So those are two of the key areas.

 5             But I'll turn it over to Tarrah, and she's

 6      going to talk more about the med tech and the

 7      nurses.

 8             Tarrah.

 9             TARRAH QUINLAN:  Thank you, Lisa.

10             Can you hear me okay?

11             Okay.

12             My name is Tarrah Quinlan.

13             SENATOR MAY:  Actually, I'm not sure that's

14      on.

15             STEPHEN B. HANSE:  You're not on.

16             TARRAH QUINLAN:  My name is Tarrah Quinlan.

17      I'm the director of education program development

18      and member operations for NYSHFA and NYSCAL.

19             I've been working in long-term care since

20      I was 16 years old.

21             I'm a registered nurse.

22             I started working in the nursing home in

23      dietary.

24             I have since was a nursing home surveyor.

25             And my last position was with the New York







                                                             72
 1      State Department of Health, as the director of the

 2      quality assurance bureau of the surveillance of

 3      nursing homes.

 4             So I have been working in long-term care a

 5      long time.  I understand the shortages of staff and

 6      what needs to be done to assist that.

 7             So my first proposal I'm going to talk about

 8      is creating the medication technician position

 9      within a nursing home; allowing the ability to train

10      medication techs, and test their competencies within

11      skilled nursing facilities, to assist with

12      lower-level medication administration.

13             They would be under the supervision of the

14      registered nurse.

15             This would allow the nurses more time to

16      provide hands-on care to the residents.  And it

17      would also, with further changes to regulation,

18      allow these medication technicians to be a part of

19      the direct-care staff in the nursing home.

20             Another proposal is changes with the

21      New York State education licensing requirements.

22             So during the pandemic we had an executive

23      order, to allow nurses across the United States and

24      in Canada, their license was in good standing, to

25      work within New York.







                                                             73
 1             And I know a lot of nursing homes that

 2      I spoke to were utilizing that, especially around

 3      the states that are around us.  That was a big

 4      supplementation of staff.

 5             To be part of the nurse licensure compact

 6      would allow nurses to have one multistate license,

 7      and the ability to practice in their home state or

 8      neighboring states or other states.

 9             That would also supplement the workforce.

10             And I just wanted to quickly talk about, as

11      it was mentioned in the previous testimony, the

12      daily HERDS survey, you know, just some thoughts on

13      that.

14             Those are your direct-care staff doing that.

15      Directors of nursing, infection preventionists, they

16      are taken away from the direct care of those

17      residents every single day.

18             I understand the need for data collection, of

19      course; however, for that to continue every single

20      day, seven days a week, with no relief, is not

21      necessary.

22             That's in addition to a weekly testing survey

23      that they have to do every Wednesday; and also in

24      addition to several supplemental surveys that the

25      Department of Health just sends out randomly







                                                             74
 1      throughout the year.

 2             So to not have to do that on a daily basis;

 3      even to not do it at all.

 4             All of this information is now reported to

 5      the federal government and NHSN, so it's really not

 6      needed.

 7             So those are just some other points that

 8      I think would help.

 9             STEPHEN B. HANSE:  So when you take together,

10      the issues of reimbursement, and real, practical

11      initiatives to bring, to recruit and retain,

12      workers, there are -- there is a pathway to address

13      the concerns in long-term care.

14             They're real, focused initiatives that can be

15      implemented in partnership with the legislature and

16      with the governor.

17             And we thank you for your time and for your

18      focus on this critical issue.

19             SENATOR MAY:  Okay.  Thank you so much.

20             Let me ask a couple of follow-up questions

21      about the HERDS survey -- actually, I've forgotten

22      what my question was on that.

23             So let me ask a different one.

24             One of the things I've worked on a lot in the

25      last year is visitation in nursing homes, and trying







                                                             75
 1      to facilitate opening the doors to more family

 2      members or loved ones to be able to visit.

 3             And I often hear that the big issue is

 4      staffing in that.

 5             So can you explain what the staffing

 6      requirements are for something like that; for

 7      bringing visitors, allowing visitors, into a

 8      resident's room, say.

 9             LISA VOLK:  So under the current guidelines,

10      they talk about core infection-control principles.

11      And within those core infection-control principles,

12      you have to maintain the PPE, the social distancing,

13      et cetera.

14             So there needs to be enough staff to kind of

15      supervise that, because they're held accountable for

16      maintaining that as a part of the guidelines for --

17      you know, through the New York State Health

18      Department.

19             So that's -- that's a piece of that; they

20      have to take that into consideration, what do they

21      have as far as, you know, that staff to do those

22      visitations?

23             It's not just kind of opening the door and

24      letting everybody in.

25             They really have to look at, what they have







                                                             76
 1      available to look at, you know, maintaining those

 2      core principles.

 3             SENATOR MAY:  Okay.  So, just in the interest

 4      of time, if we were not in a pandemic situation, if

 5      you can strip away all of those kinds of

 6      requirements, is there a significant staffing

 7      requirement to allowing visitation in nursing homes

 8      just in ordinary times?

 9             LISA VOLK:  Well, in general, there's always

10      some level of supervision when it comes to

11      visitation.

12             You want to make sure things are going okay,

13      and your residents are safe, because there are, you

14      know, times that you do have to intervene.

15             But they certainly are less stringent not in

16      the middle of a pandemic.

17             SENATOR MAY:  Okay.  Thank you.

18             I wanted to follow up on one of your very

19      first statements, Mr. Hanse, where you said, "For

20      the first time ever, we are finding our staff having

21      to leave work and take" -- "to take care of their

22      children."

23             Now, I get it; if schools are closed, it's

24      sort of a mass event.  But I imagine that happens

25      all the time, and has happened for years and years







                                                             77
 1      and years.

 2             And I just want to follow up on the

 3      discussion from the previous panel, about the need

 4      for things like childcare on-site as a way to really

 5      support these workers who are giving everything to

 6      your residents, and then, you know, their own

 7      families are losing out.

 8             So I wonder if you had thoughts, or any of

 9      you had thoughts, on that discussion that we had

10      before.

11             STEPHEN B. HANSE:  Sure.

12             And, Senator Ramos and Senator Benjamin, it's

13      a real issue, it's a significant issue.

14             And what we saw prior to the onset of the

15      pandemic, or the regulatory paradigm to establish a

16      childcare center in your workforce, there are

17      significant hurdles, especially in health care.

18             So those regulatory issues.

19             And what we're dealing with are various

20      agencies, and this is also with the workforce in

21      terms of the Education Department, that don't really

22      work in partnership.

23             And they say, This is the reg, and you can't

24      do this.

25             What we did see in the pandemic, to encourage







                                                             78
 1      our workers to come to work in this very trying

 2      time, we did have -- given the context of the state

 3      of emergency, various regulations were waived.

 4             So we were able to establish certain

 5      childcare facilities, temporary, based under the

 6      auspices of the pandemic and the emergency -- the

 7      declaration of the state of emergency.

 8             Those -- now that that's over, those -- all

 9      the applicable regulations are back in place right

10      now.

11             But we had several of our members do that,

12      try to do that, and it worked.

13             You had to find a location, but you also had

14      to find appropriate and qualified staff for

15      childcare, which has its separate employment issues,

16      because you need qualified individuals who those

17      parents can trust with their children, as they go to

18      work.  And the location of the childcare needs to be

19      very close, if not within the building.  And then we

20      have very significant restrictions in terms of the

21      utilization of the building.

22             So, again, after -- you've heard it said

23      anecdotally, but it really is the truth:  After

24      nuclear power, there is no more heavily regulated

25      industry than nursing homes.







                                                             79
 1             It's the truth.

 2             And when you really peel back the onion and

 3      you see what we have to do:

 4             Okay, we want to dedicate this wing of our

 5      nursing home to childcare.

 6             It's not that easy.

 7             Okay, we can hire someone to do it.  Have

 8      them come in.

 9             No, it doesn't work that way with the

10      Department of Health, with the Office of Children

11      and Family.  There's all these hurdles.

12             So I think if there was a legislative

13      initiative to address some of these, that could

14      help.

15             SENATOR MAY:  Okay.  Thank you.

16             Anyone else?

17             SENATOR BENJAMIN:  I'll be brief, I'll be

18      brief.

19             SENATOR MAY:  Okay.

20             SENATOR BENJAMIN:  I definitely -- you know,

21      I heard Senator Ramos mention, so I definitely want

22      to follow up on some of the regulatory issues around

23      childcare, because it just seems logical that you're

24      in the living business, children -- having spaces

25      for children to be there.







                                                             80
 1             Because I think, a career pipeline,

 2      childcare, making sure people are safe from any

 3      diseases, like obviously COVID, and working

 4      conditions, I mean, those things coming together

 5      I think will definitely help with this -- with this

 6      workforce-retention issue.

 7             To that point, can you talk a little bit

 8      about, sort of, the length -- the typical length of

 9      a work shift for someone working in one of your

10      member's facilities?

11             LISA VOLK:  I think that varies on a lot

12      of -- there's a lot of variables in that, in

13      answering that question.

14             It all --

15             SENATOR BENJAMIN:  [Simultaneous talking;

16      indiscernible] I'm sorry.  I [indiscernible] cut you

17      off.

18             Let me ask the -- being that there are

19      shortages, you have staffing issues, I have to

20      imagine there are people working very long shifts in

21      some cases.

22             You know, help us think through the

23      implications of that.

24             How long could one person be working on a

25      shift, for example, et cetera?







                                                             81
 1             LISA VOLK:  Yeah, I mean, you know, a double

 2      shift would be considered 16 hours, and you wouldn't

 3      go anything over that 16 hours.

 4             A lot of facilities will staff on 12-hour

 5      basis, and do, like, you know, so many days on and

 6      so many days off.

 7             It all depends on what the facility's needs

 8      are.

 9             I also think that you have to take into

10      consideration, when people are working overtime,

11      making sure they have some time off after working

12      some overtime.  And then that is also a challenge.

13             So it's not like just a kind of cut-and-dry

14      answer.

15             You know, some facilities, their work hours

16      are 7.5, some are 8.

17             But a double shift is 16, and normally, you

18      know, it's 12 hours in between.

19             SENATOR BENJAMIN:  Got you.

20             TARRAH QUINLAN:  And I would just add, you

21      know, myself being an RN and working in these

22      facilities, even, you know, this crisis and staffing

23      is nothing new.

24             And when I was working, it wasn't during a

25      pandemic.  And I often found myself as a







                                                             82
 1      3-to-11 supervisor, covering also that

 2      11-to-7 shift.

 3             That was an often, probably a few times a

 4      month, occurrence.

 5             STEPHEN B. HANSE:  And when you go back to

 6      the SUNY Center for Workforce Studies, and the

 7      School of Public Health, and you look at their data

 8      reported on a regional basis throughout the state of

 9      New York, the shortages throughout the various

10      classifications in health care are there pre-COVID.

11      They're going to be there post-COVID.

12             Again, it goes back to the issue that we've

13      never -- the State has never really dealt with the

14      issue.

15             And then we heard on the earlier testimony,

16      in terms of the reimbursement.

17             And, unfortunately, the State of New York was

18      the only state to cut Medicaid during a pandemic.

19             So you had that.

20             And then, on top of that, the federal

21      government provided additional funding for states,

22      temporary relief, to deal with the various

23      mandates -- the PPE; to pay higher pay, "Hero Pay,"

24      it was called -- to encourage workers to come to

25      work.







                                                             83
 1             So the states were allocated that money from

 2      the federal government.

 3             New York is one of only five states that

 4      refused to allocate any of those money to health

 5      care.

 6             So I think, when we look at the issues, we

 7      really need to, again, look at them in the context

 8      of the workforce and the reimbursement; they are

 9      inextricably linked.

10             SENATOR BENJAMIN:  Sure.

11             One last question:  Do any of your members

12      have sort of a predictable career trajectory for

13      nursing assistants?

14             I guess I'm -- you know, when I went to

15      business school, when I graduated, I knew if I went

16      to work at "X" place, you know, for these three

17      years, if I do my job, I'll go -- I'll be an

18      associate, and then I can be a vice president,

19      et cetera, et cetera.

20             And so, you know, when you're working around

21      the clock, killing yourself, you know, you might

22      say, Oh, I can quit.

23             Oh, wait a minute.

24             You know, there's a -- there's something that

25      I'm a part of; there's a trajectory, there's a







                                                             84
 1      career path.

 2             I guess, you know, it -- is that -- is

 3      that -- is that happening anywhere within your

 4      members?

 5             LISA VOLK:  It does.

 6             SENATOR BENJAMIN:  Okay.

 7             LISA VOLK:  It does.

 8             And I can speak to it because the facilities

 9      that I was a part of, from an operations standpoint,

10      even myself, I started as an LPN.

11             I really had to do, like, the background work

12      as to, what I had to do to become an RN, and what

13      would be accepted.  But I did take advantage of the

14      tuition reimbursement offered through the facility,

15      and then went back to become the nursing home

16      administrator.

17             So there were some mechanisms in place that

18      I could take advantage of; however, in particular,

19      in the facilities that I covered, we had something

20      called the "ACNA" program, which meant it was

21      additional training for the CNAs who maybe didn't

22      want to go and be an LPN, but really wanted a little

23      bump up in some way; so additional training, some

24      duties.

25             Tarrah spoke about the med tech.







                                                             85
 1             One of the things that we feel, is allow the

 2      nurses to get back to being nurses.

 3             Let the CNAs who want a little extra level

 4      up, train them to be the med techs.  And, you know,

 5      studies have shown that they have had really good

 6      success with this.

 7             So I think these are some of the things that

 8      we need to look at, like, overall.

 9             But, to your point, you know, always, tuition

10      reimbursement.  I mean, I was the recipient of a

11      scholarship through our association, that helped me

12      buy books.

13             And, I mean -- so those things are really

14      important, and just really pushing the nursing homes

15      to kind of do those things.

16             We offer that training program on a

17      train-the-trainer basis.

18             And there's lot of facilities that have taken

19      advantage of that.

20             So there are things available.

21             There are things available.

22             SENATOR MAY:  I need to break in here

23      because --

24             SENATOR BENJAMIN:  Oh.  I'm finished up.

25             SENATOR MAY:  Senator Rivera, did you want to







                                                             86
 1      say anything?

 2             SENATOR RIVERA:  Hey, folks.  I'll be brief.

 3             I'm looking through your testimony, and there

 4      are a couple of recommendations that you folks make.

 5             And I just wanted to understand -- as you

 6      know, there are so many acronyms that are always

 7      thrown around.  I just want to make sure that

 8      I understand some of them here, and particularly

 9      related to the Medicaid -- medication tech program.

10             Obviously, "CNA" is certified nurse

11      assistant.

12             But, "SNF"?

13             LISA VOLK:  Skilled nursing.

14             STEPHEN B. HANSE:  Skilled nursing.

15             SENATOR RIVERA:  Skilled nursing...

16             SENATOR MAY:  ... facility.

17             STEPHEN B. HANSE:  I'm a med tech.

18             New York State presently permits those in

19      assisted-living facilities.

20             For some reason they don't in skilled nursing

21      facilities.

22             SENATOR RIVERA:  Right.  So I want to

23      understand that particular proposal a little bit

24      better.

25             So what is the -- could you break down what







                                                             87
 1      that particular proposal would be, as in, what are

 2      the changes that you propose as a recommendation to

 3      us?

 4             TARRAH QUINLAN:  Right, right.

 5             So we would propose that -- the ability to

 6      train.

 7             There is already a training program for med

 8      techs established.  So allowing them to take that

 9      program, and then utilize it in skilled nursing.

10             It would require state legislative and

11      New York State Education Department changing

12      education law and public health law.

13             SENATOR RIVERA:  And this would be -- the

14      change would be -- what would be the change,

15      exactly, that you would be proposing?

16             So you're saying it exists in another

17      setting?

18             TARRAH QUINLAN:  They -- they're not allowed

19      currently in a nursing home.  Just nurses are

20      allowed to give medications.

21             So it would have to be written, to allow

22      medication technicians, who are properly trained and

23      certified, to then also administer within the

24      nursing home.

25             SENATOR RIVERA:  Okay.







                                                             88
 1             STEPHEN B. HANSE:  And you'll see, attached

 2      to the testimony, we have a chart with the

 3      recommendations.

 4             And that actually -- yep, you got it,

 5      Senator.

 6             That speaks to the regs.  That speaks to --

 7      that bill was a bill introduced several years ago.

 8      That's not a 2021.

 9             SENATOR RIVERA:  And did you get this to us

10      electronically as well?

11             STEPHEN B. HANSE:  I'm sorry?

12             SENATOR RIVERA:  Did you get this to us

13      electronically as well?

14             STEPHEN B. HANSE:  No.  But I'm happy to do

15      so.

16             SENATOR RIVERA:  You can share with us

17      electronically?

18             STEPHEN B. HANSE:  Sure.

19             SENATOR RIVERA:  I'd appreciate that.

20             STEPHEN B. HANSE:  Absolutely.

21             SENATOR RIVERA:  Thank you, Madam Chair.

22             SENATOR MAY:  Anyone else?

23             Senator Borello.

24             SENATOR BORELLO:  Thank you.

25             And thank you-all for being here today.







                                                             89
 1             I want to talk a little bit more about the

 2      HERDS reporting.

 3             I mean, obviously, we're talking about

 4      workforce.  We're talking about hours spent with --

 5      you know, with your residents.

 6             And I know this is something that's been

 7      around for a while, but it's my understanding this

 8      was switched to a daily reporting during the

 9      pandemic.  And it's still a daily reporting burden.

10             So can you just, I guess, being that you are

11      in the industry, and you know what it was like

12      before, how can -- how can -- what would be best to

13      do so it doesn't burden you so much, but the data is

14      still there?

15             LISA VOLK:  Tarrah talked a little bit about

16      this.

17             Some of the data that's reported already in

18      the daily HERDS survey is being reported at a

19      federal level.

20             So it's about kind of sharing that data, that

21      would be number one.

22             Number two, they don't need to do this for

23      seven days a week.  I mean, no one has a weekend off

24      anymore.

25             I mean, we have discussions with







                                                             90
 1      administrators and directors of nurses, saying,

 2      Now, I can't do anything after -- you know, until

 3      1:00, you know, because I have to have this

 4      submitted.

 5             I mean, their families are on hold.

 6             I mean, it's -- at this point, we could

 7      reduce it.  The rates have come down.  And we

 8      certainly could reduce that to even something during

 9      the week, and not involving the weekends.

10             They've been through a lot.

11             And to continue to do this, I mean, it's not

12      warranted at this point.

13             SENATOR BORELLO:  What was it prior to the

14      pandemic?  I mean, how frequently did they have to

15      report this information?  And was it more -- is it

16      more detailed now?

17             I think people need to understand what a

18      burden this really is.

19             TARRAH QUINLAN:  Yeah, so, you know, prior to

20      the pandemic -- and they still have to do this now.

21      So, again, we're talking about multiple places,

22      you're reporting the same information.

23             So prior to the pandemic, if there was an

24      infectious disease, you completed what is called a

25      "NORA" report, and you reported that to the Bureau







                                                             91
 1      of Communicable Diseases.  That makes epidemiology,

 2      everyone, aware of the issue.  That then gets told

 3      to the regulatory people.

 4             So, really, the HERDS survey previous to

 5      this, you more saw it with coastal storms, that sort

 6      of thing, you know, and how they're getting ready to

 7      prepare, that sort of thing.

 8             I have not seen, you know, at least in my

 9      time, working with the department, the HERDS

10      utilized in this way for such a long time.

11             And I just want to say, it's been since March

12      of 2020; so, over -- pretty much a year and a half

13      that, every single day of their lives, they're being

14      taken away.

15             And this is not a short survey, either.

16             This is not a survey that you're answering

17      yes, no, yes, in five minutes.

18             It's a very long survey.

19             And to add on top of that, if you had any

20      technical difficulties, then engaging the

21      department, and getting that fixed.

22             So it is quite time-consuming.  And it does

23      take, like I said, this is your DON doing this

24      report, your infection-control nurses; the people

25      who should really be with the residents.







                                                             92
 1             You know, I think it gives the impression

 2      that paperwork is more important than resident care.

 3             SENATOR BORELLO:  Well, it is government, so,

 4      you know, I'm sure that's the case.

 5             STEPHEN B. HANSE:  And I would just like to

 6      add, what we're seeing, and Tarrah makes a really

 7      critical point:

 8             These are clinical staff compiling and

 9      filling out these surveys.  And time and time again,

10      and I have a file full of them, they have to be

11      reported by 1:00 on a daily basis, seven days a

12      week.

13             There's case after case, 1:01, 1:02, where

14      the nurse hit the button, and it's officially late.

15      And the letter that comes from the Department of

16      Health to that facility is extremely threatening.

17             It basically says, we're going to charge you

18      $2,000; we're going to consider taking away your

19      license.

20             And it's that -- and we respond back.

21             There was a case where a resident -- the

22      nurse was, in almost every case, is providing care

23      to a resident, and we explain that, we can document

24      that; and it's disregarded.

25             You are a minute late.  It's $2,000, and







                                                             93
 1      we're going to take a look at your license.

 2             It's that type of atmosphere that only

 3      exacerbates people wanting to leave.

 4             Why do I want to work in this?

 5             Here I am, providing all this care in a

 6      pandemic.  I was providing care to a resident, and

 7      this is the thanks I get.

 8             So, I mean, it just adds to the myriad of

 9      issues our workers are dealing with.

10             SENATOR BORELLO:  Thank you.

11             SENATOR MAY:  Senator Serino.

12             SENATOR SERINO:  Thank you, Senator.

13             And, Lisa, this question is for you.

14             You know, during the pandemic, as you said,

15      the State allowed the workers to come in from out of

16      state during the emergency, just to work

17      temporarily.

18             But -- and I love your idea about the compact

19      licensure.  I think that's awesome.

20             But the last I knew, the nursing homes still

21      had not gotten any guidance with regard to those

22      out-of-state employees.

23             Have you heard anything on that?

24             TARRAH QUINLAN:  I know at this point they

25      were told they did not have to let them go at this







                                                             94
 1      point; that they were working that out.

 2             So they still have those nurses present.

 3             But it is true, there is not anything

 4      formally written, that I'm aware of.

 5             LISA VOLK:  They did provide to us some

 6      mechanisms to check their application status.  And

 7      we advised those particular individuals to make sure

 8      they're sharing that with the facilities, to make

 9      sure they can see where they're at in the

10      application process for New York State.

11             But, you know, there was a variety of nurses

12      from different states that came over to help us, and

13      we sure would like to keep them.

14             SENATOR SERINO:  Oh, absolutely.  And that's

15      why I love that idea.

16             I know I sent a letter to the governor and

17      the Department of Health, asking that question, and

18      many others.  And I haven't gotten a response.

19             So I'm glad you got a little bit of a

20      response.

21             But, also, when we talked about the staffing

22      shortage, sort of building off of what Senator May's

23      question, you know, we'll spend a lot of time today

24      talking about that, health-care staff in particular.

25             But are there additional staff that can be







                                                             95
 1      brought in to take some things off of the

 2      health-care team's shoulders?

 3             You know, like, we saw a lot displaced

 4      workers, people that worked in hospitality.

 5             Are there people that could answer the

 6      phones, maybe?

 7             You know, that was a big thing -- right? --

 8      families were calling constantly.

 9             Things like that.

10             Or even to facilitate some visitation.

11             And, you know, I don't know if there's a way

12      to incentivize them, maybe to do that.

13             And, also, we talked about the childcare

14      issues.

15             And one thing I've heard from staff is the

16      transportation issues, and an inability to get to

17      and back from work.

18             Do you experience that in your network?

19             And do you have any suggestions, that -- what

20      we can do on that issue?

21             I guess that's for all of you.

22             LISA VOLK:  So there are a variety of things

23      that facilities are doing.

24             We have the paid feeding-assistance program.

25      And so we have people coming in to help feed, which







                                                             96
 1      is a critical need during those -- during the hours

 2      of meals.

 3             And, yes, a lot of them employ, under a

 4      different name, ambassadors, or helping hands, to

 5      help from the ancillary standpoint, with answering

 6      phones, or, potentially, calling families back,

 7      et cetera.

 8             Extra pair of hands out there.

 9             Maybe to help deliver linen to the rooms;

10      something that does not take a skilled level.

11             So there are programs, and facilities are

12      really taking advantage of everything they possibly

13      could take advantage of right now.

14             SENATOR SERINO:  So that's already in the

15      works?

16             LISA VOLK:  Yes.

17             SENATOR SERINO:  That was happening during

18      the pandemic?

19             LISA VOLK:  Yep, yep.

20             Yes, yes, yep.

21             SENATOR SERINO:  Okay.

22             STEPHEN B. HANSE:  As far as the

23      transportation goes, in our rural areas, it is very

24      difficult.

25             We have administrators who I know, and have







                                                             97
 1      spoken to, who will drive to pick up staff

 2      themselves.  And they'll make the rounds in rural

 3      counties and communities, to pick up staff who have

 4      no access to public transportation; or her car, for

 5      that matter.

 6             SENATOR SERINO:  Yeah, that's a big issue in

 7      my area.

 8             We have a lot of rural areas, too, throughout

 9      the state.

10             So, thank you.

11             SENATOR MAY:  All right.

12             Well, thank you very much for your testimony.

13             And we'll be following up on some of the

14      issues that you raised.

15             STEPHEN B. HANSE:  Thank you very much.

16             TARRAH QUINLAN:  Thank you.

17             SENATOR MAY:  Next on our list, we have

18      Gene Hickey, and a late-minute addition of

19      Francine Streich.

20             EUGENE HICKEY:  Good morning.

21             My name is Eugene Hickey.  I'm the

22      secretary-treasurer for Local 2013 out of Brooklyn,

23      New York.

24             We currently represent about 13,000 members

25      in the five boroughs.  44 percent of our members do







                                                             98
 1      come from the health-care industry, so we're very

 2      engaged in that.

 3             We wanted to share some problems that we're

 4      having with a particular employer, Link Homecare.

 5             Link Homecare has been a bad actor over the

 6      last few years; not coming to contract agreements,

 7      not recognizing the hard work of our home health

 8      aides.

 9             Currently, they have about 600 hard-working

10      home health aides who work there at Link.

11             The health-care professionals, they worked

12      through the pandemic; they've worked hard.  They

13      went with little or no support from Link.

14             Under their management, their management,

15      Hillel Adelman, we believe he needs to have a closer

16      look from the DOH and the Department of Labor.

17             Typically, they don't provide people with

18      full-time work schedules.  They're always recruiting

19      people.

20             And what this causes, is that the aides

21      constantly move on because they need to find

22      supplemental work, because 20, 30 hours a week is

23      not going to pay their bills; and they are

24      minimum-wage workers.

25             This causes a bad experience for their







                                                             99
 1      patients because the provider is constantly a

 2      different person, so there is no continuity with the

 3      patient.

 4             Our members even report to us that there's

 5      such a bad communication with Link.

 6             They call the case manager.  They want to

 7      find out, what's the condition of the patient?

 8             They are not given any medical information

 9      for them.  They're not given health-care plans,

10      which we believe are required by the State and by

11      regulation.

12             Members are having difficulty getting into

13      the homes of our patients.

14             Patients refuse the care to come in.

15             Typically, our aides try to call the office.

16             They get no answers from the case manager; no

17      leadership gives them any guidance.

18             And they often have to call 911 to gain

19      access into the patient's home.

20             Typically, our members, they work from a

21      location that is a member's home, which is -- excuse

22      me, which is the patient's home.

23             And the training that they're given is very

24      inadequate.  They're given very little training.

25      It's all done online, even before the pandemic.







                                                             100
 1      There is no hands-on training done at the facility

 2      for Link.

 3             Our understanding is, that if it's necessary,

 4      or if someone complains, they try to send them out

 5      somewhere to get that training.

 6             We believe it should be done in-house with a

 7      setting that is appropriate for the home health

 8      aides.

 9             Link management, you know, one of our aides

10      reported us -- to us that they have not had a care

11      plan handed to them by Link in five years of

12      employment.

13             This is truly a concern of ours.

14             Without that health-care plan, it's hard for

15      the aide to care for the person.

16             They go there, they have no answers.

17             If there's a medical emergency, they can't --

18      they are told to contact Link.

19             Link does not answer them; they get nothing

20      but voice mails.  And often don't get their

21      questions answered until two to three weeks later,

22      which is way too late.

23             It is unacceptable in our eyes.

24             The aides, we have had aides that worked

25      overnight.







                                                             101
 1             There's a requirement that they get a

 2      five-hour uninterrupted sleep.

 3             Very often we hear from the aides, they

 4      didn't get the five hours' sleep.

 5             There's no compensation, and there has been

 6      no resolution to that as of this date.

 7             You know, on a note, that we're trying to

 8      resolve these -- a lot of these issues through our

 9      bargaining table.  We've been in negotiations with

10      Link Homecare for over two years.

11             For two years we have tried to get FMCS

12      involved, to get some resolution there.

13             That has not happened.

14             Right -- currently, now, we have an unfair

15      labor practices filed with the NLRB.

16             We're trying to put all our toolboxes and all

17      our tools out there to get it.  But we have not had

18      any success at the table for two years.

19             The company, also in negotiations, has not

20      agreed to sign an extension, which resulted in a

21      contract being expired.

22             By the contract being expired, it cheats our

23      employees out of the grievance process.

24             So we can't even grieve that they're not

25      getting the proper pay, the proper sleep, or the







                                                             102
 1      proper equipment.

 2             SENATOR MAY:  Okay.  Your time is up.

 3             We have a bunch of questions.

 4             Did you want to say anything?

 5             FRANCINE STREICH:  I was just going to add on

 6      something about PPE, because during the height of

 7      COVID, you know, our members were put in very

 8      dangerous situations.

 9             In order to -- the only PPE that they were

10      able to pick up was masks.

11             They weren't given gloves, they weren't given

12      gowns.  They had to pay for that out of their own

13      money.

14             To go pick up those masks, they had to travel

15      to the Link office, which is far from their homes.

16      They wouldn't get compensated for the travel time,

17      or for the time they took, you know, on their own to

18      go pick up their PPE.  And then they weren't given

19      any instruction on how to use the PPE.

20             So one of our members was working with a

21      patient who was positive for TB; was never told, and

22      was in there without gloves or a gown.

23             So, you know, our workers were deemed

24      essential workers, but the way they were treated by

25      this bad home care agency certainly didn't make it







                                                             103
 1      seem that they were essential workers.

 2             And like Gene said, we tried to negotiate

 3      pandemic pay for people, and we couldn't get it.

 4             So not only is PPP not reimbursed, but

 5      they're owed money.  They're owed time on vacation,

 6      they're owed time on time off.

 7             We don't even think that the wage parity is

 8      working the right way.  And we can't tell because

 9      people are now getting electronic pay stubs, which

10      they can't read.

11             So when they try and get information from

12      Link, they're not getting any help because they

13      can't reach anyone in the office.

14             So, you know, there's a lot of problems that

15      these 600 home health aides are facing.

16             SENATOR MAY:  Thank you.

17             I'm going to turn it over to Senator Ramos

18      for the first questions.

19             SENATOR RAMOS:  Well, thank you so much for

20      coming all the way up to Albany to share all of this

21      information with us.

22             I am very troubled by everything that you are

23      sharing with us in your testimony.

24             And I'm wondering if you can start by

25      describing a little bit more about what your







                                                             104
 1      600 members employed by Link look like, and do, and

 2      sort of what their -- the nature of their work is;

 3      perhaps what a day in the life of looks like for

 4      them?

 5             EUGENE HICKEY:  Yeah, basically, our home

 6      health aides, their day starts off, they leave from

 7      their home, they have to travel to their patients.

 8             Their main workload is, that they would go

 9      and take people's vitals.  Make sure they're taking

10      medicines.  Instruct them on how to care for

11      themselves.

12             Most of our home health aides, not even --

13      there's no area provided for lunch for them.  They

14      have to bring their own lunch.  A lot of times what

15      they do, is they have to order out their lunch,

16      which is expensive.

17             And, remember, we're talking about

18      minimum-wage workers.

19             They're very -- they're very diligent people

20      because they do this work because they love that.

21             They look like me, they look like Francine,

22      they look like you guys.

23             These are everyday people that have a genuine

24      concern for people's health, safety, and well-being.

25             It's God's work, we all know that.







                                                             105
 1             SENATOR RAMOS:  Now, at some point, you did

 2      have a collective bargaining agreement?

 3             EUGENE HICKEY:  Yes.

 4             SENATOR RAMOS:  And that's been expired for,

 5      now, two years?

 6             EUGENE HICKEY:  For two years we've been

 7      trying to negotiate.

 8             SENATOR RAMOS:  And what has that campaign

 9      looked like in order to obtain a new CBA?

10             EUGENE HICKEY:  Well, when we first started

11      negotiating, we worked off of getting an extension

12      in place so we could keep all the processes in

13      place, such as grievances.

14             And we also have an issue with them not

15      submitting dues, forwarding dues to us, actually

16      trying to cause an economic hardship on the union.

17             And, also, it's denying people access to

18      health and welfare that really do need it.

19             We typically notify the company six months

20      prior to expiration, which we did, that we were

21      willing to bargain.

22             We sent a list of proposals that were put

23      together from the HHAs, from surveys we did with

24      them.

25             We've had bargaining-committee people there.







                                                             106
 1             We presented all these things.

 2             We are also represented by an attorney.

 3             And we have tried to work through this for

 4      almost two years.

 5             And in midstream of the first year, they

 6      fired their attorney, and restarted the whole

 7      negotiations by hiring a new attorney.

 8             So that kind of staggered it a little longer

 9      than need be.

10             SENATOR RAMOS:  Did the original CBA provide

11      for health benefits for this workforce?

12             And have those services been interrupted

13      because of the expiration of the agreement?

14             EUGENE HICKEY:  Yes, it always did have

15      health and welfare in there.

16             People have not gotten health and welfare

17      because their -- the contract is expired.

18             Actually, we just had to send Link to

19      collections on some money that they owed for health

20      and welfare; they weren't paying the premiums.

21             And we just had to send them to our

22      collections lawyer.

23             FRANCINE STREICH:  And, in fact, at an

24      orientation that I just went to this week, where

25      they bring in new members --







                                                             107
 1             That's the one place that we're able to talk

 2      to the aides because it's before they're actually

 3      assigned.

 4             -- they were all being encouraged to sign up

 5      for Medicaid, which they shouldn't be telling them

 6      to do that.

 7             And I had to tell the person, "You know

 8      you're not supposed to do that."

 9             So, you know, they're not -- they don't

10      follow the guidelines.

11             And, you know, the majority of our workers

12      are women -- immigrant women, women of color -- and

13      I think Link takes advantage of our members.

14             SENATOR RAMOS:  Have there been any

15      conversations about oversight with the Department of

16      Health and Mental Hygiene, and what have those been

17      like?

18             What type of oversight have they been able to

19      provide, particularly throughout the pandemic when

20      none of these workers have had access to health

21      insurance?

22             FRANCINE STREICH:  Yeah.

23             EUGENE HICKEY:  Yeah, and we have been going

24      through a lobbyist group to try to find what's the

25      right organization to go to complain.







                                                             108
 1             We have had a lot of conversation --

 2             SENATOR RAMOS:  I'm sorry.  You've hired a

 3      lobbyist to tell you where to go to complain?

 4             EUGENE HICKEY:  Where to file the complaints.

 5             SENATOR RAMOS:  I'm sorry about that.

 6             EUGENE HICKEY:  Right, because, you know, we

 7      wanted to go to the right organization.

 8             We've made calls to different organizations,

 9      and they -- it wasn't helpful to us.  We were told

10      they were overseen by the Department of Health.

11             SENATOR RAMOS:  And how many of your members

12      passed away during the pandemic, employed by Link?

13             FRANCINE STREICH:  Well, total, we had

14      50 that passed away.  But we had close to a thousand

15      came down with COVID.  And that's just what we were

16      able to find out.

17             You know, Link wouldn't report it to us.

18             So that's counting some of our other -- you

19      know, our other workers as well.

20             Many of our other places would tell us, you

21      know, how many people came down with COVID.

22             One of the aides told me this morning that

23      they weren't given any information about how they

24      were supposed to report COVID cases.

25             So I don't even know if Link was getting that







                                                             109
 1      information.

 2             SENATOR RAMOS:  And so when --

 3             [Simultaneous talking; indiscernible.]

 4             SENATOR RAMOS:  -- sorry.

 5             When the pandemic started, and, you know, we

 6      reached the peak quite quickly here in New York, the

 7      State Department did not provide any sort of

 8      guidance to any of the Link employees on how to do

 9      their job in a safer way?

10             FRANCINE STREICH:  Not -- not that we're

11      aware of.

12             I mean, we provided information.  I mean, we

13      put things on our website.

14             You know, we had difficulty accessing the

15      members because, for years, Link was hiding the list

16      from us.  So even though there were 600 workers,

17      they only had -- we were only collecting dues for

18      100 -- or 180?

19             EUGENE HICKEY:  About 180 folks.

20             FRANCINE STREICH:  You know, people that we

21      knew of.

22             So they were hiding, for years, all of these

23      workers.

24             So we finally, in this last bargaining, got

25      the list.  And then it was trying to reach out to







                                                             110
 1      people, give them information about COVID safety.

 2      You know, on our website, we have a lot of

 3      information.

 4             But, for years, we weren't able to even

 5      contact them because they were being hidden from us.

 6             They don't go to a central place for

 7      training, so we couldn't even go find them there.

 8      It's all online.

 9             So we did have people doing 311 calls during,

10      you know, the height of COVID, to complain about

11      PPE.

12             And, you know, we can't file as a group with

13      the Department of Labor, but we are helping people

14      get together their pay stubs and their proof,

15      because a lot of them are owed money.

16             SENATOR RAMOS:  Well, I'm probably out of

17      time by now, but I'm very interested in helping you.

18             So --

19             SENATOR MAY:  Three more minutes.

20             SENATOR RAMOS:  -- oh, I have three more

21      minutes?

22             Oh, that's the clock.

23             Thank you.

24             Well, I don't know, I mean, perhaps, is there

25      any other information that would be helpful to me,







                                                             111
 1      as the Labor Chair, in order to help you, and

 2      better -- and for everyone here, particularly the

 3      press, to understand what's going on at this

 4      facility -- or, I think, with this employer?

 5             EUGENE HICKEY:  Yeah, we definitely need --

 6      we need help to get these folks to the table, and to

 7      agree.

 8             We get to an agreement that everybody was

 9      with happy at the table.  Their attorney goes back

10      to Mr. Adelman.  And then we hear radio silence

11      for a month or so, until we start calling, filing

12      more charges.  Then they finally come to the table.

13             FRANCINE STREICH:  And they forget everything

14      they said.

15             EUGENE HICKEY:  And then -- yeah, and then

16      renege on everything they say.  They constantly

17      changed their position.

18             Once we thought we had a deal, where we had

19      everything, everybody laid out, where there would be

20      health care or a retirement program, a little bit of

21      raises.

22             We signed off on the MOA.  We sent it to the

23      company approximately 60 days ago.

24             We still have not gotten an answer from Link.

25             SENATOR RAMOS:  Can you very quickly tell me







                                                             112
 1      about your retirement plan for your members?

 2             EUGENE HICKEY:  The retirement plan they

 3      currently have is none.

 4             We implemented -- what we would like to

 5      implement is a 401(k) plan.  The company is willing

 6      to do that, so they say at negotiations, "but with

 7      no match," which we believe needs to be matched.

 8             FRANCINE STREICH:  And they were saying,

 9      five years, no raises.

10             I mean, this was their position until we got

11      them down to three years.

12             I mean, they're a really bad actor, and we

13      don't know what they're doing with all of the money.

14      They even got some PPP money, and we don't know what

15      they did with it.

16             You know, our members are not getting

17      reimbursed for, like, if they're taking a patient to

18      a doctor.  We've even heard family members complain

19      that they haven't gotten reimbursed for that.

20             So there's something with the money going on.

21             SENATOR RAMOS:  Do you even -- do you know

22      the name of their attorney?

23             EUGENE HICKEY:  Yeah.  I can get you the name

24      of [indiscernible].

25             SENATOR RAMOS:  Okay.  Please do.







                                                             113
 1             Thank you.

 2             SENATOR MAY:  All right.  Thanks.

 3             I'm going to follow up, just quickly, because

 4      I want to -- I hear stories like this all the time

 5      about home care workers.

 6             But you represent thousands of other home

 7      care workers --

 8             Is that true?

 9             FRANCINE STREICH:  And other workers.

10             SENATOR MAY:  Yeah.

11             -- who don't have these problems, who do get

12      five hours of sleep a night, who do get travel

13      reimbursement?

14             EUGENE HICKEY:  We actually represent

15      three other home health aide organizations that we

16      have a working relationship with, and have not had

17      any of these problems with them.

18             SENATOR MAY:  Okay.  Well --

19             EUGENE HICKEY:  They all come to the table,

20      we bargain, we got collective bargaining agreements

21      in place in the others.

22             SENATOR MAY:  Well, I just want to say that's

23      a testament to how valuable collective bargaining

24      is, because so many home care workers who aren't

25      represented report exactly these kinds of problems







                                                             114
 1      all the time.

 2             So I want to thank you for the work you do to

 3      help the workers who are under your umbrella to get

 4      those kinds of protections, because they're so

 5      important.

 6             FRANCINE STREICH:  And just to emphasize what

 7      Gene said, the fact that they won't process

 8      grievances now, almost makes it as if they don't

 9      have a union.

10             So we have all -- you know, I talked to

11      people this morning.  You know, they're owed pay.

12      They're owed -- you know, they're having problems.

13      And because they won't process grievances, you

14      know...

15             EUGENE HICKEY:  Right.  That's our mechanism

16      to resolve issues.  And, apparently, they don't want

17      to resolve the issues, or else they would come to

18      the table, come to an agreement.

19             Not even come to an agreement, but at least

20      sign an extension, keep the existing contract in

21      place, while we work through the issues.

22             They refused to do that.

23             So it's very important that, as Francine

24      said, these folks, they feel like they don't have

25      anybody.







                                                             115
 1             For years, we've chased after Link.

 2             They've hidden somewhere between 400 members,

 3      which we finally did get in contact, that never knew

 4      that they were part of a union; they were never

 5      told.

 6             SENATOR MAY:  Okay.  Thank you.

 7             Senator Serino.

 8             SENATOR SERINO:  Thank you, Senator.

 9             You know, I receive so many phone calls from

10      health-care workers regarding gloves.  Right?

11             That is mind-blowing because that should be a

12      basic priority.

13             And during last year's hearing on nursing

14      homes and the residential health-care facilities,

15      that was a huge part of our discussion, was the lack

16      of PPE training.

17             And I was just wondering, have you noticed

18      any change on that since then, since last year?

19             FRANCINE STREICH:  Not with Link.

20             EUGENE HICKEY:  No.  No.

21             The only changes that occurs, when that --

22      when a field director has gone to the facility and

23      actually embarrassed them.

24             We've actually brought gloves to facilities

25      to hand them out.







                                                             116
 1             But you're right, it's a basic need of

 2      protection, it's your first line of protection.

 3             And these folks are out there with no

 4      protection.

 5             FRANCINE STREICH:  Yeah, even in our

 6      assisted-living facilities, where we represent

 7      workers, I mean, it's better, but it's still, like,

 8      controlled.

 9             They have to go through a manager if they

10      need it.  And oftentimes they're afraid to ask the

11      manager.

12             So, you know, it's not easy to get the PPE

13      that they need.

14             Masks, yes.

15             Gloves and gowns, no.

16             SENATOR SERINO:  That's absolutely

17      horrifying.

18             FRANCINE STREICH:  Yeah.  Or they're the

19      wrong gloves, let me say that.

20             We have places where they're wearing gloves

21      that they've gotten, and they're open around the

22      wrist.  And, you know, they're coming in contact

23      with body fluids.

24             SENATOR SERINO:  And I know that this is

25      obviously a hearing about staffing shortage, but --







                                                             117
 1      and not procedure.  But procedure is so important.

 2      Right?

 3             Because, if you feel like your own health is

 4      at risk, you know, that's going to have quite an

 5      impact on you.

 6             So what suggestions do you have to improve

 7      that training?

 8             FRANCINE STREICH:  Well, I mean, you know,

 9      what our aides would say, is that the online

10      training doesn't work.

11             You know, watching a video, and it's not even

12      like a group Zoom.  I mean, it's, like, they log on

13      themselves to watch this video.  And half the time

14      they'll say, the link -- the Link -- Link's link

15      doesn't work.

16             So, you know, there needs to be more

17      in-person, more hands-on, training.

18             When they're sent out to do the required

19      training that they're supposed to get, they have to

20      pay for it, which is ridiculous.

21             Link should be providing that.

22             So I think that's one thing, is that, you

23      know, the training really needs to be tightened

24      down.

25             But the other thing is that, on an ongoing







                                                             118
 1      basis, Link doesn't have a system to answer calls.

 2             So we just heard the other day, they're

 3      thinking of outsourcing it to a call center, because

 4      they have case manager who has 100 calls that come

 5      in.

 6             Well, yeah, we know they have 100 calls come

 7      in because our members tell us they can't reach

 8      anyone.

 9             So they're not able to get help every day in

10      their jobs.  You know, Link has no system to provide

11      support to people.

12             And I've tried myself, I've called.  I've

13      been put -- you can call the number.  I've been put

14      on hold.  I've been cut off.  They transfer you to

15      another number, it's a voice mail.

16             They can't reach their case managers.

17             And we have families, like a parent of a

18      client/a resident, who is -- she can't reach them

19      either; she can't reach her case manager.

20             So I think they have to -- you know,

21      something has to be done, not only for training, but

22      ongoing support and communication.  And then the

23      whole PPE issue has to be resolved.

24             You know, and they shouldn't have to go on

25      their own time to pick up PPE, and it's not even the







                                                             119
 1      full PPE.

 2             SENATOR SERINO:  No, absolutely, they need to

 3      be protected.  I mean, if they're protected, and

 4      then the vulnerable residents are protected as well.

 5             FRANCINE STREICH:  They're terrified that

 6      they're going to bring something home to their

 7      families --

 8             SENATOR SERINO:  Yes.

 9             FRANCINE STREICH:  -- because they're in

10      homes where the only thing that was required of the

11      patient by Link, was that the patient be wearing a

12      mask, and our, you know, provider be wearing a mask.

13             But then there's people walking around the

14      home who -- who knows what their status is, and

15      they're not required to wear masks.

16             So, you know, this is a big concern when

17      you're going into people's houses: how safe are you?

18             You know, how would we all feel, walking into

19      a home?

20             EUGENE HICKEY:  Yeah.  And we hear the

21      stories from the folks/from the HHAs, that they

22      fear.  Like, they go into the garage or a back

23      porch, they take all their clothes and put them in a

24      plastic bag before they even go home to their loved

25      ones.







                                                             120
 1             A lot of these facilities they go to, it's a

 2      person's home.  So they can't really change their

 3      clothes there like if you were in a factory or

 4      something.

 5             So they're in a pretty awkward position.

 6             And as I think Francine had said, is that a

 7      lot of the folks, you go into their homes, you don't

 8      know what they have because they don't have a care

 9      program, they don't know what's in this plan.

10             Does this person have dementia?

11             Does person have TB?

12             They have no idea what they're walking into.

13             FRANCINE STREICH:  I got a copy of a text the

14      other day from one of our providers who's new.

15             They told her, Can you take this case?

16             You know, she said, Yes.

17             They sent her the patient's name and the

18      address, and that was it.  And then she got there.

19             I said, Well, was there a care plan there?

20      You know, the nurse should leave a care plan.

21             She said, No.

22             SENATOR SERINO:  Oh, my God.

23             FRANCINE STREICH:  So it's, like --

24             SENATOR SERINO:  That's terrible.

25             FRANCINE STREICH:  -- just sending them out.







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 1             SENATOR SERINO:  Well, I hope that gets

 2      resolved, because that's awful.

 3             FRANCINE STREICH:  Yeah.

 4             SENATOR SERINO:  Thank you.

 5             SENATOR MAY:  All right.  Senator Mayer.

 6             SENATOR MAYER:  Just quickly, isn't Link

 7      licensed by the state Department of Health as a

 8      Medicaid home care provider?

 9             FRANCINE STREICH:  Yep.

10             SENATOR MAYER:  And are they not paid

11      Medicaid reimbursement for each of these patients

12      that your members visit?

13             FRANCINE STREICH:  Not all of them; but, yes,

14      most of them.

15             SENATOR MAYER:  The vast majority --

16             FRANCINE STREICH:  Yes.

17             SENATOR MAYER:  -- I would assume are

18      Medicaid?

19             Have you filed a formal complaint at any time

20      with the Department of Health regarding the conduct

21      of Link?

22             FRANCINE STREICH:  This was our first step

23      here today.  And then, yes, that will be the next

24      step.

25             SENATOR MAYER:  But you haven't gone to them







                                                             122
 1      yet, the Department of Health?

 2             FRANCINE STREICH:  Not as a --

 3             SENATOR MAYER:  [Simultaneous talking;

 4      indiscernible] Department of Health.

 5             FRANCINE STREICH:  Not as a union, no.

 6             Individuals, yes.

 7             SENATOR MAYER:  Individuals have gone to the

 8      Department of Health.

 9             And has there been any response?

10             FRANCINE STREICH:  Not yet.

11             Not that we know of.

12             SENATOR MAYER:  And have they gone to the

13      Department of Labor as well?

14             FRANCINE STREICH:  Not yet.

15             SENATOR MAYER:  Okay.  Thank you.

16             SENATOR MAY:  All right.

17             Thank you very much for your testimony, and

18      for bringing this to our attention.

19             EUGENE HICKEY:  Thank you.

20             SENATOR RAMOS:  And we'll follow up, yes.

21             EUGENE HICKEY:  Yes.  And I'll get you their

22      attorney's information.

23             SENATOR MAY:  Next we have, Grace Bogdanove,

24      William Roe, and Tonya Blackshear.

25             All right.







                                                             123
 1             We'll start with Grace.

 2             GRACE BOGDANOVE:  All right.

 3             Well, first, I would just like to thank

 4      Senator May, Senator Rivera, and Senator Ramos,

 5      everyone here, for having us.

 6             My name is Grace Bogdanove.  I'm the

 7      Western New York nursing home division

 8      vice president for 1199 SEIU, United Healthcare

 9      Workers East, out of Buffalo, New York.

10             I'm joined by Tonya and Bill, two of our

11      members.

12             1199 represents over 65,000 nursing home

13      workers across our state.

14             And I appreciate the opportunity to share our

15      union's perspective on the workforce shortages and

16      the challenges in the nursing home industry.

17             Our union played a pivotal role in New York's

18      new requirements for minimum spending on quality

19      care and staffing, as well as the new requirement

20      for minimum hours of care.

21             Adequate nursing home staffing has been the

22      number-one priority for 1199 members for years, and

23      we are hopeful these changes will make a real

24      difference for residents and health-care workers.

25             From our experience, the workforce challenge







                                                             124
 1      in New York is not a result of there being too few

 2      caregivers available.

 3             CMS COVID-19 data for the week ending

 4      June 20th shows that 89 percent of facilities

 5      responding said that there is no shortage of aides,

 6      97 percent said that there was no shortage of

 7      clinical staff.

 8             Over and over again, workers tell us that

 9      facilities are hiring.

10             So instead of a worker shortage, the reality

11      is, that inadequate pay and benefits, poor working

12      conditions, and the inability to have a seat at the

13      table on matters concerning resident care are

14      driving caregivers from the bedside.

15             The real challenge that we're facing is

16      turnover.

17             In 2019, LeadingAge reported that the

18      turnover rate for CNAs in New York State was

19      25 percent; however, regional medians vary, from a

20      very low of 9 percent in New York City, to a high of

21      52 percent in the Buffalo region.

22             So what drives caregivers away from nursing

23      homes?

24             Typically, the pay is inadequate and the

25      workload is overwhelming.







                                                             125
 1             Caregivers do not feel valued or have a say

 2      in how care is delivered.

 3             And, finally, research indicates that working

 4      in a for-profit facility is associated with higher

 5      turnover, likely because these issues are more acute

 6      for workers in the for-profit setting.

 7             We know that higher turnover is associated

 8      with lower-quality care.

 9             Continuity of care is crucial for nursing

10      home residents.

11             Caregivers get to know residents that they

12      see daily, they understand resident needs, and can

13      identify changes in conditions, ensuring a greater

14      quality of care provided to the residents.

15             A 2021 study showed that facilities with the

16      highest median turnover rates had the lowest CMS

17      overall star ratings, and the highest rated

18      facilities had the lowest turnover.

19             If we're going to improve nursing home care

20      in New York, and providers are going to meet the new

21      standards for staffing, we must reduce turnover.

22             Living wages, quality and affordable health

23      care, and a secure retirement are the fundamental

24      features that can keep workers at the bedside, even

25      when other conditions, such as short staffing, are







                                                             126
 1      present.

 2             In addition to quality wages and benefits,

 3      workers must have a voice in how care is delivered.

 4             In the 2018 cost reports, we found the

 5      statewide retention rate for CNAs to be

 6      75 percent, but the statewide average retention rate

 7      for CNAs not represented by a union was lower,

 8      68 percent.

 9             I already mentioned the 9 percent turnover

10      rate for CNAs in New York City.

11             This makes sense.

12             These are largely union jobs, with union

13      negotiated affordable and quality health care and

14      retirement benefits, and a unionized workplace is

15      the vehicle for workers to have a voice in how

16      health care is delivered.

17             As simple as our solutions sound, our

18      experience is that some employers are still doing

19      the opposite.

20             We still bargain contracts with employers who

21      fight tooth and nail to limit increases in wages and

22      benefits.  They then turn around and pay premium

23      prices for per diem and contracted staff because

24      they can't recruit workers at the wages that they

25      pay directly employed staff.







                                                             127
 1             For example, just last year, 1199 members at

 2      a nursing home in Buffalo had to fight for an

 3      improved CNA start rate; a start rate that remained

 4      below $15.

 5             This is a facility whose CEO has an estimated

 6      net worth of over 500 million.

 7             And, recently, 1199 members at two other

 8      facilities in Western New York negotiated for

 9      months, fighting to raise hiring rates with an

10      employer that offers new hires the choice between

11      being in-house employees and working for the agency.

12             We know that many of these agencies are

13      connected to and often owned by the very same

14      network of people who own and operate these

15      facilities.

16             And it should come as no surprise that some

17      of the workers in these facilities are no longer

18      directly employed; but, instead, choose to work

19      through these agencies in order to earn a higher

20      wage.

21             So to reiterate, our recommendations to keep

22      and grow the workforce are:

23             To strongly enforce the new minimum staffing

24      and spending requirements to improve quality jobs

25      and care.







                                                             128
 1             To provide adequate wages, quality and

 2      affordable health care, and retirement security to

 3      caregivers directly employed by the nursing home.

 4             To improve worker engagement and investment

 5      in the workplace by including caregivers in

 6      recruitment, quality improvement, problem-solving,

 7      scheduling, and mentoring new staff.

 8             To improve onboarding, training, and worker

 9      supports.

10             I would like to mention that our training

11      fund focuses on providing these supports.  And we've

12      provided written testimony on this for you to

13      review.

14             And, finally, to support funding increases

15      for nursing home care that are targeted at improving

16      wages, benefits, training, and supports for

17      caregivers directly employed by providers.

18             I'd also like to mention that, in a previous

19      panel, med techs were mentioned as a possible

20      solution; however, this descales LPN labor, and it

21      destroys the CNA-to-LPN career ladder.

22             This is key to retention in nursing home

23      industry.

24             So during the pandemic, some of our

25      facilities engaged their workforces in meeting the







                                                             129
 1      challenge of COVID-19.

 2             In many cases, these facilities did a better

 3      job at protecting both residents and staff.

 4             We're confident that we can do the very same

 5      to meet the workforce challenge of turnover and

 6      retention.

 7             Thank you.

 8             SENATOR MAY:  Thank you.

 9             Mr. Roe.

10             WILLIAM ROE:  Good morning.

11             I appreciate the opportunity to speak before

12      this committee.

13             My name is William Roe.  I'm the son of a

14      marine who served in Vietnam, and my grandfather who

15      served in World War II.

16             I myself, I'm a nurse.  I work in

17      Manhattan -- I work in two nursing homes: one in

18      Manhattan; of course, one in The Bronx.

19             Before my nursing career, I was a stock

20      broker on Wall Street for eight years.

21             Due to 9/11, I worked in World Trade

22      Center I, and I was on my way to work, and I escaped

23      the tragedy.

24             Due to that event, I could no longer continue

25      working in downtown Manhattan, so I changed my







                                                             130
 1      career.

 2             My career was changed.

 3             I was interested in nursing because it was

 4      more fundamentally moral.  And I could help and

 5      benefit people who were suffering illnesses, and

 6      different things like that.

 7             I have a personality, basically, that, you

 8      know, I can basically overlook certain things, and

 9      help people feel better, and overcome their

10      illnesses and their diseases and their downtrodden

11      spirit.

12             Basically, my goal is to improve our

13      residents' health.  But, very often, residents have

14      terminal illnesses, and I'm the last person that

15      they see.  So I try to make their last days brighter

16      days.

17             I try to make their families feel more

18      encouraged that there is a better day coming.

19             Prior to the COVID pandemic, staffing was

20      very good in hospitals and in nursing homes; we had

21      no issue with that.

22             Sometimes we had to send people home because

23      of the staffing situation, the staffing situation

24      was so great.

25             When COVID came, it was a different type of







                                                             131
 1      enemy, because it was in the air.

 2             It was in the air; and, basically, not only

 3      could you get sick, you could bring it home to your

 4      family, and then further progress the situation.

 5             I'm an 1199 union delegate.  And I have to

 6      admit, the COVID pandemic has disturbed the

 7      staffing.

 8             Can you imagine having 40 residents, 1 nurse,

 9      2 CNAs?

10             Can you imagine having a floor that doesn't

11      even have a nurse, and you have to cover your floor,

12      which is 40 residents, and then another floor, which

13      is another 40 residents?

14             This is what this COVID pandemic has brought

15      us.  It's a reality we live with every day.

16             And I'm asking this panel to look into it and

17      to help us out, because times are hard.

18             Unfortunately, some of the workers in the

19      health-care industry, they're not encouraged to come

20      back.  That's one of the reasons of the shortage.

21             Due to the fact that you're putting yourself

22      on the front line, and you're not -- your needs are

23      not being met and your dignity is not being met.

24             Dignity can't be paid.  It cannot.

25             Can't pay for my dignity.  But you can meet







                                                             132
 1      it with a proper wage.  You can meet it with proper

 2      PPE equipment.  You can meet it with respect and

 3      dignity.

 4             Can you imagine, during this time, when they

 5      celebrated the heroes, they gave us T-Shirts and

 6      they gave us pens.

 7             And we were putting ourselves on the front

 8      line, risking our lives.

 9             And to be honest with you, we didn't do it

10      for money.  We did it out of our own self-will.

11             But don't disrespect our dignity by not

12      meeting our needs, and not respecting us and what

13      we're putting ourselves through and the sacrifices

14      that we're making.

15             That's why we're here today.

16             This is the workforce challenge we have to

17      overcome.

18             Workers need to feel they can walk into a

19      facility without risking their health or the health

20      of their family.

21             We need to make sure we have enough PPE and

22      infection-control plans in place, and workers know

23      the plan -- the plans are fully effective.

24             Finally, we need to pay workers wages that

25      reflect both the risk that we'll face -- that we







                                                             133
 1      will face in a nursing home setting when there is a

 2      deadly virus.

 3             And more importantly, we have to pay workers

 4      a wage that recognizes the dignity and importance of

 5      the work we do every day.

 6             If we can keep them safe and pay them the

 7      wages that reflects the importance of the work, they

 8      will come into the facility.

 9             People will be more encouraged to come back

10      into health-care facilities, understanding that

11      they're facing a COVID-19 risk to their very lives.

12             Thank you very much for your time, and

13      understanding.

14             SENATOR MAY:  Thank you.

15             TONYA BLACKSHEAR:  Hi.  Good morning.

16             My name is Tonya Blackshear, and I work as a

17      CNA in a nursing home in Utica.

18             I have been a CNA for over 26 years.

19             26 years may sound like a long time to do a

20      very difficult job, and it is.  But, I like taking

21      care of the residents, and I'm committed to making

22      sure they get the best care they can.

23             Over the years I've gone to school for other

24      health-care positions.  But, from the bottom of my

25      heart, my place was in the nursing home with those







                                                             134
 1      residents.

 2             The challenge is, how do we make sure there

 3      are lots of young women -- and it is women, for the

 4      most part, starting out today -- who will be there

 5      26 from now.

 6             My facility has always struggled keeping new

 7      staff, and the pandemic has made this worse.

 8             It was scary during the pandemic.

 9             I remember when I had to go into a room where

10      I knew the resident was COVID-positive.

11             I cried at first, but I put on my PPE and did

12      what I had to do because the resident needed that

13      care.

14             I was fortunate not to get sick, but some

15      did.  And some quit, and they never returned.

16             Before the pandemic we had a lot of

17      vacancies, and now it's worse.

18             The current staff worked double shifts, come

19      back to the work after catching some sleep, and can

20      be faced with having to do another double.

21             It's brutal on the body, and people are

22      getting hurt, like I did.

23             From my experience, for every ten new workers

24      that came into the building, five don't make it past

25      the probation period, and two make it past the first







                                                             135
 1      year.

 2             We do orientation every week for new staff,

 3      and we average about nine or ten new staff per

 4      month.

 5             That means we are seeing over 100 new staff a

 6      year, but we can only keep -- maybe keep 20.  The

 7      work is simply too hard for what we are paid.

 8             Our employer thinks that because we work in a

 9      poorer area, they can pay us poverty wages.

10             But people can go to fast-food and make more

11      than our starting rates.

12             What's happening now, is our facility is

13      mostly hiring agency staff who get paid a lot more

14      than we do.

15             CNAs start at $13.50 here, and the agency

16      is making over 16.

17             LPNs at my facility are making 18.75, and

18      agencies are coming in making over $28.

19             Also, a lot of long-term staff are switching

20      to per diem because they can make more.

21             They lost their health benefits, but, for

22      them, the extra pay is worth it.

23             We have two agency LPNs who have worked

24      with us on the floor since the pandemic started.

25             They both always said, that if they were







                                                             136
 1      offered their agency rate of pay, they would stay,

 2      be in the house for union employees.

 3             The last time we negotiated a contract, our

 4      employer refused to raise the start rate.

 5             Now they are paying for this by having to

 6      hire agency instead.

 7             I know it takes a special person to work in a

 8      nursing home, but it shouldn't just be that way.

 9             Employers need to value the work we do.

10             Employers need to have to start paying wages

11      that are well above fast-food if they want to keep

12      people who are coming in the door.

13             It's not that there are no workers applying

14      for nursing home jobs.

15             Remember, we are getting about 100 new hires

16      a year.  Employers need to pay them enough so we

17      don't lose 80 of these 100.

18             Thank you.

19             SENATOR MAY:  Thank you.

20             And thank all of you for your testimony, and

21      the work you do, and -- and your stories, which are

22      so compelling.

23             I -- Tonya, I wanted to follow up on a couple

24      of things you said.

25             You talked about working double shifts.







                                                             137
 1             One of the things that we've heard -- that

 2      we've certainly heard during the pandemic, was that

 3      people -- I shouldn't say in the past tense, it's

 4      still going on -- but people were working a shift at

 5      one facility, and then working a second shift, but

 6      not at the same facility, because they couldn't get

 7      overtime pay.  So they were going to a separate

 8      facility in order to make ends meet because they

 9      needed the additional work.

10             Is that your experience, or are people

11      working double shifts and getting overtime pay?

12             TONYA BLACKSHEAR:  Oh, there's some employees

13      that might have did that.  But the employees, that

14      most of them, they liked the job, so they stayed

15      there and did doubles, to make sure the care was

16      getting done.

17             SENATOR MAY:  And did they get overtime pay

18      for that?

19             TONYA BLACKSHEAR:  Yeah, they got -- they got

20      overtime.

21             SENATOR MAY:  And, then, when you talk about

22      the per diem, this is the same as the agencies that

23      you were talking about, Grace?  Is that right?

24             GRACE BOGDANOVE:  So, not quite.

25             For Tonya's case and her facility, the







                                                             138
 1      per diem employees are part of the union, so they

 2      remain union employees.  But they just forego some

 3      of the other negotiated benefits within the

 4      contract, like health insurance and pension.

 5             And, unfortunately, you know, these members

 6      have to make that choice because their paycheck, at

 7      the end of the day, doesn't cut it, and they have

 8      bills to pay.

 9             But no one should have to sacrifice between a

10      quality and affordable health-insurance plan and

11      their pension plan, and making a couple extra bucks

12      on the job.

13             SENATOR MAY:  But that's negotiated by the

14      union as an option for the workers?

15             GRACE BOGDANOVE:  Yep, absolutely.

16             I mean, some of our workers would go agency

17      and have no union job security, and not have, you

18      know, set hours that they could potentially pick up

19      at a facility.

20             So in this contract, the per diems are part

21      of the union.

22             That's not the case in every facility.

23             SENATOR MAY:  And then the agencies that you

24      were talking about are these, essentially, temp

25      agencies that provide workers?







                                                             139
 1             GRACE BOGDANOVE:  Right.  Separate contracted

 2      agencies that, you know, send workers to facilities

 3      to fill open holes.

 4             But, more and more, because there's such high

 5      turnover, agency workers, they have their pick of

 6      shifts.  They can come in and pick up as many hours

 7      as they want, and, really, they could work full-time

 8      hours if they wanted to, and earn that higher wage.

 9             But when they feel that burnout, or when

10      they're tired, they can take a step back.

11             And regular full-time and part-time employees

12      have a commitment to the facility and to their

13      residents, so they continue that work.

14             SENATOR MAY:  And then you said that the

15      agencies were often owned by the same people who own

16      the facilities?

17             GRACE BOGDANOVE:  Sure.

18             SENATOR MAY:  Is that -- that's nursing homes

19      and assisted-living facilities?

20             GRACE BOGDANOVE:  Yes.  My experience is with

21      nursing homes, and that is something that we see

22      frequently, whether it's a relative, or somebody

23      who's somewhat within that network of owners, there

24      is usually a connection to several of these

25      agencies, where owners of facilities have a familial







                                                             140
 1      or work relationship that connects them to the

 2      agencies that they contract with.

 3             SENATOR MAY:  Okay.  That's really helpful to

 4      know.

 5             I wanted to just end by asking you

 6      about something that I have read about in

 7      Washington State.

 8             SEIU in Washington State has a

 9      labor-management partnership with the State of

10      Washington, with private health-care industries, and

11      created a training -- health-care northwest training

12      partnership, that I'll just read how they describe

13      it.

14             "The nation's first large-scale career

15      pathway program for home care aides" --

16             This is about home care, but I think it also

17      applies to the aides who work in nursing homes as

18      well.

19             -- "so that they work together to create an

20      apprenticeship, and have brought in 3,000 new

21      apprentices over the last five years."

22             So I was wondering if there is anything like

23      that, that SEIU is thinking about, in terms of

24      collaborations with the State, with the facilities,

25      in order to create -- I guess I don't know to what







                                                             141
 1      extent the union is involved in actually recruiting

 2      new people in the field, or do you just represent

 3      people once they have decided to enter this work.

 4             And would you be interested, if this were a

 5      model that we could try to import here to

 6      New York State?

 7             GRACE BOGDANOVE:  Sure.  Absolutely.

 8             I can actually cite two examples for you, one

 9      in Syracuse and one in Buffalo, where we have LPN

10      apprenticeship programs.

11             We have partnered with management at two of

12      our nursing homes in the upstate region, to actually

13      create a way for CNAs to go to LPN school; remain

14      employed as CNAs while going back to school --

15      right? -- keeping their jobs and their benefits, so

16      that we can help them move upwards on that career

17      ladder.

18             That's a joint effort between union,

19      management, and with the help of our training fund.

20             So that's where I mentioned our training fund

21      is ahead of the game on this.  And we're very

22      involved, and very excited to continue this work.

23             We need employers to work with us.

24             SENATOR MAY:  Great.

25             Thank you very much.







                                                             142
 1             SENATOR RAMOS:  I actually want to begin by

 2      acknowledging your ability to come here and testify

 3      today, perhaps taking a day off from work.

 4             You know, we've -- up until this moment,

 5      we've really only heard from health-care executives;

 6      but not the actual rank and file, not the actual

 7      people doing the work of caring for others.

 8             So I just want to thank you for taking the

 9      time, and acknowledge the fact that you're able to

10      do this because you have a union to take care of

11      you.

12             And I'm wondering if the union has had any

13      conversations with the second floor, with the

14      governor's office, throughout this pandemic, about

15      hazard pay for your members, and for other

16      health-care professionals, throughout this endeavor?

17             GRACE BOGDANOVE:  Yeah, absolutely, we've had

18      conversations, from the basic level with our

19      employers, to all of our elected representatives.

20             And, you know, many of our employers failed

21      the members over the past year, and did not provide

22      hazard pay, did not provide proper PPE.

23             But we have been exhausting every avenue to

24      make sure that our folks get paid for what they

25      deserve.







                                                             143
 1             SENATOR RAMOS:  You know, I'm -- I used to

 2      work for SEIU, Local 32BJ specifically, for many

 3      years.  And I'm very proud to say I'm probably one

 4      of the few people of my generation who have a

 5      pension to look forward to.

 6             And so I'm wondering if you can describe for

 7      others, what your wages and benefits are?

 8             Because we've heard a little bit about what

 9      it's like to be a non-union worker in this industry.

10             What's it like to actually have a collective

11      bargaining agreement?

12             What does that provide for you?

13             WILLIAM ROE:  Basically, in regards to

14      nursing, a nursing benefit package would include

15      full-time, you get 4 weeks' vacation, you get

16      12 sick days, you basically get 2 personal, and you

17      get your birthday.

18             SENATOR RAMOS:  Nice.

19             WILLIAM ROE:  You also receive, like, for

20      paternity or maternity.

21             In my case, you know, I can't get pregnant,

22      but I had to assist, you know, in the birth of my

23      child.

24             SENATOR RAMOS:  That's right.

25             WILLIAM ROE:  So it's called "paternity" --







                                                             144
 1             SENATOR RAMOS:  That's right.

 2             WILLIAM ROE:  -- not maternity.

 3             SENATOR RAMOS:  Parental leave.

 4             WILLIAM ROE:  So they provide two days --

 5      two or three days for that, paid.

 6             And, basically, we're looking into that to

 7      improve that in the next contract.

 8             GRACE BOGDANOVE:  I would just add, the

 9      national benefit fund, our health-insurance plans,

10      our pension plans, are, you know, key pieces of what

11      we negotiate into our collective bargaining

12      agreements, and are crucial for retention, and for

13      recruitment, into nursing home industry.

14             SENATOR RAMOS:  Tonya, you work in Utica, not

15      in the five boroughs; and, therefore, your minimum

16      wage is very different from ours downstate.

17             Would you argue that perhaps the upstate

18      minimum wage was erroneously made less than

19      New York City, and should actually be the same and

20      leveled throughout the state?

21             TONYA BLACKSHEAR:  Yes.  We argue so much

22      that it should be across the board for everyone.

23             We -- you know, when we come to the tables,

24      we hear the other side, and the lawyers say, "We

25      better be glad that we got a job."







                                                             145
 1             I think that's insulting to say that to the

 2      members, when we work hard, and we fighting at the

 3      table to negotiate, to get what we have to get for

 4      everyone, not just certain people.

 5             So our contract is ending right now.

 6             So, May, we go to negotiate again.

 7             I'm hoping that they boost the pay rate up.

 8             We just got to fight harder and harder so we

 9      can get the members into the building.

10             We can't have them keep going out because you

11      keep wanting to pay -- don't want to pay the right

12      pay rates to these employees.

13             They can go everywhere else to get more

14      money.

15             But sometimes when people at the nursing

16      home, and they feel like these residents are their

17      family.  We don't just come there just for a

18      paycheck, but we still got to survive, too.

19             SENATOR RAMOS:  Yes.  No, absolutely.

20             And thrive.

21             Not just survive, thrive.  Right?

22             TONYA BLACKSHEAR:  Thrive, yes.

23             SENATOR RAMOS:  So what would those extra

24      dollars mean for a family like yours?

25             What would you be able to provide for your







                                                             146
 1      family, or, you know, how would that change your

 2      life?

 3             TONYA BLACKSHEAR:  Well, actually, it would

 4      pay my bills.

 5             I won't have to live for paycheck to

 6      paycheck.

 7             And after that, you know, the bills that

 8      I have past due, I can actually pay on them if I get

 9      a decent rate; or I wouldn't have to borrow from my

10      uncle, my mother, just to strive and pay what I have

11      to pay at home.

12             SENATOR RAMOS:  Uh-huh, uh-huh.

13             Are you a mom, too?

14             TONYA BLACKSHEAR:  Yes.

15             SENATOR RAMOS:  Yes.

16             Is childcare something that you currently

17      have to deal with, or have had to deal with, in your

18      career?

19             TONYA BLACKSHEAR:  Well, back then, because

20      my daughter is 31.

21             So she -- you know, she strives, and she

22      worked in a nursing home, too.  So she had her

23      struggles into a nursing home, too, where she had to

24      pay, make ends meet, too.  But, you know, now she

25      works for the State.







                                                             147
 1             She said she couldn't work for the facility

 2      because they wasn't paying enough.

 3             I mean, I could have went to school for

 4      anything.

 5             I went for phlebotomist.  I didn't want that.

 6             I went for forensic.  I couldn't do that.

 7             I don't know, from -- in the bottom of my

 8      heart, something told me to stay at that nursing

 9      home because these residents depend on me.

10             SENATOR RAMOS:  Uh-huh.  That's very

11      beautiful.

12             It sounds like you found your vocation, and

13      it sounds like it might be your daughter's, too.

14             So she said she's happy working for the

15      State?

16             TONYA BLACKSHEAR:  Yes.

17             SENATOR RAMOS:  What are -- what are -- can

18      you tell us a little bit about her conditions?

19             TONYA BLACKSHEAR:  She went to -- she was

20      working as a regular employee, but she also went to

21      agency, because she said they weren't paying enough.

22             Because she has three children, so she said

23      that wasn't enough for her.  So she applied for the

24      job in Utica, and they moved her to Syracuse.

25             Now she's going for a supervisor position.







                                                             148
 1      And she just bought a house, because she said she

 2      makes more.

 3             SENATOR RAMOS:  Okay.  Well, that's nice.

 4             I guess in my -- what remains of my time --

 5             Thank you, Zach, because I can't see that.

 6             -- I'm wondering if I can -- if we can learn

 7      more about, perhaps, what the union is doing to

 8      organize new workplaces, and what that looks like;

 9      what the hinderances of organizing might be, given

10      how remote, you know, home attendants might be if

11      they're servicing patients in their home?

12             I imagine that it is very difficult because

13      there is no central workplace, necessarily.

14             What's the organizing look like?

15             GRACE BOGDANOVE:  I don't want to steal the

16      spotlight from the home care panel, but, you know,

17      I think it is difficult, from my understanding.

18             That's not my division.

19             I've got the nursing home division.  I can

20      speak to our organizing efforts.

21             SENATOR RAMOS:  Okay.

22             GRACE BOGDANOVE:  You know, for nursing

23      homes, it's a little -- it's totally different than

24      home care -- right? -- because people are in one

25      place, so it's traditional union organizing.







                                                             149
 1             What I will say is that, you know, just like

 2      what we see at the bargaining table with employers,

 3      really, really nickel and diming us, and really

 4      fighting our members on any raise in benefits or

 5      wages, it's just as difficult to organize a new

 6      workplace.  Where our members want to bring a union

 7      into their workplace, employers fight tooth and nail

 8      to keep us out.

 9             And that certainly has not changed.  I think

10      it's maybe gotten worse.

11             SENATOR RAMOS:  How do they do that?

12             What type of methods do they use to keep the

13      union out of the workplace?

14             Do they captive-audience meetings?

15             GRACE BOGDANOVE:  Absolutely.

16             SENATOR RAMOS:  Uh-huh.

17             GRACE BOGDANOVE:  Absolutely,

18      captive-audience meetings.  Right?

19             Bring in consultants.

20             They pay, you know, ridiculous amounts of

21      monies to bring in union-busting consultants, and

22      all of these firms, when, really, the workers just

23      want a seat at the table.  They want a voice in how

24      care is delivered, and in their wages and benefits

25      at work.







                                                             150
 1             SENATOR RAMOS:  Okay.

 2             Thank you.

 3             SENATOR RIVERA:  Hey, folks.  Thank you for

 4      being here.

 5             I just have a couple of questions.

 6             Kind of the centerpiece of your testimony,

 7      actually, was very much I guess in line with what

 8      we've heard from some in the industry earlier, as

 9      far as turnover being the big issue.

10             Obviously, the reimbursement, we've gone over

11      this many times -- right? -- as far as

12      reimbursement.

13             And we've had the conversation about the cuts

14      that happened during the pandemic.  [Indiscernible.]

15             And, certainly, many of us fought to make

16      sure that wouldn't be the case, but, you know, our

17      good governor thought that it was the best way to

18      go.

19             Anyway, as far as reducing turnover, though,

20      obviously, the better pay and better working

21      conditions are a key thing.

22             Also, making sure there's a career path is

23      also part of what you suggested.

24             I wanted to just dig a little bit into the

25      stats, because you don't seem -- you seem to agree,







                                                             151
 1      certainly, a turnover is an issue, but the turnover

 2      is not as high as was said earlier, because there

 3      was certainly a lot of concerning numbers that we

 4      heard earlier, as far as 90 some-odd percent.

 5             Do you think -- do you agree with those

 6      numbers?

 7             Were those -- because, obviously, turnover is

 8      at the core of it, but seems that the stats are a

 9      little bit different.

10             GRACE BOGDANOVE:  No, certainly, I think

11      turnover is a huge issue right now.

12             So, you know, whether our numbers don't line

13      up exactly, it is an incredibly pressing issue.

14             To me, it's one of the most pressing issues

15      right now in the industry.

16             You know, people come in through the door,

17      and so it looks like your staffing numbers are okay,

18      because they're there.  It's their first week on the

19      job, but you've got numbers on the floor.

20             What we're not seeing there, though, is these

21      people have to be oriented to the floor.

22             Do the staff have the time -- the in-house

23      staff, do they have time to orient the new employee

24      properly so that they can really get a sense of the

25      residents, of the layout of the floor, and how







                                                             152
 1      things work?

 2             It's all extra work to have to orient a new

 3      person; and then to see them walk out the door a few

 4      days later, a week later, a month later, like Tonya

 5      was saying.

 6             I mean, turnover is an incredible challenge

 7      right now.

 8             And, you know, people come in through the

 9      door, thinking it might be a rewarding, you know,

10      career, and it certainly is.  But right now, with

11      the way that working conditions are, and with the

12      low pay and poor benefits, it just really isn't

13      worth it for a lot of folks.

14             SENATOR RIVERA:  So as far as the top line

15      here, if we can assure more -- better pay, we can

16      assure better working conditions, and make sure that

17      there's a career path for folks that enter the

18      industry, those are kind of the top -- you would say

19      those are the top-line things?

20             Obviously, each one of those is a very big

21      bucket, but at least those are the top lines, you

22      would say?

23             GRACE BOGDANOVE:  Absolutely.

24             And, you know, I will say there are employers

25      who have recognized that, and who have worked with







                                                             153
 1      1199 -- right? -- to do LPN apprenticeship programs;

 2      to come to the table and say, What is a competitive

 3      market rate that we can offer for CNAs?  Let's

 4      actually put our heads together here, and let's do

 5      this right by these residents.

 6             In the same breath, we have employers who do

 7      the exact opposite; who don't want to work with

 8      1199 members, who cut them out of conversations when

 9      it comes down to how resident care is delivered, or

10      issues on the floor, and who fight us at the

11      bargaining table.

12             SENATOR RIVERA:  And, certainly, having that

13      collective bargaining power actually assures that

14      the folks who work in the unionized workplaces have

15      an ability to do those fights?

16             GRACE BOGDANOVE:  Absolutely.

17             It's a tough fight, but it's one that our

18      members take on every day.

19             SENATOR RIVERA:  And last, but not least, if

20      there was such a thing, I don't know, to guarantee

21      health care for everybody, something, I don't,

22      legislatively, like something called the "New York

23      Health Act," as an example, do you think that you,

24      in your negotiations, would be able to do more for

25      your members, since them, as residents and full-time







                                                             154
 1      employees in the state of New York, would be --

 2      would have health care guaranteed to them?

 3             Do you think that you would be able to then

 4      have better benefits for your members?

 5             GRACE BOGDANOVE:  Sure.  Yeah.

 6             I mean, whether that's, you know, focusing on

 7      improving that pension, or improving the wage rates,

 8      or working on a shift differential, or whether

 9      that's looking at other health-insurance plans --

10      right? -- whatever that is, absolutely.

11             If our members are able to get quality health

12      insurance through the State --

13             SENATOR RIVERA:  No, not quality health

14      insurance, but guaranteed health care.

15             GRACE BOGDANOVE:  Guaranteed health

16      insurance --

17             SENATOR RIVERA:  There's a distinction here.

18             GRACE BOGDANOVE:  -- right? -- then,

19      absolutely, it raises the bar.

20             Anything that raises the bar for our workers

21      allows us to get better for them.

22             SENATOR RIVERA:  Thank you, Madam Chair.

23             SENATOR MAY:  Thank you.

24             Anyone else?

25             Oh, Senator Serino.







                                                             155
 1             SENATOR SERINO:  Thank you.

 2             William, your story really touched my heart.

 3             We need more people like you, and like -- and

 4      Tonya.

 5             You know, during last year's testimony from

 6      SEIU, we heard from a lot of the employees, that

 7      they said they had to actually wear garbage bags to

 8      work, which is so unacceptable.

 9             We have to make sure that, you know, you have

10      the proper provisions, and you're adequately

11      addressing them.

12             And then, Grace, with your -- you spoke about

13      the apprenticeships.

14             How do you let people know about them?

15             Like, do they have to already be in the

16      health-care field, or do you offer some other

17      outreach?

18             Because I love the apprenticeship programs.

19      I think they're awesome.

20             GRACE BOGDANOVE:  Yeah, for those specific

21      LPN apprenticeship programs, they were for in-house

22      CNA's to move forward to get their LPNs.

23             So it was all about the union members who are

24      already in-house, working as CNAs, going through

25      this program to become LPNs.







                                                             156
 1             But there was plenty of, you know, outreach

 2      we did within the community.

 3             We wanted people to know that this program

 4      existed, so that people would consider coming on as

 5      CNAs, entry level, in that way, and then moving up

 6      in the future.

 7             SENATOR SERINO:  Do you go into the schools,

 8      too, to talk to the students?

 9             GRACE BOGDANOVE:  Yeah.  Training fund,

10      I believe all of that would probably be in their

11      written testimony, so I will leave that to them.

12             And if there's any follow-up, I'll make sure

13      we get that information to you.

14             SENATOR SERINO:  Great.

15             Thank you.

16             Thank you-all for what you do.  I really

17      appreciate it.

18             And I can tell you guys have your heart and

19      soul in this, so thank you.

20             SENATOR MAY:  Thank you.

21             Senator Benjamin, and then Senator Borello.

22             SENATOR BENJAMIN:  Sure.

23             I also want to commend you-all on being here,

24      and your comments; and, William, your testimony was

25      very powerful for me.







                                                             157
 1             I used to work on Wall Street, too, and left,

 2      so I completely understand your sentiment.

 3             Well, I have a question for you, actually.

 4             In your testimony you mentioned that, you

 5      know, things were fine before COVID.

 6             And you mentioned, you know, it sounded like,

 7      what I heard from you, I want to make sure I'm clear

 8      on this, that the biggest issue for us to address is

 9      sort of the safety around COVID, the PPE, et cetera,

10      infection-control plans, et cetera, more so than,

11      say, childcare issues, and some other factors.

12             So I just wanted to get your comment on that,

13      to make sure I'm clear on what I heard from your

14      testimony, and how you feel on the ground.

15             Because, I mean, sometimes, you know, we

16      might sit here and have our ideas about what people

17      need.

18             But you're on the ground, so I want to make

19      sure I'm clear on what I'm hearing from you.

20             WILLIAM ROE:  Everyone's situation is

21      different, but there is a priority in terms of

22      safety.

23             Safety is first, that's the priority.

24             So, basically, in the beginning of COVID,

25      institutions and nursing homes, hospitals, they did







                                                             158
 1      not meet the level of the concern of COVID.

 2             You had workers, CNAs, nurses, buying their

 3      own masks, because the masks and the gowns that the

 4      facilities were giving were not worth it, and didn't

 5      provide yourself enough coverage to feel safe in

 6      that type of an environment.

 7             So PPE is a high priority in the nursing home

 8      or in the workplace setting.

 9             Okay.  Childcare, now, life changed during

10      COVID, because schools closed.

11             The school is closed, then you have to think

12      twice about what is going to happen to your kids.

13             They're going to be home.

14             Your schools really played a part in people's

15      lives because they don't have to have a babysitter

16      because the kids were in school.

17             By the time the parent would come home from

18      work, pick the kid up from school, you didn't need a

19      babysitter.

20             But being that the schools closed, childcare

21      became a high priority, and still is, because

22      parents are still reluctant to send their kids to

23      school because of the COVID pandemic.

24             So in terms of our priority, to answer your

25      question, I feel they both -- both PPEs and







                                                             159
 1      childcare, they both hold probably the similar

 2      weights in terms of what people need in their lives,

 3      you know, in terms of your family and in terms of

 4      the workplace environment.

 5             SENATOR BENJAMIN:  Well, let me just say --

 6             I just only had that question.

 7             -- thank you for the work that you do.

 8             I'm honored to be here and hear you speak.

 9             It gives me real, sort of, hope for humanity,

10      that you're out here doing this hard work.

11             You put yourselves on the line, and we owe

12      you a debt of gratitude.

13             And I know myself and our colleagues will do

14      everything we can to treat you appropriately,

15      because you did, and are continuing to do, God's

16      work on behalf of all of us.

17             Thank you.

18             SENATOR MAY:  More than a T-shirt and a pen,

19      for sure.

20             Senator Borello.

21             SENATOR BORELLO:  Well, I want to echo

22      everyone's sentiments, and thank you so much.

23             And, you know, in particular, when listening

24      to you, you know, staring 9/11 situation in the

25      face, making that amazing change in your life, and







                                                             160
 1      then facing a pandemic, which, in the end, took more

 2      lives of New Yorkers than 9/11 -- thank you.

 3             Thank you-all for what you do, for being

 4      frontline workers.

 5             Grace, you know, I'm very familiar with 1199.

 6      I've been to your office a few times.  Worked hard

 7      with your folks, including Peter DeJesus, to fight

 8      back on the closure of a hospital in my district.

 9             So thank you for all that you've done.

10             I just want to address the issue of, which

11      was brought up, roughly, 8 in 10 of the patients in

12      nursing homes are on Medicaid, and we've seen

13      nine consecutive years of rate cuts; the most

14      recent, the only state out of the 50 that actually

15      cut Medicaid reimbursements during the pandemic.

16             So we can talk about how amazing you folks

17      were, but, in the end, you know, that was continuing

18      to burden all of you, and to put more pressure and

19      stress on all of you, on top of the folks that

20      operate the facilities.

21             So my question is:  Has the union stepped

22      forward to speak out against these cuts?

23             And I'm assuming the answer is yes.

24             But I'm just -- the advocacy, and the

25      understanding that this is not just impacting the







                                                             161
 1      ownership.  It's impacting every single one of you

 2      folks that work hard every day, risked your lives,

 3      to care for these -- for our most vulnerable

 4      citizens.

 5             GRACE BOGDANOVE:  Absolutely.  There should

 6      be no cuts to funding for our nursing homes at all.

 7             And, in fact, you know, we would appreciate a

 8      little more funding.

 9             SENATOR BORELLO:  And I agree with you.

10             I mean, you know, we're seeing, last year we

11      passed some reforms to Medicaid non-emergency

12      transportation, which have yet to be implemented.

13             That's millions and millions of wasted

14      dollars in waste, fraud, and abuse that's occurring

15      in that Medicaid non-emergency transportation.

16             That's one that could be directed back to

17      supporting you folks, as opposed to, you know,

18      paying for what is, essentially, fraud that's

19      occurring on a rampant basis.

20             You know, we see it in my district every day.

21             So I would strongly suggest that we continue

22      to, you know, work towards that.

23             We have, certainly, the ability, since we're

24      already -- it's just -- it's a misdirection of where

25      those funds are going.







                                                             162
 1             It's going to this -- to these type of

 2      fraudulent situations.

 3             And even our state comptroller said there's

 4      billions, with a "b," every year in waste, fraud,

 5      and abuse in our Medicaid system; yet we are cutting

 6      reimbursements.

 7             SENATOR MAY:  Well, I want to thank you-all.

 8             I have one more follow-up, which is, when we

 9      talk about misdirection, you -- Grace, you mentioned

10      the salaries of some of the CEOs, and the money

11      spent on consultants, and everything.

12             Here you've got somebody with amazing

13      financial experience in addition to the nursing

14      experience.

15             Have you thought about worker co-ops?

16             Are there efforts to create actual

17      worker-owned facilities?

18             Has that ever been thought of, or tried here?

19             GRACE BOGDANOVE:  It's interesting you should

20      mention that.

21             I know I've read a little bit about some kind

22      worker-agency co-ops that have succeeded elsewhere,

23      not in New York State.

24             So it's certainly something to look into.

25             SENATOR MAY:  You've got all the skills







                                                             163
 1      there, all the knowledge.

 2             Okay.  Well, again, thank you-all for the

 3      amazing work that you do, and for your testimony.

 4             It's been really enlightening.

 5             I appreciate it.

 6             GRACE BOGDANOVE:  Thank you for having us.

 7             SENATOR MAY:  And I echo Senator Ramos, for

 8      taking a whole day to come up here, from your work,

 9      too.

10             So just a little update.

11             We had on the schedule to take a break at

12      12:00, but I would like us to do one more panel

13      because we haven't gotten that far through the

14      program.

15             So we're going to do Panel 5, and then we'll

16      take probably a little shorter break than we had

17      planned.

18             But -- so that's, Sarah Daly,

19      Michele O'Connor, and Doug Wissman.

20             We'll start asking fewer questions.

21             Don't be insulted if there aren't as many

22      questions, moving forward.

23             All right.  We have Sarah Daly to start with.

24             SARAH DALY:  Hello.

25             Good morning, and thank you again to







                                                             164
 1      Senators May, Rivera, and Ramos for convening this

 2      hearing.

 3             My name is Sarah Daly, government relations

 4      analyst at LeadingAge New York.

 5             Many of you know that LeadingAge New York

 6      represents over 400 not-for-profit and public

 7      long-term-care and acute-care providers.

 8             The providers we represent embody the full

 9      continuum of services an individual may need as they

10      age.

11             On behalf of our membership, I thank you for

12      convening this hearing and for the opportunity to

13      provide testimony.

14             As has been discussed all morning, providers

15      across the long-term continuum are facing

16      extraordinary and unprecedented workforce challenges

17      that predate the COVID-19 pandemic.

18             A combination of the state's changing

19      demographics, inadequate reimbursement, competitive

20      labor markets, and regulatory requirements have

21      hindered recruitment and retention of quality

22      workers for many years.

23             Of course, COVID-19 has now exacerbated

24      existing staffing shortages and depleted provider

25      financial resources.







                                                             165
 1             Our members report more severe workforce

 2      shortages statewide than ever before.

 3             They are trying every possible creative

 4      strategy to recruit and retain staff, from signing

 5      bonuses, to career-ladder programs of their own.

 6             Still, they report dozens of open positions,

 7      and few, if any, applicants at this point.

 8             Of course, an important component of any

 9      workforce conversation is wages.

10             New York's long-term-care providers cannot

11      raise wages to compete for workers because they are

12      vastly underpaid by their predominant payer,

13      Medicaid.

14             They have not received a Medicaid

15      reimburse -- Medicaid rate increase since 2007

16      despite rising costs, and have experienced deeper

17      cuts than any other health-care sector, year after

18      year.

19             The 64 million included in the 2021-22 state

20      budget for nursing home staffing is barely a third

21      of the 168 million in annual Medicaid cuts imposed

22      on nursing homes in 2020.

23             As Senator Borello touched on earlier,

24      New York was one of the only states in the entire

25      country that actually enacted Medicaid cuts during







                                                             166
 1      the pandemic.  Most other states did provide

 2      increases of some kind.

 3             The financial stress on long-term-care

 4      providers has been further aggravated during the

 5      COVID-19 pandemic by falling census figures,

 6      extraordinary pandemic-related costs, and the

 7      additional Medicaid cuts enacted in 2020.

 8             Unfortunately, the State has not pursued

 9      comprehensive and proactive investments for

10      regulatory reforms to address our aging population

11      and their needs.

12             Like many individuals who avoid planning for

13      their future long-term-care needs, New York has no

14      plan and has made no investment to address this

15      crisis.

16             Notwithstanding the demographic wave that is

17      already giving up -- driving up demand for services

18      and limiting the supply of workers for the past

19      several years, the State has focused its health-care

20      investments on the acute-care and primary-care

21      sectors, and its budget cuts on the long-term

22      post-acute-care sector.

23             We need resources to bring new workers into

24      the field and to enhance their compensation.

25             As many of our not-for-profit providers do







                                                             167
 1      pay higher than minimum wage as it is, or would like

 2      to pay even more, but they simply do not have the

 3      resources to do so.

 4             Ultimately, our not-for-profit members will

 5      not continue to operate if they cannot safely staff

 6      their facilities, and they will be forced to close

 7      their doors or sell to for-profits.

 8             We've seen this already.

 9             Since March of 2020, the start of the

10      pandemic:

11             We have lost one not-for-profit nursing home

12      in Westchester;

13             Two upstate homes have announced fall

14      closures;

15             At least two are for sale in New York City,

16      as I believe was also mentioned earlier;

17             And several on Long Island have been sold or

18      are in sale negotiation;

19             An assisted-living facility that served

20      Medicaid beneficiaries closed in Western New York,

21      that is a member of ours.  And another is in the

22      process.

23             A number of other nursing homes and

24      assisted-living providers are evaluating long-term

25      viability at this point, given the continuing







                                                             168
 1      financial impacts of COVID-19 and the deficiencies

 2      that were existing beforehand.

 3             If New York is to ensure access to

 4      high-quality care for a growing number of older

 5      adults in our communities, we need to infuse

 6      resources into the system, identify ways to attract

 7      new workers, and implement reforms that enable

 8      optimal use of a limited workforce.

 9             As outlined in detail in our written

10      testimony, LeadingAge New York proposes a

11      multifaceted workforce plan that would include both,

12      substantial investment, and no-cost regulatory and

13      statutory reforms, to reduce barriers to their

14      recruitment, retention, and efficient deployment of

15      nursing home, assisted-living, and home care staff.

16      On the medication -- I know I'm running a little low

17      on time -- but on the medication technician issue,

18      LeadingAge New York does have a bill that we've

19      drafted for that.

20             And we believe it would be a great step in

21      the right direction to, again, enhance the career

22      ladder for CNAs, and help them see kind of an easier

23      step between CNA and LPN.  It's a bit more tangible

24      for them to maybe wrap their minds around.

25             And also, of course, taking the stressors off







                                                             169
 1      of the RNs and the LPNs themselves.

 2             Unfortunately, right now, there are many LPN

 3      vacancies.

 4             So if we can perhaps just train our CNAs a

 5      bit more, again, kind of showing them the way, we

 6      believe that would be a big help.

 7             If there's one point we wish to leave you

 8      with from this testimony, it is that the legislature

 9      must make long-term care its top priority in the

10      state budget for state fiscal year 2022-23.

11             A substantial and meaningful investment of

12      Medicaid and non-Medicaid dollars must be made in

13      long-term care that will enable material increase in

14      wages and associated benefits.

15             Thank you very much for your time.

16             SENATOR MAY:  Thank you.

17             MICHELE O'CONNOR:  Good morning,

18      Senators May, Rivera, and Ramos, and distinguished

19      members of the Senate Aging, Health, and Labor

20      committees.

21             My name is Michele O'Connor, and I am

22      the legislative and policy director for

23      Argentum New York.

24             Thank you for the opportunity to speak with

25      you today, to discuss workforce issues in







                                                             170
 1      assisted-living residences and adult-care

 2      facilities.

 3             Argentum New York is the New York chapter of

 4      Argentum, the largest national association

 5      representing professionally managed senior living

 6      communities.  Argentum New York represents

 7      75 communities across the state, serving over

 8      7,500 residents.

 9             The population is aging nationwide, and

10      New York is no exception.

11             The U.S. Census Bureau projects that by 2060,

12      1 in 5 Americans will be over the age of 65, and the

13      over-85 population will have tripled.

14             The National Investment Center for Seniors

15      Housing & Care estimates that, to take care of this

16      aging population, our country will need to have at

17      least 1.4 million senior caregivers by 2025, which

18      is right around the corner.

19             Currently, 3.2 million New Yorkers are over

20      65, and this population is growing faster than any

21      other age group in the state.

22             As more and more seniors are choosing options

23      that allow them to age in place with appropriate

24      supports and services, including residing in

25      assisted-living residences, supporting and expanding







                                                             171
 1      the frontline health-care and senior caregiver

 2      workforce has never been more critical.

 3             Over the last 18 months, the pandemic has

 4      presented providers with enumerable challenges as

 5      they worked, and continue to work, around the clock

 6      to provide high-quality care, supports, and services

 7      to their residents while protecting them from

 8      COVID-19, which exemplifies how crucial these

 9      workers are in caring for our seniors.

10             One of the greatest challenges providers face

11      is adequate staffing.  Repeated and numerous staff

12      furloughs due to COVID-positive tests and/or

13      exposure, childcare issues, has made it even more

14      difficult to meet the staffing needs of communities.

15             Additional staff has been required of every

16      assisted-living community in the state to meet the

17      infection-control protocols required by the

18      Department of Health, ensure safe visitation, and

19      conduct health screenings for all individuals

20      entering these communities.

21             Even as our providers offer additional hero

22      pay, childcare support, and transportation

23      assistance, they still struggle to ensure

24      appropriate staffing levels in their communities to

25      care for their residents; yet they meet these







                                                             172
 1      challenges every day with no financial assistance

 2      from the State and very little from the federal

 3      government.

 4             We have requested an allocation from funds

 5      from New York -- from the funds New York received

 6      from the American Rescue Plan Act to help offset the

 7      tremendous financial losses our providers have

 8      incurred as a result of responding to the pandemic.

 9             To date, we have not heard that that

10      allocation will be forthcoming, despite the letter

11      of support sent to the commissioner from many of

12      you, which we really appreciate.

13             We will be requesting the legislature

14      provide fiscal relief to assisted-living- and

15      adult-care-facility providers in the upcoming

16      budget.

17             Through our consultation with Argentum

18      national, we know advocacy is ongoing on the federal

19      level to support senior caregiving workforce

20      strategies, including expanding and supporting

21      workforce development programs.

22             Identifying and modifying existing federal

23      programs within the Department of Health and the

24      Department of Labor that use evidence-based

25      approaches to increase earnings, and create







                                                             173
 1      apprenticeships, that will keep local senior living

 2      communities competitive so that they will attract

 3      jobs.

 4             Expand education training tracks.

 5             Senior caregiving can be a long-term career

 6      with job security.

 7             Building and implementing competency-based

 8      education pathways from high school to and through

 9      community and technical colleges, to 4-year colleges

10      and universities, as appropriate, and offer loan

11      forgiveness for individuals entering the senior

12      caregiving profession.

13             New York created a new category of home

14      health aides known as "advanced home health aides,"

15      in 2016, which would have created such a pathway for

16      advancement.

17             However, there are a number of barriers,

18      including funding and regulatory requirements, that

19      have made the program extremely difficult to

20      implement.

21             Immigration reform is also important.

22             While training and education programs can

23      create a pipeline of competent caregivers, they

24      should be supplemented by a skills-based immigration

25      system that responds to the demand from growth







                                                             174
 1      sectors for qualified individuals, to help address

 2      the workforce shortages in critical occupations,

 3      including senior living.

 4             I'm just going to touch on a couple of other

 5      state models.

 6             Other states have developed programs that

 7      encourage and build upon a senior caregiving

 8      workforce that New York may want to replicate or

 9      modify.

10             For example, California has a senior-care

11      workforce development program that includes

12      partnering schools, career centers, and vocational

13      schools with programs just relevant to senior

14      living.

15             The program also includes creative

16      recruitment strategies that provide additional

17      training and opportunities to advance in the senior

18      caregiving arena.

19             Also under development is a community

20      college, trade school, seniors care certificate, in

21      a partnership with the nursing program that includes

22      rotation in assisted-living residences.

23             Caring for our seniors is of the utmost

24      importance as our population continues to age, and

25      it is imperative that we focus on investing in,







                                                             175
 1      expanding, and supporting the senior caregiving

 2      workforce.

 3             Thank you.

 4             SENATOR MAY:  Thank you.

 5             DOUG WISSMAN:  Thank you, Senator May,

 6      Rivera, and Ramos.

 7             My name is Doug Wissman.  I am a board member

 8      of Greater New York Health Care Facilities

 9      Association; and a CFO of a large facility in

10      Queens, New York; and I also am a trustee for the

11      1199 Welfare and Benefit funds.

12             So I've been in this business for 27 years.

13             And over the last two decades, there's been

14      numerous funding initiatives to help the facilities

15      maintain their staffing levels; from health-care

16      retention and recruitment add-ons; to grant

17      opportunities; to funds, that we work directly with

18      1199, to provide training and development of staff.

19             We -- due to these strategies, we've been

20      able to maintain our staffing levels and provide

21      care for the patients in New York.

22             Unfortunately, that all changed during COVID.

23             Overnight, we went from being fully staffed,

24      to having a situation where almost all of society

25      shut down and was locked up in their homes, except







                                                             176
 1      for our workers and other essential workers.

 2             Many of our staff had comorbidities

 3      themselves, and elected not to come back to work.

 4             Our staff was already aging, and many of them

 5      decided to retire early because of the fear that

 6      they had.

 7             A tremendous amount of our staff was just

 8      plain afraid to come to work.  They have children at

 9      home.  They care for elderly at home.

10             And it presented a huge problem for the

11      entire industry.

12             The staff was afraid to get on the trains,

13      the buses, or whatever transportation they utilized

14      to get to work.

15             Fortunately, we were able to maintain

16      staffing levels where it was safe for the residents.

17             Our census was impacted greatly by the fact

18      that many elected procedures in hospitals were

19      delayed.  Patients were -- or, potential admissions

20      were not leaving their homes.  People were not

21      falling.  People were not getting the flu.

22             So our census dropped dramatically.

23             That was, somehow, how we were able to

24      maintain our staffing levels.

25             Now, as we move forward, we're starting to







                                                             177
 1      see our census improve.  Unfortunately, many of the

 2      staff are not coming back.

 3             There are shortages of LPNs and RNs, and

 4      even CNAs in certain sections of the state.

 5             It's not a one-size-fits-all.

 6             There are CNAs available for certain

 7      shifts.  For weekends, it's a problem.

 8             You know, there's staff -- we're a

 9      24/7 business.

10             It's not always the same that there's CNAs

11      or nursing staff that are willing to work the shifts

12      that we need.

13             And in order for us to retain and recruit

14      staff, we need funding.

15             We have programs where we develop geri aides

16      into CNAs, and we pay them while they attend

17      school to become CNAs.  We sponsor CNAs to become

18      LPNs.  These programs all require funding.

19             And the majority of the industry is suffering

20      catastrophic losses at this point.

21             Our facilities are in dramatic danger of not

22      surviving.

23             The censuses are historically low.

24             They're starting to creep back, and I am

25      concerned, that as our census improves, that there's







                                                             178
 1      not going to be enough staff to take care of the

 2      patients, in which case, many facilities will be

 3      forced not to admit patients, and there could be an

 4      issue with access.

 5             We are requesting, that along with additional

 6      funding, that the State really looks at all these

 7      programs that were presented today, to really expand

 8      the workforce, collectively, with the stakeholders,

 9      with 1199, the collaborative approach with the

10      union, with the associations, so that we, as

11      New Yorkers, can go forward in the future.

12             These facilities are our infrastructure, and

13      it's key that we maintain our infrastructure as our

14      population ages so that we can have places where our

15      citizens can be taken care of.

16             Thank you.

17             SENATOR MAY:  Okay.  Thank you.

18             So we heard from the previous panel about

19      high executive salaries, and the expenditures on

20      consultants coming in to help keep unions out, or

21      whatever.

22             I'm wondering if -- how much of your budget

23      actually goes directly to aide care for the

24      residents?

25             DOUG WISSMAN:  We -- our facility currently







                                                             179
 1      meets all the requirements that are in this budget;

 2      meaning, we are already spending well in excess of

 3      70 percent on our direct patient care.

 4             In addition, we exceed the 40 percent on

 5      direct-facing care.

 6             That, to me, is not necessarily the issue.

 7             The issue here is the flexibility within the

 8      budget that allows us to spend where we need to

 9      spend money.

10             And acknowledging that there is a shortfall

11      in the funding, there is no flexibility.

12             I can tell you that, depending on the acuity

13      level of our different units, we staff it

14      differently.

15             And if we look at it as an average, we're

16      meeting these requirements with the number of hours.

17             But, on certain units, I may need more

18      CNAs, I may need more RNs, I may need more

19      LPNs.

20             To basically have language that kind of puts

21      us in a box where we're not able to adjust, and

22      there may be a facility that has a disproportionate

23      number of patients that require different level of

24      care, where they might not fall into those

25      regulatory numbers, that could present a problem in







                                                             180
 1      the future.

 2             The other issue is, right now, I'm in major

 3      competition with every other building, with every

 4      hospital, with every doctor's office.

 5             There are no LPNs and RNs.

 6             It takes a special person to work in the

 7      long-term-care industry.

 8             And there are many RNs and LPNs that find

 9      it much easier to go and work for a hospital, where

10      they get three 12-hour shifts; for an agency, where

11      they can dictate the hours that they want to work;

12      or even a doctor's office where it's 9 to 5, 8 to 4.

13             Those are the challenges we face.

14             SENATOR MAY:  Okay.  Thank you.

15             And you mentioned about needing to put

16      different kinds of staff in different places.

17             I'm wondering about the long-term-care

18      residents who are maybe not classified as needing

19      acute care, or whatever, do they tend to get the

20      least of the, say, RN time, and that sort of thing;

21      whereas, a post-op recovery may get --

22             DOUG WISSMAN:  Again, there are different

23      clinical issues, where different patients have

24      clinical needs, where it could require a nurse for

25      wound care, CNA for behavioral issues.







                                                             181
 1             I am not personally a clinician, but those

 2      are the issues that we see on different floors.

 3             If there's a high acuity for patients who are

 4      receiving wound care, which could be long-term

 5      patients.

 6             Behavioral psych patients require direct

 7      hands-on CNA hours.

 8             There are patients, for example, Lewy body

 9      dementia which may require one-on-one.

10             It's very different, depending on the acuity

11      of the patient.

12             SENATOR MAY:  Okay.

13             Well, thank you so much for the work you do,

14      and for your testimony.

15             I will see if we have other questions.

16             SENATOR BENJAMIN:  I have one quick question.

17             SENATOR MAY:  Okay.  Senator Benjamin.

18             SENATOR BENJAMIN:  I will be very quick.

19             Doug, you made some interesting points around

20      flexibility, which I generally think is logical.

21             I guess my question, my concern is, how is

22      there -- how do we ensure, within some flexibility

23      that might be necessary for a certain facility, that

24      there's accountability towards ensuring that the

25      appropriate resources are going towards care for







                                                             182
 1      residents, while having that flexibility?

 2             Do you have a thought --

 3             DOUG WISSMAN:  We're in a very highly

 4      regulated industry.

 5             We have annual surveys.

 6             We have a 5-star rating, which we submit

 7      quarterly MDSs, which measure acuity of patients.

 8             There's a lot of data out there that can

 9      substantiate outcomes without tying us to certain

10      metrics.

11             And I know my building has been 5 stars since

12      the day the 5-star rating was initiated.

13             And we take a lot of pride in providing the

14      appropriate care for our patients.

15             SENATOR MAY:  Any questions?

16             Senator Serino.

17             SENATOR SERINO:  Hi, everybody.

18             I just want to say thank you for being here.

19             And, you know, I agree with you, it's not

20      one-size-fits-all.  You don't know who you're going

21      to have in the facilities.

22             And I think that that really puts a strangle

23      on you because, like you said, Doug, you're a 5-star

24      facility.

25             So I just -- basically, I didn't have a







                                                             183
 1      question today.  I just wanted to say thank you for

 2      being here, and your testimony, and for all that you

 3      do.

 4             SENATOR MAY:  Let me follow up with one final

 5      question, which was about the LPN vacancies.

 6             Was that you who brought that up?

 7             SARAH DALY:  Yes.  Yep.

 8             SENATOR MAY:  Do you have a sense of how

 9      New York compares to other states in terms of that

10      kind of staffing shortage?

11             SARAH DALY:  I don't have a sense of that,

12      but we could certainly look into it more closely for

13      you.

14             I mean, I get the impression that, certainly,

15      New York is not alone in facing this demographic

16      shift.  We all know that millennial generation is

17      having fewer children.  And, you know, this shift is

18      kind of longstanding.  Right?

19             But I can certainly -- we can certainly look

20      into that for you.

21             We just know our members have had LPN

22      openings for -- again, before the pandemic that have

23      gone unfilled.

24             And so, for us, a medication technician role

25      could take some of the stressors off of RNs and







                                                             184
 1      LPNs that are there, and also encourage CNAs to

 2      get a sense of what more responsibility might look

 3      and feel like.

 4             I'd also like to note that assisted living

 5      doesn't have medication technicians currently.

 6             And Michele might be able to elaborate on

 7      this.

 8             They can assist residents with

 9      self-administering medications, but they can't

10      administer non-invasive medications themselves.

11             But med techs do currently exist in the OPWDD

12      settings.  And training is already available for

13      that setting, that could easily be used for nursing

14      homes.

15             And we've seen a lot of success with this

16      model in other states, such as Maine.  They've had

17      med techs for, I think, over 10 years now, and

18      they've seen great success with it.

19             So we just think it's time for New York to

20      really start thinking more innovatively in this way.

21             SENATOR MAY:  So there are -- are there

22      workers who are classified as med techs, but they do

23      something different in the assisted-living

24      facilities?

25             SARAH DALY:  No, there's not an actual med







                                                             185
 1      tech role in assisted living.

 2             Michele, do you want to elaborate on that?

 3             MICHELE O'CONNOR:  You know, we don't have a

 4      "med tech" category at all.

 5             Medication, as Sarah said, can only be

 6      administered by an aide.  Like they can hand it to

 7      the person, but it's like, a self-administration.

 8      And there's like six steps they have to go through

 9      to do so.

10             LPNs and RNs are the ones that can

11      administer.  And then it's usually only in like in

12      an EALR setting, which is an "enhanced

13      assisted-living residence," because there's some

14      barriers, that the basic ALRs don't really employ

15      nurses necessarily to -- that can at least work in

16      their nursing capacity.

17             So there's a little bit of a -- like I said,

18      barrier, in terms of that.

19             Which is one of the things -- like, that was

20      one of the great things about the "advanced home

21      health aide" category, because they would have been

22      allowed to -- well, they would -- they are allowed

23      to administer medication, you know, after completing

24      certain training.

25             But as I said, we can't -- we are having a







                                                             186
 1      lot of trouble getting that off the ground.

 2             SENATOR MAY:  So the category exists, but

 3      there are no people who actually have that?

 4             MICHELE O'CONNOR:  There's a lot barriers to

 5      it.

 6             Funding is one of them.

 7             Just getting a training program that, you

 8      know, meets all of the regulatory requirements.

 9             There's also some educational requirements

10      that we kind of thought were a little greater than

11      necessary for this category of aide.

12             But...

13             SENATOR MAY:  So it's a category that exists,

14      but we don't have any mechanism for having people

15      actually --

16             MICHELE O'CONNOR:  Yeah, we don't have a --

17      it's not off the ground yet.

18             SENATOR MAY:  Yep, okay.  All right.

19             That's helpful to know.

20             Thank you very much.

21             Thank you for your testimony, and for the

22      work you do.

23             SARAH DALY:  Thank you.

24             MICHELE O'CONNOR:  Thank you.

25             SENATOR MAY:  All right.  We're going to take







                                                             187
 1      a 20-minute break here, and come back for our last

 2      few panels on the nursing and assisted-living realm,

 3      and then we'll move on to the home health area.

 4                (A recess commenced.)

 5                (The public hearing reconvened.)

 6             SENATOR MAY:  All right.  We're on.

 7             Okay.  Thanks.

 8             Welcome back, everybody.

 9             We're on the sixth panel of our hearing, and

10      that's Dallas Nelson and Diedre Gilkes.

11             I'm not sure I got that pronunciation right.

12             I also want to mention a switch on Panel 8.

13             Agnes McCray, who was scheduled to testify a

14      lot later, she came in from Syracuse on a train at

15      5:30 this morning, and she's got a 4:00 train to

16      catch home.

17             So we're putting her on Panel 8.

18             But for Panel 6, we'll start with

19      Dallas Nelson.

20             DALLAS NELSON, MD:  Hi.

21             SENATOR MAY:  Hi.

22             DALLAS NELSON, MD:  I'm Dallas Nelson.

23             Good afternoon.

24             And I love talking to you while you're well

25      hydrated and nourished.







                                                             188
 1             But thank you for the invitation.

 2             I'm from Rochester, New York, but I'm here

 3      representing New York Medical Directors Association.

 4             That's an organization that's goal is to

 5      educate and advocate for long-term-care medical

 6      directors and medical providers.

 7             I also direct a group that serves as primary

 8      care for 15 nursing homes and 33 senior living

 9      facilities.

10             I am the medical director of two nursing

11      homes, two assisted livings.  And one of those

12      nursing homes served as a COVID-positive unit for

13      the state.

14             I also have primary-care patients across the

15      continuum of care of long-term care.

16             And I am a granddaughter of a nursing home

17      resident.

18             So I wanted to let you know that an engaged,

19      knowledgeable medical director can genuinely improve

20      a facility's care by applying science to care.

21             And one of the things we medical directors

22      are supposed to be experts in is quality assurance

23      and process improvement (QAPI).

24             And QAPI teaches us that the systems

25      generally create the outcomes they are designed to







                                                             189
 1      produce.

 2             The long-term-care system is currently

 3      producing a severe shortage of frontline workers;

 4      namely, nurses and CNAs.

 5             Before COVID, the staffing levels in some of

 6      my facilities was below what was needed to render

 7      proper care.

 8             The staff was chronically stressed, and --

 9      because they were covering more work than they could

10      possibly do.  The long-term-care industry was

11      plagued by frequent turnover of staff and

12      leadership.

13             Then COVID-19 made the nursing homes the

14      center of the hotspots of the most serious outcomes

15      of the pandemic.

16             And each surge of the pandemic decreased

17      staffing further in my nursing homes, further

18      worsening our ability to respond to the pandemic and

19      make the residents safe.

20             The rate of death of nursing home workers was

21      amongst the most dangerous jobs in America.

22             CMS, Senator Mayer, said that it was

23      80 deaths per 100,000 FTEs, which is higher than

24      the logging industry.

25             Frankly, the long-term-care facilities became







                                                             190
 1      an environment of overwork, fear, and danger.

 2             I can write the most beautiful

 3      state-of-the-art medical plan for my patients, but

 4      if nobody is there to execute them, it does not

 5      matter.

 6             As a society, we are paying in human

 7      suffering for the current long-term-care system.

 8             Our parents and grandparents are suffering

 9      from staff shortages, and as a result, there's a

10      greater incidence of falls with fracture; death,

11      secondary to failure to thrive; and skin breakdown.

12             The problems are not a result of laziness or

13      greed.

14             The quality improvement teaches us that

15      searching for bad apples is not necessarily -- will

16      not necessarily result in widespread positive

17      change.

18             More effectively, we need to bring together

19      people with deep knowledge of the system, frontline

20      workers, and those with -- who control the resources

21      and regulations, to study the root causes of the

22      problem, and design interventions to fix the system.

23             The pandemic highlighted how intertwined all

24      the levels of health care are.

25             We need patients to move from the hospital to







                                                             191
 1      the nursing home, back to their assisted living, and

 2      home; and vice versa.

 3             The -- each level of the health-care system

 4      is needed to serve the entire complement of

 5      vulnerable people, and they are all competing for

 6      similar finite pool of resources.

 7             The New York Medical Directors Association

 8      felt that The Reimagining Long-Term-Care Task Force

 9      was a good first step in that direction.

10             It may be too late for that bill, but we

11      would like further legislation to spur on the effort

12      to start to redesign the system of long-term care.

13             We know this can be done.

14             We also know that we can have a collaborative

15      relationship with government.

16             The New York -- sorry, the Colorado Medical

17      Directors Association regularly meets with their

18      department of health, to work to fix their

19      long-term-care system.

20             And we would hope to have a collaborative

21      relationship with our Department of Health.

22             Assisted livings need supports to be able to

23      respond to infectious outbreaks, which currently do

24      not exist.

25             And we -- our hope is that all the







                                                             192
 1      stakeholders responsible for the care of the

 2      vulnerable elderly will work together to

 3      collaboratively improve the system.

 4             Thank you.

 5             SENATOR MAY:  Thank you.

 6             I don't want to mispronounce your name again,

 7      so I will let you introduce yourself.

 8             DIEDRE GILKES, RN:  Hi.  My name is

 9      Diedre Gilkes.  I'm a registered nurse.  I'm

10      presently employed at Rutland Nursing Home, which is

11      part of Kingsbrook Jewish Medical Center.

12             I'll just tell you a little bit about myself.

13             I was a CNA -- I started out as a CNA at the

14      same nursing home, and worked my way up to become an

15      RN.

16             I went part-time, so it took a little longer

17      than the person who would generally go full-time.

18             With me is my daughter, up there, she's 12,

19      Gabrielle.

20             And I brought her here to see, you know, what

21      it is about; not just, you know, money buying you

22      this or that, you know?

23             So the problem we're having now is,

24      Rutland Nursing Home has about 446 beds, including

25      an acute-care vent unit of 30 beds, an acute







                                                             193
 1      step-down with 34 beds, a pediatric unit, and rehab

 2      subacute, and several regular long-term units.

 3             Staffing has been a chronic problem in

 4      nursing homes and long-term-care facilities for many

 5      years.

 6             COVID has just opened up what has been long

 7      ago been happening.  Okay?

 8             At Rutland, for example, the RN staffing in

 9      our acute vent and step-down unit has worsened, and

10      there are fewer RNs assigned to those units, and

11      I'll explain.

12             For 29 vent units, you have only one RN, with

13      two LPNs.  That's like a disaster waiting to

14      happen.

15             These are acute patients.  They came from --

16      directly from the hospital to us, and some of them

17      are unstable.

18             Sometimes, the facility, they look at just

19      numbers, not acuity of the patient.

20             And we are burnt out, the nurses.

21             In addition, on many of our long-term

22      resident units, there are no RNs assigned to

23      provide direct patient care.

24             They are staffed entirely by LPNs and aides

25      which an RN manager oversee the direct care.







                                                             194
 1             The reductions in RN time for both regular

 2      long-term residents and patients on the acute unit

 3      impacts the quality of care, and contributes to

 4      staff burnout and turnover.

 5             The situation we face during the worst of the

 6      pandemic made staffing the resident care worse.

 7             Many staff were exposed to the virus and

 8      became sickened, and others quit or retired because

 9      of the horrific working conditions we faced.

10             We believe the legislature should consider

11      the following measures to improve recruitment and

12      retention of staffing in our nursing home, and to

13      create a more stable workforce to provide care for

14      an increasing aged population:

15             The new nursing home staffing law is a good

16      start, but it does not go far enough.

17             The new law sets minimum of 3.5 hours of

18      total nursing care, including RNs, LPNs, and

19      aides, of which at least 2.2 hours must be nursing

20      aides, and 1.1 hours RNs or LPNs.

21             Many nursing homes are already meeting this

22      minimum standard, and it does not set a minimum

23      number of registered nurse hours per patient, and

24      I'll give you an example.

25             On Friday I had 47 patients, with 3 nurses,







                                                             195
 1      including myself.

 2             I'm charging 47 patients, auxillary staff.

 3             I have to document.  I have to discharge.  Do

 4      care plans.

 5             It's not enough time, and it's too much.

 6             We think that the legislature should amend

 7      this law to phase in higher staffing requirements in

 8      stages, with a goal of four, to 1 hours of total

 9      nursing care, including at least 0.75 hours of

10      RN time per resident day.

11             RNs are very important to assessing

12      patients, implementing care plans, and ensuring that

13      infection-control protocols are fully implemented to

14      protect residents and staff.

15             In addition, it is important to establish

16      separate direct nursing to patient ratios for the

17      acute-care units where residents are permanently

18      vented or under more intensive care.

19             These acute-care specialty units should not

20      be included in minimum nursing hours calculations

21      for the residents on the regular long-term floors.

22             Improve staff working.

23             Salaries and working condition in the nursing

24      home industries are worse than in hospitals and

25      other Article 28 facilities.







                                                             196
 1             This a major contributing factor in the high

 2      turnover and staff burnout.

 3             To address this issue, the legislature should

 4      consider measures that require or incentivize

 5      employers to meet local, regional, or statewide

 6      benchmarks for pay and health and pension benefits.

 7             In addition, the legislature should consider

 8      enacting legislation to mandate that all employers

 9      create active committees in all nursing homes, that

10      give the workers a direct say in establishing

11      staffing plans, infection control, and other

12      workplace safety policies and general work

13      conditions.

14             I'm not done, but time is up.

15             SENATOR MAY:  Time is up, but thank you so

16      much.

17             Thank you, to both of you, for your

18      testimony.

19             I wanted to go a little deeper into something

20      you said, about how the facilities look at just

21      numbers and not the acuity of the patient.

22             I think that was --

23             DIEDRE GILKES, RN:  Yes.  That's one of my

24      biggest fights pretty much every day, because

25      they'll say, Okay, you have three nurses, and this







                                                             197
 1      is what the State is okay with.

 2             Therefore, they're not penalized because we

 3      give you the minimum what the State says is

 4      required.

 5             But the acuity is much higher.  You know, we

 6      need more staff.  It's just what it is.

 7             We need a law, which recently passed, but

 8      they need mostly for nursing homes to say, okay, as

 9      an RN, I have 10 patients per nurse, not 20 patients

10      per nurse.

11             How much can I give to that patient?

12             And these are patients that are, you and I,

13      that have aged, that have retired, that are now in

14      nursing homes, that had lives that you and I lived,

15      you know, and not just an old person in the bed,

16      or -- it's somebody's mother, grandmother, aunt,

17      uncle.

18             And we can't just look at them as numbers.

19             And that's what I've been advocating and

20      fighting for pretty much every day.

21             Every day.

22             SENATOR MAY:  Right.

23             I hear that, and I appreciate it.

24             DIEDRE GILKES, RN:  So we need ratios.  We

25      need ratios to nurses, just as what they have in the







                                                             198
 1      hospital, 6-to-1.

 2             I moonlight at many places.

 3             In the hospitals, I have six patients to

 4      one nurse.

 5             In the nursing home, I have 20 patients to

 6      1 nurse.  Sometimes you have 40 patients to 1 LPN.

 7             It's impossible to direct good care; good,

 8      quality care.

 9             It's not -- they're not getting it, period.

10             They're not.

11             SENATOR MAY:  Judging from your testimony, it

12      sounds like the nurses often spend a lot of their

13      time managing staff rather than on direct care.

14             Would you say that's true?

15             And are they the right people to be doing --

16             DIEDRE GILKES, RN:  When you say "managing

17      staff," what do you mean?

18             SENATOR MAY:  Well, I'm just taking from what

19      you said, that the nurses would be deciding --

20             DIEDRE GILKES, RN:  No.  I'm saying, if

21      I have 20 patients, how much care can I deliver, you

22      know, safely with 20 patients?

23             It's too many patients.

24             SENATOR MAY:  But you're not then supervising

25      CNAs, or --







                                                             199
 1             DIEDRE GILKES, RN:  I'm still doing that.

 2             I still have to make sure they do what they

 3      have to do.

 4             I do the assignments.

 5             So I'm the nurse in charge.  I still have

 6      20 patients.  I have to do the assignments for the

 7      CNAs and the LPNs.  And then I have an assignment

 8      for myself also.

 9             SENATOR MAY:  See, that's what I was

10      wondering.

11             DIEDRE GILKES, RN:  Oh.  Okay.

12             SENATOR MAY:  How much of your time goes to

13      making those assignments, for example?

14             DIEDRE GILKES, RN:  It's a challenge every

15      day.

16             SENATOR MAY:  Okay.

17             I have some other questions, but I would like

18      to see if anyone else has any?

19             SENATOR MAYER:  So, first place, I want to

20      thank both of you, from different perspectives,

21      because your focus is on the care.

22             And it's so appreciated by me, and I think

23      those of us who all experienced COVID, that your

24      focus is on the patients.

25             I really do appreciate that you are talking







                                                             200
 1      about that in such a serious way, both of you.

 2             Doctor, I would like to ask you, you gave me

 3      an example of states where there is regular

 4      conversation between medical directors of facilities

 5      and the state Department of Health.

 6             Has there been any of that here?

 7             DALLAS NELSON, MD:  Has there been here?

 8             SENATOR MAYER:  Here in New York.

 9             DALLAS NELSON, MD:  We have been privileged

10      to have intermittent presentations from the State at

11      our meeting.

12             But we don't have collaborative

13      sit-at-the-table, sort of, discussions on how to

14      manage those, which was very evident throughout the

15      pandemic.

16             Many regulations rolled out very fast, and

17      many of them were, if I -- I was, like, Do they know

18      that's not possible, you know, to do? such as, the

19      twice a week testing.

20             We were getting the results about 14 days

21      after we got the first one.  And we had people

22      working, positive, but we didn't know because the

23      test -- we didn't have the resources to implement

24      the policy.

25             SENATOR MAYER:  And not to focus exclusively







                                                             201
 1      on these rules, but the rules came out without input

 2      from you as medical directors; correct?

 3             DALLAS NELSON, MD:  That's correct.

 4             And usually on Sunday night, about midnight.

 5             SENATOR MAYER:  We all lived through it, too,

 6      because our families had to experience the

 7      consequences.

 8             But thank you for that.

 9             And then, on the nursing side, you gave the

10      example, in a vent unit --

11             DIEDRE GILKES, RN:  Yes.

12             SENATOR MAYER:  -- right?

13             Are these --

14             DIEDRE GILKES, RN:  Ventilators.

15             SENATOR MAYER:  -- yeah, long-term vent

16      patients, or post-COVID vent, or a mixture?

17             DIEDRE GILKES, RN:  Long term.

18             So they might be coded on in the hospital,

19      and they brought to us as vent patients, yes.

20             So some are stable, some are very unstable;

21      but the hospital cannot keep them anymore, so they

22      come to us.

23             SENATOR MAYER:  And they're not -- and they

24      cannot go home?

25             DIEDRE GILKES, RN:  They cannot go home.







                                                             202
 1             SENATOR MAYER:  So 29 patients with 1 RN.

 2             DIEDRE GILKES, RN:  One RN, sometimes,

 3      with -- one RN and two LPNs.

 4             SENATOR MAYER:  Is that a night-shift ratio?

 5             DIEDRE GILKES, RN:  Sometimes night-shift

 6      ratios, yes.

 7             And they're severely short?  Yes.  Big time.

 8             SENATOR MAYER:  So you are a member of

 9      NYSNA --

10             DIEDRE GILKES, RN:  Yes, I am.

11             SENATOR MAYER:  -- correct?

12             And NYSNA has a collective bargaining

13      agreement --

14             DIEDRE GILKES, RN:  Yes --

15             SENATOR MAYER:  -- [indiscernible]?

16             DIEDRE GILKES, RN:  Yes.

17             SENATOR MAYER:  Does it have any ratio --

18             DIEDRE GILKES, RN:  There's a -- yes, there's

19      a ratio, at least, I believe 4 RNs-to-1 LPNs.

20             Sometimes it does not occur.

21             SENATOR MAYER:  I see.

22             DIEDRE GILKES, RN:  I am mostly from the

23      subacute rehab.

24             So people that do like the knee surgery in

25      the hospital, they would come to us.  And then we







                                                             203
 1      would, you know, give them the rehab, and so forth,

 2      and then send them home.

 3             So the turnover is pretty fast.

 4             And some of these patients also have COPD,

 5      they have other issues, other than the knee surgery

 6      that they may come in from.

 7             So they are -- some of them are unstable --

 8      pretty unstable.  Respiratory issues, in a heart

 9      beat, they're coding, and so forth.

10             SENATOR MAYER:  And of your colleagues that

11      work with you, other nurses and CNAs and others,

12      LPNs, approximately how many became

13      COVID-positive -- do you know? -- in your facility?

14             DIEDRE GILKES, RN:  Pretty much, I would say

15      90 percent.

16             I was one of them.

17             SENATOR MAYER:  90 percent?

18             SENATOR RIVERA:  Nine zero?

19             DIEDRE GILKES, RN:  Of the staff, yes.

20             A lot of us got sick.

21             Because, before COVID hit, apparently, it was

22      around.  We didn't have masks on.

23             I was -- for one, I was giving medication.

24      The patient coughed.  Not knowing he had COVID, we

25      thought it was the flu symptoms.







                                                             204
 1             We tested him for the flu.

 2             Turned out it was COVID, and I caught it, and

 3      it just spiraled down right then.

 4             I was out, and I came back, and it was just

 5      horrible.  It was a horrible experience, and I'll

 6      never forget it.

 7             SENATOR MAYER:  I'm so sorry.

 8             DIEDRE GILKES, RN:  We lost so many patients,

 9      too.  So many.

10             It's nothing like what you see on the

11      television.  Nothing.

12             Nothing.

13             SENATOR MAYER:  Well, thank you for sharing,

14      because we do know how terrible it was.

15             We don't think it's [indiscernible].

16             DIEDRE GILKES, RN:  I remember my husband

17      saying, Are you going back to work?  Do not go back

18      to work.

19             I was, like, I have to go back.  Who's going

20      to do the work?

21             You know?

22             Even my daughter, she was crying, "Mommy,

23      don't go back," but I had to.

24             SENATOR MAYER:  Oh, I'm so sorry.

25             DIEDRE GILKES, RN:  You know, somebody has to







                                                             205
 1      do it.

 2             SENATOR MAYER:  Thank you for coming.

 3             Thank you for what you've done.

 4             Both of you, thank you for what you've done.

 5             And there's consequences to all the sacrifice

 6      you made, and we have to make sure we address them.

 7             So thank you for being here.

 8             SENATOR MAY:  Thank you.

 9             We're so glad that you're here.  We're so

10      glad your daughter has her mother.

11             And for the work that both of you do.

12             Let me ask a couple of brief questions.

13             One of them is, you said, you started as a

14      CNA.

15             DIEDRE GILKES, RN:  Yes, I did.

16             SENATOR MAY:  And now you're an RN.

17             Are there ways that the State can help people

18      make that transition, develop from CNA to RN?

19             DIEDRE GILKES, RN:  Okay, with my -- it's

20      hospital and nursing home [indiscernible] together.

21             But at the nursing home, we have two units.

22      We have NYSANA and 1199.

23             So 1199 has this program, where they are now

24      doing, where the CNAs are upgrading, which

25      presently have them in school, and they're doing







                                                             206
 1      their LPNs.

 2             So, hopefully, we're hoping, that when

 3      they've completed, that they'll come and give back

 4      to the facility.  And that's what we're hoping for.

 5             So they do have that, 1199 has that program.

 6             NYSNA, I'm not sure.

 7             But I did that on my own, though.  I just

 8      went back to school and just did what I had to do.

 9             SENATOR MAY:  Good for you.

10             Fantastic.

11             And then, Doctor, I wanted to ask you about

12      the input issue that you raised, about being able to

13      meet with the Department of Health, for example, and

14      have them hear your input about these things.

15             The -- is there nothing like that now in

16      New York State?

17             I'm glad that Colorado has a model, but it's

18      startling.

19             DALLAS NELSON, MD:  Yeah, right, Colorado has

20      a journal club, and they all get together and learn

21      the state-of-the-art and geriatric care together.

22             I lectured some of their state DOH surveyors

23      in Colorado.

24             But we don't have that sort of dialogue.

25             As geriatric medicine experts, and experts in







                                                             207
 1      long-term care, we would love to have just a

 2      dialogue about the application of different

 3      regulations, the effects of those, what would

 4      incentivize that sort of the best practice in our

 5      industry, and what it's like, you know, on the

 6      ground.

 7             We really -- medical directors, you know, we

 8      don't have jobs if the facilities don't exist.

 9             But we're primarily there for the patients,

10      and really want to advocate for them getting good

11      care.

12             And it's hard to do.

13             SENATOR MAY:  Okay.

14             And, finally, I do have a bill to try to

15      incentivize more people to go into geriatrics.

16             But I don't know if you have ideas about how

17      we get -- I know there is a crisis, like all these

18      other workforce crises we're talking about, in

19      people specializing in geriatrics, either at the

20      nursing or the physician level?

21             DALLAS NELSON, MD:  Uh-huh. yeah, I mean,

22      geriatrics, as a medical discipline, is not

23      considered real medicine.

24             I don't know how -- it's reputationally

25      difficult, but I love, love, taking care of these







                                                             208
 1      patients.

 2             But it's one of the few specialties that you

 3      can train longer and get paid less in.

 4             So it's hard to attract people into a field

 5      with -- that is, number one, not respected because

 6      of ageism in society; and then remunerated more

 7      poorly; and works in conditions in which you can

 8      write orders, and they will not be executed due to

 9      staffing shortages.

10             You know, that is a very, very disturbing

11      thing for a doctor to go through.  And you have a

12      very hard time keeping doctors in a situation where

13      they cannot render good care.

14             SENATOR MAY:  Well, as somebody who used to

15      teach at the college level, I'm very familiar with

16      the training years and earning less.

17             But can you just take -- we have one minute

18      left -- and describe what "geriatrics" is, for

19      someone like Gabrielle, for, potentially?

20             When I heard about what geriatricians do,

21      it's actually a really an exciting field,

22      potentially.

23             DALLAS NELSON, MD:  Oh, geriatrics, I love

24      geriatrics, because I get to take care of complex

25      patients.  Right?  And I must balance their multiple







                                                             209
 1      comorbidities to -- the primary goal is that they do

 2      well, feel well.

 3             So it's very patient-centered, it's very

 4      individualized.

 5             You can't apply all the guidelines to every

 6      patient, or you'll hurt them, because they're so

 7      complex, that all the guidelines conflict.

 8             And you also have the opportunity to listen

 9      to them more, and work to hone their care to what

10      they want, and what they want out of the medical

11      system.

12             There's nothing cookie-cutter about the

13      medicine that I practice.

14             And it's very rewarding to be with people

15      when they need you so much.

16             SENATOR MAY:  And you're looking at their

17      medical situation, but also their social situation,

18      and their family situation.  Sort of, there are so

19      many dimensions to it.

20             DALLAS NELSON, MD:  Yes.  It's a very

21      person-centered care, and individualization of the

22      care is very important.

23             So you need to know the medicine so that you

24      can apply it very carefully to this very vulnerable

25      population.







                                                             210
 1             SENATOR MAY:  Thank you for that.

 2             We want to lift up geriatrics as much as

 3      possible.

 4             Anyone who is listening, think about going

 5      into this field.  It's an important one.

 6             Thank you, both, for your important work, and

 7      for your testimony.

 8             DALLAS NELSON, MD:  Thank you.

 9             DIEDRE GILKES, RN:  Thank you for having us.

10             SENATOR MAY:  All right.  Panel 7 is

11      Hannah Diamond, Maria Alvarez, and Lindsay Heckler.

12             And we'll go in that order.

13             Hannah, if you want to start?

14             HANNAH DIAMOND:  I want to thank the

15      standing committees on Aging, Health, and Labor

16      for hosting today's hearing on the nursing home,

17      assisted-living, and home care workforce in

18      New York State.

19             My name is Hannah Diamond.  I am the state

20      policy advocacy specialist at PHI, a New York-based

21      national non-profit organization that has been the

22      nation's leading expert on the direct-care workforce

23      for three decades.

24             PHI works to transform elder care and

25      disability services by promoting quality direct-care







                                                             211
 1      jobs as the foundation for quality care.

 2             My testimony today focuses on the nearly

 3      530,000 direct-care workers, including nursing

 4      assistants, home health aides, and personal care

 5      aides who assist New Yorkers across long-term-care

 6      settings.

 7             Action is critically needed to support the

 8      current workforce, recruit new job seekers to

 9      strengthen the pipeline into the sector, and to help

10      ensure that we never again reach such a crisis point

11      as we did during the pandemic.

12             To that end, I would like to highlight

13      opportunities to improve jobs for direct-care

14      workers, and increase the availability and readiness

15      of this workforce.

16             First, the legislature must increase

17      compensation for direct-care workers.

18             As a result of low wages, often unpredictable

19      hours, and limited annual earnings, nearly

20      50 percent of direct-care workers in New York live

21      in or near poverty and rely on public assistance,

22      and many are leaving the long-term-care sector for

23      higher paying opportunities.

24             Although our written testimony provides

25      four recommendations, I will expand on two to







                                                             212
 1      improve compensation for direct-care workers.

 2             First, the legislature should direct the

 3      Department of Health to establish, with stakeholder

 4      input, livable and competitive base wages for

 5      direct-care workers across long-term-care settings.

 6             The Department of Health should integrate

 7      these base wages into Medicaid rates through a

 8      transparent rate-setting process.  And then the

 9      Department of Health must also mandate a base rate

10      that managed long-term-care plans must pay providers

11      to fully cover costs associated with labor.

12             Second, the legislature should enact and

13      fully fund the Fair Pay for Home Care bill.

14             By providing home care workers with a living

15      and competitive wage, this legislation will attract

16      and retain workers, and help overcome a worsening

17      workforce shortage.

18             If enacted, this legislation would lower

19      poverty rates among home care workers, reduce

20      expenditures on public benefits, and increase

21      spending within local economies.

22             Second, we must strengthen direct-care worker

23      training.

24             Current training standards and programs, for

25      the most part, do not sufficiently prepare workers







                                                             213
 1      for their complex and challenging roles.

 2             The first recommendation would be, that the

 3      legislature should direct the Department of Health

 4      to facilitate consistent feedback from all relevant

 5      stakeholders, to monitor the State's implementation

 6      of the State's ARPA spending plan.

 7             This oversight is critical for ensuring that

 8      all of the provisions within the plan are

 9      appropriately implemented, including, but not

10      limited to, those related to training.

11             Second, because the workforce investment

12      program's funding ended in March of this year,

13      immediate financial support is needed to ensure that

14      WIOs can continue to meet the training needs of the

15      long-term-care workforce.

16             The legislature must provide immediate bridge

17      funding for WIOs so that they can continue

18      fulfilling their important role, either through the

19      ARPA spending plan, if it's approved, or through

20      other funding mechanisms.

21             And, third, beyond this initial bridge

22      funding, the workforce investment program should be

23      reviewed and renewed for an additional four years,

24      with key amendments based on lessons learned.

25             Third, we must create opportunities for







                                                             214
 1      advancement for direct-care workers.

 2             Career advancement opportunities within

 3      direct-care are also critical for retaining workers,

 4      for amplifying their contribution to care, and

 5      achieving quality outcomes and cost-savings.

 6             To develop advanced roles, PHI recommends

 7      that the legislature enact and fully fund the Home

 8      Care Jobs Innovation Fund.

 9             And, second, as the new 1115 Medicaid waiver

10      is designed, the Department of Health should

11      consider building in advanced-role demonstration

12      projects.

13             And, finally, PHI commends -- or, recommends

14      that the State convene a direct-care workforce task

15      force to develop a coherent and sustainable response

16      to the challenges facing the direct-care workforce

17      in long-term care.

18             To produce evidence-based recommendation, the

19      State must also improve its efforts to collect data

20      about direct-care workers across all long-term-care

21      settings.

22             To accomplish this, the State must survey all

23      relevant departments and agencies, to catalog

24      existing workforce-related data collection

25      mechanisms, as well as to identify gaps and







                                                             215
 1      inconsistencies.

 2             The State must also survey direct-care

 3      workers themselves, to make sure that their voices

 4      are included in discussions surrounding challenges

 5      and solutions.

 6             In conclusion, PHI appreciates the

 7      opportunity to testify today, and looks forward to

 8      ongoing conversations about how to best support

 9      direct-care workers in long-term care.

10             Thank you.

11             SENATOR MAY:  Thank you.

12             Maria.

13             MARIA ALVAREZ:  Yeah, hi.

14             Good afternoon, I guess.

15             Thank you very much for holding these

16      important hearings.

17             My name is Maria Alvarez.  I'm the executive

18      director of New York Statewide Senior Action

19      Council.

20             And we are a consumer-directed and

21      consumer-governed organization --

22             SENATOR RIVERA:  Is your mic on?

23             SENATOR MAY:  Yeah, I think maybe it's not.

24             SENATOR RIVERA:  Go ahead, say "hello."

25             MARIA ALVAREZ:  Hello?  Hello?







                                                             216
 1             Okay.

 2             -- that, next year, will be 50 years old.

 3             So, today, we've heard wonderful testimony

 4      from my colleagues here.  And I've given you my

 5      complete statement.

 6             So I wanted to just, in less than

 7      4 1/2 minutes, to talk about some issues that

 8      I think we need to keep up in front, and that is the

 9      community.

10             So my testimony will be one that will

11      identify issues as they're affecting elders and

12      caregivers today, and the impact this will have for

13      the future, along with possible solutions for your

14      consideration.

15             Right now in New York State, we have more

16      people who are 65 years and older than are 13 years

17      and younger, which means that this is an aging

18      state.  And all of these issues about nursing home

19      and care -- and home care are really the future, is

20      really what's going on, because there's going to be

21      a million more seniors, 65 and over, after --

22      between the years 2016 and 2026.

23             So -- and, you know, just to talk about what

24      the doctor was saying before, when anybody talks to

25      me about health care, two-thirds of the cost of







                                                             217
 1      health care that comes out of the Center for

 2      Medicare and Medicaid Services is on seniors.

 3             So when anybody talks about health care, we

 4      should be keeping senior citizens up in front

 5      because those are the consumers.

 6             Anyway, I wanted to talk to you about

 7      something that's going on in the community, so --

 8      and it's calls that I receive all the time.

 9             People are not being able to go back to work

10      because their loved ones are not cared for.  There's

11      a workforce shortage.

12             So we have people -- so -- and these calls

13      that I receive are about people who are not able to

14      get back to work because there's not care for their

15      mother that they cannot -- they can't do.

16             So what do you say?

17             Okay, well, go on Family Medical Leave Act.

18             Well, then, we're asking women of color,

19      mostly, who are caregivers, that's who the pool

20      usually is, to stay home, caring, and doing a very

21      hard job, for 60 -- and collect 67 percent of their

22      paycheck every week for 12 weeks, because that's

23      what it is.  Right?

24             Or -- and if it runs out, and they can't

25      receive that health care -- that home care, then







                                                             218
 1      they won't have pay, because their jobs won't be

 2      able to pay for them -- for something that they're

 3      not doing.

 4             But what I want to bring to your attention,

 5      though, is that the population, in general, moving

 6      forward, will be women, minorities, and people --

 7      and health care is the most -- the largest growing

 8      industry.

 9             We need to figure this out.

10             This is a tremendous opportunity for women

11      who are low income and minorities to get ahead.

12             We need to give them an opportunity to get

13      ahead.

14             And I just feel that, in any other industry,

15      people would say, Oh, great.  We have a need.  Let's

16      figure this out so that we can make a good profit

17      and move ahead.

18             But that's not what happens in this industry.

19             What they do is, they do not value the

20      worker.  The worker is not valued here.

21             They are made to work longer hours.  They're

22      made to work, travel far distances.  They don't give

23      them enough hours so that they can have benefits.

24             In any other scenario, this would not be

25      acceptable.







                                                             219
 1             Why are we not giving this the same respect

 2      to what the future is?

 3             Because, let's be pragmatic about it.

 4             If these women cannot get back to work, or if

 5      the minority communities will not be able to get

 6      ahead, we're going to have a less -- you know, less

 7      tax base, more burden on the State, and nobody is

 8      going away, because people are here; people are

 9      getting older, and they're here to stay.

10             So we need to figure out a way to make this

11      an opportunity for growth for what is going to be

12      the future of New York State.

13             SENATOR MAY:  Thank you.

14             LINDSAY HECKLER:  Hi.  Thank you for the

15      opportunity to testify today.

16             I am Lindsay Heckler, a supervising attorney

17      with the Center for Elder Law & Justice.

18             We are based in Western New York, and provide

19      free civil legal services to older adults and people

20      with disabilities.

21             Our primary goal is to use the legal system

22      so that our clients can age with independence and

23      dignity.

24             And as partners with the regional ombudsman

25      program, we advocate for people living in nursing







                                                             220
 1      homes and assisted living.

 2             Now is the time to invest in the people of

 3      New York, and ensure all individuals have the

 4      ability to age with independence and dignity.

 5             This means investing in the long-term-care

 6      workforce while, at the same time, reforming the

 7      delivery of long-term-care services and supports.

 8             Both are necessary to ensure that every

 9      person who needs these services and supports

10      receives them, they are of quality, and promote

11      independence and autonomy in the least restrictive

12      setting.

13             While our testimony is specific to the

14      workforce issues in nursing homes and

15      assisted-living facility, we encourage the Senate to

16      act holistically and not in silos.

17             It is essential to implement policies that

18      prioritize keeping older adults and persons with

19      disabilities in the community and out of

20      institutionalized settings; for example, including

21      the Fair Pay for Home Care in the next budget.

22             If we are taking appropriate measures and

23      keeping older adults in the community, then the

24      number of nursing home beds in the state will

25      naturally decrease.







                                                             221
 1             What cannot happen, however, is rampant

 2      widespread closure.  People will be harmed.

 3             In addressing staffing shortages, it's

 4      important to remember that nursing homes make the

 5      choice to admit new residents.

 6             Once a new resident is admitted, it is the

 7      facility's responsibility to ensure that person's

 8      needs are met.

 9             If a facility is not properly staffed,

10      whether it's nursing, social work, dietary,

11      housekeeping, or other, that facility has a

12      responsibility to not admit more residents.

13             For example, a 120-bed facility in Buffalo

14      has been cited 6 times since December of 2017 for

15      insufficient staffing; most recently, May 2021.

16             In this May inspection, the Department of

17      Health found the facility failed to ensure that

18      residents with pressure ulcers receive the necessary

19      treatment and services to promote the healing,

20      prevent infection, and prevent new ulcers from

21      developing.

22             This is the third time the facility has been

23      cited for this exact same violation since July of

24      2018.  Third time.

25             In addition, this facility repeatedly







                                                             222
 1      ranks at the bottom of staffing levels in

 2      Western New York, and has one the highest usages of

 3      contract staffing, which is associated with lower

 4      quality of care.

 5             When addressing the issue of the workforce

 6      shortage, a question has to been asked:

 7             Why don't people want to work at certain

 8      facilities?

 9             Why is there high turnover?

10             Yes, low pay is a factor; however, there are

11      other keys to recruitment and retention: teamwork,

12      respect, and organizational culture.

13             These things cannot be legislated, and at the

14      end of the day, are the operator's responsibility.

15             The words, "That's not my job," should never

16      be uttered in a nursing home; yet we hear that often

17      in these bad-performing facilities.

18             Enforcement of the staffing requirements is

19      needed to ensure resident needs are being met.

20             While the State can offer carrots, such as

21      grants or awards for nursing homes who improve

22      staffing levels, at some point the stick needs to be

23      more strongly used to get operators to comply with

24      their mandated responsibilities.

25             In addition, the State can reinvest how







                                                             223
 1      Medicaid dollars are spent, such that residents who

 2      live in these repeat underperforming facilities have

 3      meaningful opportunity to return to the community or

 4      other location of their choice.

 5             Now, nursing homes aren't unique in being

 6      understaffed.

 7             Adult-care facilities (ACFs), or assisted

 8      living, also face challenges.

 9             In general, ACFs do not have the same

10      requirements as nursing homes, and the level of

11      staffing and type depending on the facility's

12      licensure.

13             We know there are ACFs that are not properly

14      staffed; however, there's no publicly available

15      information on staffing in these facilities.

16             For example, an assisted-living residence

17      with enhanced and special-needs beds in

18      Williamsville was cited in February of 2021, at the

19      endangerment, for failure to ensure there were

20      enough staff to comply with the supervision and

21      monitoring requirements needed to assure the safety

22      and welfare of the residents.  A resident also

23      eloped in November 2022 -- or, 2020.  Excuse me.

24             This same facility previously made headlines

25      when a resident who had dementia wandered from her







                                                             224
 1      room, December 2017, and almost froze to death.

 2             Staffing matters, and we need a strong

 3      direct-care workforce in order to achieve holistic

 4      reform and support older adults to live in the

 5      location of their choice, often the community.

 6             People should not be left in nursing homes

 7      because there's a home care workforce shortage, nor

 8      should people be subject to neglect in

 9      long-term-care settings because of insufficient

10      staffing.

11             Thank you for your time.

12             SENATOR MAY:  Thank you.

13             Thank you, all.

14             I have a couple of questions, I guess one for

15      each of you.

16             I'm wondering about, you talked about

17      poverty-level wages, or people earning -- working in

18      these facilities and not breaking above the poverty

19      line.

20             Have you -- is there research that can give

21      us some guide to what the cost to the State is of

22      having the -- having people working in these

23      facilities who are also on public assistance,

24      presumably?  Is that measured?

25             HANNAH DIAMOND:  I would argue that if you







                                                             225
 1      pay people a higher wage, then expenditures related

 2      to public benefits decrease.

 3             So that's -- to answer your question, I think

 4      that investing in workers, in general, paying them

 5      with a livable wage, would pay for itself, by

 6      reducing those public-benefit expenditures;

 7      providing them with more financial stability, which

 8      then they can then contribute back into their

 9      economy.

10             So it would be a worthwhile investment to

11      invest in workers, to improve their financial

12      stabilities, and also improve quality care at the

13      same time.

14             SENATOR MAY:  Thank you.

15             Yeah, that's what underlies our Investing in

16      Care Act, which that's the philosophy:  Put the

17      money into these jobs that could be created

18      tomorrow, and there's a lot that comes back to us as

19      a state budget, but also into our communities.

20             I would love to follow up with you about the

21      MLTC workforce investment program, and how it was --

22      it was ended in this last budget?

23             HANNAH DIAMOND:  It ended in March of this

24      year.

25             SENATOR MAY:  Was that a planned thing, or







                                                             226
 1      did that -- did we do that in our budget?

 2             HANNAH DIAMOND:  I mean, it was just not

 3      renewed funding, so the funding ended.

 4             There is -- within the ARPA implementation

 5      spending plan, there is a provision within there

 6      that can allow WIOs specifically to train the

 7      workforce, and help to provide them with training

 8      for advanced roles specifically.

 9             So that's something that we're very

10      interested in.

11             But I think that, one, we don't know that the

12      ARPA spending plan is going be approved by CMS.

13             And even if it is approved, it's only

14      one year.

15             So we really need to provide the workforce

16      investment program with extended funding so that we

17      can see the impact of the work that the workforce

18      investment organizations are doing.

19             And we really need to be quantifying kind of

20      how that is impacting the workers, so that, then, we

21      could, hopefully, scale up this initiative, and all

22      pilot programs that it's helping with.

23             SENATOR MAY:  Thank you.

24             And then, Maria, we work together all the

25      time, and I am grateful for all the work you do.







                                                             227
 1             I wanted to just pull out something that's in

 2      your written testimony, that you didn't mention, but

 3      it's about a trend in New York of sending nursing

 4      home residents to other states because there isn't

 5      the staff.

 6             Is that the reason for it?

 7             Or what -- I'm not aware of that even

 8      happening, so I don't know what the scale of that

 9      issue is.

10             And I wonder if you can just say a little bit

11      more about it.

12             MARIA ALVAREZ:  Yeah, well, so --

13             SENATOR MAY:  It's on page 13 of her

14      testimony, for the people who [indiscernible].

15             MARIA ALVAREZ:  Yeah, I'm sorry.  This is a

16      very long testimony.

17             I have a lot to say, obviously, and

18      I couldn't say it all in five minutes.

19             But, yes, there is a trend where --

20      especially that happens in a lot of rural areas,

21      where there is not -- there -- a lot of the nursing

22      homes, I think somebody here was talking about how

23      they were shutting down, and they don't have enough

24      care in the area.

25             So what ends up happening is, that they have







                                                             228
 1      to send them to other places to get care.

 2             And it's just a shame, because we have --

 3      it's almost like -- for example, in New York City

 4      you have a lot of people.  There's still a shortage,

 5      and it's for different reasons.

 6             But if I -- I've traveled the state.  And

 7      every single -- I've never been to a county that

 8      tells me, I don't have a workforce issue.

 9             And so some of the solutions are, that they

10      have to go out of state.

11             You know, in the North Country, they send

12      people to Vermont, to other places.

13             I actually have a colleague right now, it's

14      not for workforce issues, but for care issues,

15      that's in Boston, because, apparently, there's not

16      the care that he needs here in New York.

17             So, yeah.

18             SENATOR MAY:  But it's the residents making

19      that decision, or the facilities are actually

20      sending them?

21             MARIA ALVAREZ:  No, the facilities.

22             SENATOR MAY:  Wow.

23             MARIA ALVAREZ:  Because, really, what a --

24      a family wants to be close, to be able to visit, and

25      see what's going on in the nursing homes.







                                                             229
 1             SENATOR MAY:  Right.

 2             MARIA ALVAREZ:  You know, on my -- again,

 3      I was trying to come across with a case study, that

 4      it's not unique.

 5             It comes -- I've had three of those calls in

 6      the last week about the same thing.

 7             But, basically, somebody who, not being able

 8      to get all the home care possible so that she could

 9      get back to work, now she's saying, Well, now I'm

10      going to even look into placing my mother in a

11      nursing home.

12             Now, the whole guilt, first of all, about,

13      because they didn't think that they would have to

14      come to that.

15             But then it's, Well, I want to -- I've got to

16      find somebody close -- you know, a nursing home

17      that's close enough, that doesn't have violations,

18      that doesn't have infectious diseases, that will let

19      me visit.

20             You know, these are all things that are very

21      real for a consumer.

22             You know, that we can -- can you imagine

23      somebody with -- having your mother with dementia,

24      turning her over to a nursing home, and not being

25      able to -- to -- you know.







                                                             230
 1             And by the way, it's a lot much in their care

 2      that they need to see people that they know, and not

 3      being able to visit.  Right?

 4             SENATOR MAY:  Yeah.

 5             MARIA ALVAREZ:  So -- so then that paralyzes

 6      the person even more, and they'll say, Well, I don't

 7      know if I could put my mother in any nursing home

 8      right now because all of these things are happening.

 9             SENATOR MAY:  Right.

10             MARIA ALVAREZ:  You know, and a lot also has

11      to do with the -- with -- we get a lot of calls, and

12      people complain that, Where do I go, what recourse

13      do I have, if all of these things are happening in a

14      nursing home or for home care?  You know?

15             The ombudsman program, we've had many

16      conversations about how underfunded, undermanned,

17      they are.

18             Actually, I had to tell you this because

19      we've had ombudsmen local -- from the local offices,

20      saying, We're only one or two people who have to

21      cover various counties; all the institutions of

22      various counties.

23             SENATOR MAY:  We're working on that.

24             MARIA ALVAREZ:  Tell your elected officials.

25             You know, and they're telling us, Tell your







                                                             231
 1      residents or the families to tell the elected

 2      officials what's going on.  We cannot handle this.

 3             SENATOR MAY:  Right.

 4             MARIA ALVAREZ:  You know?

 5             Call the DO -- the Department of Health, you

 6      know, to have nursing homes that receive fines --

 7      first of all, it takes them, for a long time, just

 8      to get to those -- those -- to get to visit these

 9      nursing homes that people are complaining about.

10             When they finally come up with fines, there

11      are fines that are so low, frankly, that it's a cost

12      of doing business.  The nursing homes actually

13      budget in their budget for fines.

14             I mean --

15             SENATOR MAY:  Yeah.  Thank you.

16             I'm going to break in, just so I can ask one

17      more question here --

18             MARIA ALVAREZ:  Yes.  I'm sorry.

19             SENATOR MAY:  -- which is, to Lindsey:

20             What does the State need in order to enforce

21      the staffing levels that we are requiring?

22             What needs to be put in place to do that?

23             LINDSAY HECKLER:  Well, I would pass

24      legislation that, for one, creates a do-not-refer

25      list to nursing homes that are routinely







                                                             232
 1      understaffed, such that hospitals are not allowed to

 2      send patients to there, those nursing homes.

 3             Also, while I am very critical of the

 4      Department of Health, Department of Health does not

 5      have enough people doing the actual surveys.

 6             But at the end of the day, it is the

 7      operator's responsibility.

 8             Yes, we can increase the Medicaid rates, but

 9      it takes a leader to run a nursing home.

10             And the operators really need to do more to

11      create that professional working environment that

12      people want to show up to every day.

13             Because, as you've heard from many people,

14      nurses themselves, today, it's really hard work.

15             SENATOR MAY:  Is there some kind of

16      credential that the operators have to get in order

17      to have that job, that could be then tied to

18      performance in [indiscernible] --

19             LINDSAY HECKLER:  We could have a whole

20      separate hearing on the relevance of the public

21      health and health planning council.

22             But I would be happy to discuss with you that

23      separately.

24             They do, supposedly, go through character and

25      competency assessments.







                                                             233
 1             SENATOR MAY:  Okay.  Great.

 2             Thank you very much.

 3             Thank you-all.

 4             Do we have others?

 5             Senator Borello, you -- we'll let you go

 6      first this time.

 7             SENATOR BORELLO:  Well, thank you.

 8             First of all, thank you again for being here.

 9             Morgan, I was kind of -- or, excuse me.

10             Hanna -- excuse me -- I was kind of taken

11      aback a little bit.

12             You know, we've been sitting here,

13      criticizing private institutions for the pay raise,

14      and so forth; yet here we are, the State sets the

15      rate for direct-care workers.

16             And according to your testimony,

17      New York State, and the funding that's behind that

18      for Medicaid, which continues to be cut, is paying,

19      on average, $14.24 per hour.

20             So I just want to make sure I am getting this

21      correct, because it's in your testimony.

22             So New York State government is paying less

23      than fast-food wages for direct home care workers at

24      the moment.  Is that correct?

25             HANNAH DIAMOND:  It's absolutely correct.







                                                             234
 1             SENATOR BORELLO:  I see.

 2             HANNAH DIAMOND:  This industry, on average,

 3      I actually have a statistic that I would love to

 4      share with you.

 5             In comparison to other sectors in the

 6      state -- this is New York-specific -- in the state,

 7      with similar entry-level requirements, these jobs

 8      are, on average, receiving $3 less per hour.

 9             And then for other jobs with lower

10      entry-level requirements, these jobs are receiving

11      65 cents per hour less.

12             So, yes, it's not -- this industry is not

13      paying a competitive wage; and it is the largest

14      industry, and the most quickly growing industry in

15      the state.

16             SENATOR BORELLO:  But in last year's budget,

17      the State was going to try and fix this by creating

18      a -- some kind of a wage parity.

19             And this wage parity has resulted in lower

20      than the minimum wage currently that we pay

21      fast-food workers.

22             Is that basically what you're saying?

23             HANNAH DIAMOND:  My argument is that it's not

24      competitive; and, therefore, workers are leaving for

25      other sectors.







                                                             235
 1             SENATOR BORELLO:  So we didn't fix anything

 2      by doing this?

 3             HANNAH DIAMOND:  I think that we have more

 4      work to do.  Yeah.

 5             SENATOR BORELLO:  But we'll pay someone, a

 6      taxi driver, to take somebody to a doctor's

 7      appointment, two, three, four hundred dollars for

 8      one trip, but we're not paying minimum wage to

 9      health-care workers.

10             So...

11             HANNAH DIAMOND:  We're not paying a livable

12      wage --

13             SENATOR BORELLO:  Yes.  Okay.

14             HANNAH DIAMOND:  -- to home care workers.

15             SENATOR BORELLO:  I just want to point out

16      that we're, you know, basically, kind of the pot

17      calling the kettle black, as we criticize people

18      in the private sector, not-for-profits, when

19      New York State's not living up to that commitment

20      in its own right.

21             So, thank you.

22             SENATOR MAY:  Thank you.

23             Senator Serino.

24             SENATOR SERINO:  Thank you, Madam Chair.

25             Maria, I wanted to say, thank you --







                                                             236
 1             And for all of you, thank you.

 2             -- but for you mentioning about how, when

 3      places close, and family members can be displaced

 4      anywhere.

 5             We just had a situation where it was my

 6      constituent, but the assisted-living facility was in

 7      another senator's district.  And the daughter went

 8      on vacation.  I think she was away for almost a

 9      month.  She didn't know where her mom went.

10             So we worked together, and we were able to

11      find out.

12             But, you know, that -- we should have safe,

13      reliable places for people to go in the communities,

14      and so that they don't have to travel out.  And, you

15      know, especially like somebody with a little bit of

16      dementia, or whatever, you know, it's scary, too.

17             So, I appreciate everything that all of you

18      do.

19             And like I said, thank you for bringing that

20      up.

21             Thank you.

22             SENATOR MAY:  Thanks.

23             And, Senator Ramos.

24             SENATOR RAMOS:  Thank you.

25             Thank you so much.







                                                             237
 1             I really appreciate your point about livable

 2      wages, because I do feel that fast-food workers have

 3      finally been able to be acknowledged and dignified

 4      in the work that they do.

 5             And pitting one workforce against the other

 6      really doesn't actually solve our issues.

 7             It's not that fast-food workers make too

 8      much; it's that home care workers make too little.

 9             And I really appreciate your point there.

10             I'm wondering, your comments on career

11      advancement and workforce development and

12      apprenticeships, based on what we've heard today, it

13      sounds like the bulk of these programs largely come

14      from the unions, from what I've heard.  It's 1199,

15      it's NYSNA, that offer these opportunities at a

16      greater scale, and have, perhaps, even a greater

17      rate of success than anywhere else.

18             Are there ways --

19             And I apologize, because I know much more

20      about the construction industry than I do about this

21      one, where state-approved apprenticeship programs

22      can only be offered by unions.

23             I don't think that that's the case in this

24      industry.

25             But what can be done in order to, I guess,







                                                             238
 1      offer the same quality of apprenticeship and

 2      career-advancement programs outside of the unionized

 3      workforce?

 4             HANNAH DIAMOND:  Sure.  So that's, the

 5      workforce investment programs plays a really

 6      significant role in preparing -- in helping the

 7      workforce with retention- and recruitment-related

 8      issues.

 9             So it's an organization like PHI, or like the

10      union, that receives funding, to work with providers

11      to -- for example, when it came to the pandemic, to

12      provide training about infection control or stress

13      management to the workers; to design advanced roles

14      which I would love the opportunity to talk a little

15      bit about.

16             We've been talking about advanced roles, you

17      know, to take a CNA to an LPN or a nurse.

18             So we want to make sure that these

19      positions -- nursing assistants, home health aides,

20      personal care aides -- that those positions, there

21      are opportunities within those roles.

22             So some examples:

23             You have a peer mentor who could provide

24      supports to new ongoing hires.

25             You could have a transition specialist who is







                                                             239
 1      following a client while they're in the rehab or a

 2      nursing home, post discharge for 30 days, to make

 3      sure that they don't have a repeat hospitalization,

 4      which is, therefore, improving their outcomes, and

 5      then meeting [indiscernible] payments.

 6             You have advanced home health aides that can

 7      assist with medication administration.

 8             All of those roles need funding, both for the

 9      training of those roles, for delivering that

10      training, developing the training, training --

11      paying the workers while they're receiving the

12      training, then paying the worker a higher wage after

13      completing the training.

14             So all of that needs to be funded within the

15      advanced-role development process.

16             And the workforce investment program, again,

17      hopefully, if it were to be funded, would help with

18      that.

19             But, also, like the Home Care Jobs Innovation

20      Fund, is a great -- would be a great avenue to

21      support kind of innovation as well.

22             SENATOR RAMOS:  Interesting.

23             So it sounds like, because there's such a

24      high rate of turnover in the industry, there really

25      isn't a pipeline or an avenue for institutional







                                                             240
 1      knowledge, really, to be passed on.

 2             HANNAH DIAMOND:  Right.  There's a loss of

 3      that knowledge, which is tragic.

 4             And that's why we're trying to provide

 5      advanced opportunities that capitalize on the

 6      expertise that these workers have, to both support

 7      other workers, because supervision is such a

 8      challenge within this field.

 9             Providing support, capitalizing on the

10      worker's expertise, and giving them room for

11      advancement, which is respect and recognition of the

12      work that they do.

13             SENATOR RAMOS:  So how are best practices

14      developed and taught to home attendants, or -- and,

15      you know, other people who work in this industry?

16             HANNAH DIAMOND:  So when the workforce

17      investment organization -- or, the workforce

18      investment program had funding, we worked directly

19      with providers, and worked with workers, to --

20             SENATOR RAMOS:  But you're not mandated to?

21             Or do you have to -- does every facility have

22      to come to you for this?

23             HANNAH DIAMOND:  No, no.  No.

24             SENATOR RAMOS:  Interesting.

25             Okay.







                                                             241
 1             Maria, I'm wondering about, just from a

 2      consumer perspective, the quality of care, and how

 3      it differs from facility to facility.

 4             Are there any specific criteria and/or

 5      indicators that I should be looking out for?

 6             I'm Latina, so I would never put one of my

 7      parents in a nursing home.  No offense to those

 8      who -- but it's a cultural thing.  We don't do that,

 9      largely.  You know, our parents live with us.

10             But -- but how -- what should I be looking

11      out for as a consumer if I'm in that situation?

12             MARIA ALVAREZ:  Okay.  So, for example,

13      nursing homes, they have a code -- right? -- and

14      they have rules, about what visitation is, what type

15      of -- I mean, even down to the food that they

16      receive.

17             They have rights.  You know, residents have

18      rights.

19             And what we have found is that, especially

20      during the pandemic, and now post pandemic, they

21      are -- what's happening, every nursing home is

22      interpreting the guidelines as they see fit.

23             So, for example, a visitation order, where,

24      during the pandemic, at the beginning, they were

25      allowing nobody to come.







                                                             242
 1             And then there were severe problems with

 2      people calling us, saying, I don't know anything

 3      about my -- you know, my -- my loved one; to, then,

 4      all of a sudden, the rules started easing up.

 5             However, there were times where, in one

 6      nursing home they will say, This could be

 7      compassionate care.  If you have Alzheimer's,

 8      "compassionate care" means that they should be able

 9      to get a visitation from at least one person, under

10      COVID; while another nursing home will say no.

11             So it took us a long time to go in and

12      advocate.  And this is case by case.

13             And we're not the only ones receiving these

14      calls.  But -- you know, and then that puts a big

15      strain on the ombudsman.  Right?  And, you know, you

16      have to keep on doing that.

17             SENATOR RAMOS:  Is there any type of, like,

18      consumer reports --

19             I see you [indiscernible], and I have

20      questions for you, too.

21             -- but is there any sort of, like, consumer

22      reports "grade," or, you know, where I can quickly

23      see that one facility is rated higher, or one agency

24      is rated higher, than the other?

25             MARIA ALVAREZ:  Yes, yes, there are.







                                                             243
 1             The State has a report card for every nursing

 2      home, and you can see what their stars are, and

 3      infectious disease -- you know, things, all the way

 4      from infectious diseases, and staffing ratios, and

 5      things like that.  You can see all of that there.

 6             SENATOR RAMOS:  All right.  Thank you.

 7             Lindsay is eager to jump in, but can you

 8      also --

 9             LINDSAY HECKLER:  Sorry.

10             SENATOR RAMOS:  No, don't be sorry.

11             -- but can you also maybe add a little bit

12      about -- I wanted to learn from you, about the

13      actual oversight that is provided by DOHMH.

14             I am a huge critic of the governor's

15      insistence on austerity budgeting.

16             I believe that the DOL is just as underfunded

17      and overcapacity as DOHMH.  So I would like to know

18      a little bit more about that.  And then I'll have

19      another one.

20             LINDSAY HECKLER:  In short, we just don't

21      know how many surveyors are currently working

22      outside of FOIL requests.

23             So we have submitted FOIL requests, and are

24      looking through the information.

25             But people are filing complaints, and waiting







                                                             244
 1      well over a year for a response.

 2             And to be blunt, the only way you're going to

 3      get a Department of Health surveyor into a facility,

 4      is if the complaint alleges that harm has occurred.

 5             They are so backed up with the complaints,

 6      that even on their annual surveys, which is partly

 7      governed by the federal process, they can only

 8      investigate so many complaints at a time during

 9      their annual survey; but then they only have so many

10      people to actually physically investigate.

11             So a lot of these investigations, I question

12      the thoroughness of them, when they are only calling

13      the facility, asking what happened, and

14      unsubstantiating that complaint.

15             SENATOR RAMOS:  And then not visiting them?

16             LINDSAY HECKLER:  Yes.

17             SENATOR RAMOS:  Oh, wow.

18             LINDSAY HECKLER:  They have resumed

19      visitation.  So in the example of the nursing home

20      and assisted-living residence, which are two

21      different surveyor teams, they are catching some of

22      these insufficient-staffing deficiencies.

23             But, quickly back to where people can see the

24      rating system, yes, there's the CMS rating system;

25      yes, there's the nursing home profiles with the







                                                             245
 1      State.

 2             I do not put stock in the CMS rating system

 3      because a lot of the star ratings are based on

 4      non-complaint data.  It's what they are putting into

 5      the system.

 6             If I'm a consumer or their representative,

 7      I'm looking at the payroll-based journal staffing

 8      data that is put out by CMS.

 9             SENATOR RAMOS:  In your testimony you said

10      that there are certain things in work culture that

11      cannot be legislated.

12             Challenge accepted.

13             What are the types of things in work culture

14      that you think, that you feel, and -- I don't mean

15      to put you -- you know, it's something I would like

16      to work with you on -- that perhaps, you know, are

17      out of the box and we should be looking into?

18             LINDSAY HECKLER:  Well, I think there are --

19      and I defer to the specific workforce training

20      programs -- but it's how are -- how's your

21      administrator, how's your director of nursing, how

22      is the operator, when they come into the building?

23             Are they a hands-on approach, or do they hide

24      in their office?

25             When there's 1 CNA for 20-plus residents, and







                                                             246
 1      they need more help, are other members of the team,

 2      if they're there, available and willing to jump in?

 3             It starts at the top for leadership.

 4             And that's -- it's just a small piece of the

 5      puzzle.

 6             Whenever "not my job" is heard, there should

 7      be a problem there.

 8             SENATOR RAMOS:  I have three seconds to ask

 9      you if you know what the pay ratio usually is

10      between CEO and average worker in these facilities?

11             Because I saw some pretty nifty watches up

12      here earlier.

13                [Laughter.]

14             LINDSAY HECKLER:  I'm not that skilled.

15             SENATOR RAMOS:  All right.

16                [Laughter.]

17             SENATOR RAMOS:  Thank you.

18             SENATOR MAY:  Anyone else have a question?

19             I do want to just follow up on one thing,

20      from what Jessica was asking, about the five-star

21      rating system.  We hear about that a lot.

22             It's a federal thing, is my -- or, a

23      national-level thing.

24             In your experience, does it actually line up

25      with the quality of care that's being provided?







                                                             247
 1             LINDSAY HECKLER:  I would never put my loved

 2      one in a nursing home that's rated below four stars.

 3             Five stars and four stars have their

 4      challenges.

 5             But if -- and this is my personal opinion,

 6      and also based on professional review and experience

 7      of going into these locations -- the one star and

 8      two stars are most likely to have repeat

 9      deficiencies and not address the problems.

10             MARIA ALVAREZ:  And can I just say something

11      about nursing homes?

12             Up until recently, there were public --

13      New York State had public- and county-run nursing

14      homes, things like that.

15             They've all been sold off -- not all.

16      3 percent are still public.

17             But they've been sold off to profit-making

18      organizations that -- whose interest is really the

19      bottom line.

20             But a lot of these things were done without

21      public input.

22             And that -- if I said anything here today,

23      it's that I said a lot, but we need more public

24      input into any decisions that are made at these

25      levels.







                                                             248
 1             SENATOR MAY:  Okay.  Well, thank you.

 2             Thank you-all for your advocacy and your good

 3      work, and for your testimony today.

 4             SENATOR MAY:  Our next panel, we have

 5      Marcella Goheen and Agnes McCray.

 6             And, unfortunately, Ian Magerkurth had to

 7      leave.

 8             So it's a Central New York theme.

 9             Agnes McCray.  She has a 4:00 train to catch.

10      Right?

11             Ian Magerkurth, who was on our list from the

12      Alzheimer's Association, was unable to stay.

13             AGNES McRAE:  Good afternoon, everyone.

14             SENATOR MAY:  Good afternoon.

15             AGNES McRAE:  My name is Agnes McCray, and

16      I am a human rights advocate, and I live in

17      Syracuse, New York.

18             For the past 27 years now, I have been a part

19      of the -- excuse me -- I have been a part of the

20      consumer personal care assistance program.

21             Now, I must tell you that, before that, as

22      I was transitioning, I was told that, because the

23      aide service that I currently had was going out of

24      business, so I actually paid out of pocket to

25      maintain my services, because I remember the nurse







                                                             249
 1      saying to me, We just -- we don't have those

 2      services that can support you.

 3             So she left, and I was on my own for

 4      11 months.

 5             I had to pay out from my SSI to get some

 6      services.

 7             Now, why?

 8             Why did they tell me that I wasn't -- that

 9      they could not fulfill my needs?

10             Because, see, I don't consider myself as a

11      person with a disability.  I call it "extraordinary

12      differences."

13             So, from the time I was a child, and old

14      enough to dream, I always wanted to just live my

15      life the way I wanted to.

16             I didn't know how it was going to be

17      accomplished, but I always knew I wanted to be --

18      have children and [indiscernible].

19             So because I had children, without even

20      asking or finding out, they decided that it was --

21      that there's no way that I could have any type of

22      services.

23             So I ended up paying out of my pocket.

24             And then the personal care assistance program

25      came along.  I got the phone call from their







                                                             250
 1      founder, who brought it to Syracuse, Sally Johnson,

 2      she said, "There is a program for you."

 3             And I was hesitant.

 4             I said, Okay, I will try it.

 5             Here I am, 27 years later.  My children are

 6      grown now.  But -- and I have always kept my aide

 7      services.  I always had a roster of persons that

 8      I hire to take care of not only my personal needs,

 9      but to help me to become a very successful, darn

10      good advocate.

11             And I must say that they have always put

12      their -- my needs ahead of their families'.

13             If you look at my testimony, I'm talking

14      about one specific attendant that I had for

15      14 years.

16             And after 14 years, because her daughter

17      was -- she came before her daughter was even in

18      kindergarten.  And after 14 years, she had to choose

19      between her daughter's needs, because she was a

20      single parent, and taking care of me.

21             I am lucky because, my youngest son, who you

22      see right behind me, has put his college career on

23      hold for a minute, until I am able to find staff.

24             And it's very hard to find staff.

25             We had an ADA celebration yesterday, and







                                                             251
 1      celebrated 31 years.  And we were all -- the

 2      advocates were all talking about going to different

 3      places so that your staff can make more money.

 4             It's not only about Fair Pay for Home Care,

 5      it's about my health as well.

 6             I have not seen a hospital in the past

 7      11-1/2 years.  I'm very proactive in taking care of

 8      myself.

 9             But I know for being an advocate, that

10      it's -- like I said, it's not only about the Fair

11      Pay for Home Care, it's across the board.

12             It's having the attendants know to take care

13      of those elderly patients who live on their own.

14             The agencies are strapped.  They're not

15      showing up because you can make more money

16      elsewhere.

17             I think that we, in light of the Disability

18      Awareness Act and other promise which gives us the

19      right to freedom, and the right to choice and the

20      right to choose.

21             We really need to look at this and choose

22      help now.

23             I know of another person that has, because he

24      was on his own for four years, independently living

25      out of [indiscernible] nursing home.  And living in







                                                             252
 1      [indiscernible] since the pandemic, he went into a

 2      nursing home three times, because, all of a sudden,

 3      his home, and what he knew, was deemed unsafe.

 4             SENATOR MAY:  Okay.  Agnes, I'm sorry, can

 5      you wrap up?

 6             We are -- your testimony, and then we'll have

 7      questions for you.

 8             AGNES McRAE:  And I just wanted to say that,

 9      also, we need to put more options on the table,

10      because health is -- health is really about wealth.

11             And we know with COVID now, and everything

12      that is happening, I do not want to put myself at

13      risk, and I don't want to have to choose between

14      whether I'm going to be paying rent with my SSI

15      check or paying for someone to come in and take care

16      of me.

17             Will I, all of a sudden, be deemed unfit,

18      after 27 years of independently making that choice

19      on my own?

20             Thank you very much.

21             SENATOR MAY:  Thank you.

22             And, Marcella Goheen.

23             MARCELLA GOHEEN:  Hi.  Good afternoon.

24             Thank you so much for the opportunity to

25      testify.







                                                             253
 1             Thank you, Senator May, for your service;

 2      Senator Rivera, Senator Ramos.

 3             My name is Marcella Goheen, and I'm a

 4      caregiver advocate, and the wife of

 5      Robert Victor Viteri who lives in a resident --

 6      I knew I would cry -- in a long-term-care facility.

 7             I am founder of EssentialCareVisitor.com, a

 8      digital on-line advocacy tool that educates,

 9      advocates, collaborates with private and public

10      partners, to collaborate with family consumers to

11      serve their vulnerable loved ones in a

12      long-term-care facility.

13             I founded EssentialCareVisitor.com on

14      March 12, 2020, at 1 p.m. in the afternoon, when

15      I was told by our administrator and senior staff

16      that I would no longer be able to enter the nursing

17      home to continue my collaborative care with my

18      husband, who I had been serving for the past

19      four years up to that point.

20             I was a daily caregiver, five to seven hours

21      a day, as he suffers from a rare neurodegenerative

22      process that has no name.

23             It would be nine months later until I saw him

24      again, after I had to file an unprecedented

25      Supreme Court lawsuit to sue the facility to abide







                                                             254
 1      by the federal law, which was his federal disability

 2      to receive his caregiver and his person, as he is

 3      nonverbal.

 4             I currently am a daily caregiver to my

 5      husband, serving him in collaboration with the

 6      nursing home staff daily.

 7             I testify today on the shoulders of so many

 8      vulnerable loved ones in heaven who we lost --

 9             Viceraci [ph.].  Mr. Birch [ph.].

10             -- so many on my husband's floor --

11             He was one of the only survivors.

12             -- and the many residents still alive who are

13      needing to receive the full quality care in a

14      post-pandemic setting that is their federal resident

15      right, according to the Omnibus Act of 1987.

16             I also stand in unity with the staff, the

17      aides, the nurses statewide today, who continue

18      courageously to serve our vulnerable residents

19      without care tools and appropriate compensation to

20      do so.

21             They are serving, as you and I sit here

22      today, from their gut, while they work within a

23      health-care system that is collapsing around them.

24      And these workers still choose to come to work daily

25      to help my husband, and the thousands of others like







                                                             255
 1      him.

 2             To them I say, Thank you.

 3             I'm also standing on the shoulders of

 4      my 92-year-old mother who was part of the

 5      1987 Omnibus Act.  She ran nursing homes from

 6      1986 to 2006.

 7             She told me, when I was 11 years old, when

 8      she walked me through her nursing homes, "You see

 9      these people?  Some of them have families, some of

10      them don't.  Most of them don't.  It's our job to

11      take care of them."

12             We as family members are witnessing

13      unspeakable staffing issues statewide.

14             Put simply, the problem is, there is no

15      staff.

16             Staff have been laid off in union-busting

17      ploys; however, vulnerable populations are rising.

18             Staff are leaving through their own choice.

19             Staff are traumatized.

20             Staff are collecting unemployment.

21             Staff are exhausted.

22             And more concerning, there is no staff to

23      recruit.

24             But according to the personal caregiver bill,

25      which, in June 24th, suddenly, we're not in a







                                                             256
 1      pandemic, we're not allowed to enter because we're

 2      no longer in a pandemic.

 3             So facilities are practicing various versions

 4      of the caregiver bill.

 5             There is a catastrophe happening.

 6             The accelerated human decline and unnecessary

 7      loss within long-term care setting is a tragic

 8      disaster.

 9             We are being told by staff, statewide:

10             It is worse than the pandemic.

11             Maybe the same, says another.

12             If there's no staff to get residents out of

13      bed, give them their medication, take them outside,

14      turn them, feed them, bathe them.  We are breaking

15      our oath as a society and commitment to our

16      vulnerable.  We are harming them.

17             I introduced today a family consumer advocacy

18      project that was dreamed up by

19      EssentialCareVisitor.com.  It is also thought up by

20      a couple of nurses in the facility I am in, as well

21      as the caregiving staff that I have had the

22      privilege to collaborate with over the past

23      eight months, as I was able to enter my facility

24      through my lawsuit.

25             This plan is a hopeful solution containing







                                                             257
 1      interdisciplinary emergency response.  And it is an

 2      emergency.

 3             I have 49 seconds, and I'm not done.

 4             I'm so sorry.

 5             SENATOR MAY:  We have questions for you.

 6             MARCELLA GOHEEN:  It's called

 7      "multigenerational recruiting process," that will

 8      serve our loved ones who are now dying, not because

 9      of the staff and nurses do not care, but because

10      there is no staff to care.

11             Our essential campaign is called "Raise Up

12      Care."

13             Raise Up Care will work to break the

14      collective trauma response that every seat at the

15      table is enduring.

16             This campaign is not a "should" or a "may" or

17      a "could"; it is a "must" if we are going to save

18      lives.

19             The "R" in Raise Up Care stands for, we must

20      refrain, restore, and renew long-term-care

21      facilities.  We must retrain and reeducate all the

22      staff and all the stakeholders.

23             We need to ask ourselves, What does it mean

24      to care, as a human, for a vulnerable human?

25             It is not something that we like to talk







                                                             258
 1      about as a society, yet it is the one thing that we

 2      all have in common:  We are all going to get sick,

 3      and we are all going to leave this earth.

 4             The residents are us.

 5             "A" in the Raise Up to Care, is we must

 6      acknowledge, affirm, and address the trauma in the

 7      long-term facilities.

 8             The angel care staff who are working

 9      tirelessly as we sit here today continue to fight to

10      restructure nursing home reform.

11             We cannot lose these senior staff.

12             They are more than our heros; they are the

13      best of ourselves.

14             But not only do they need their higher salary

15      reform and aid-to-resident ratio adjustments, they

16      need mental-health services, as well as

17      trauma-informed care settings that address their own

18      trauma, having survived something so complex with

19      our family members, as well as witnessing the trauma

20      of our vulnerable residents.

21             I'm sorry.

22             And the "I" is incentivize, invest,

23      investigate, care systems for all stakeholders.

24             The "S" is to provide the sustainable,

25      quality care models.







                                                             259
 1             And then the "E" is for empowering, engaging,

 2      and educate.

 3             [Simultaneous talking.]

 4             SENATOR MAY:  I'm going to cut you off there.

 5             But, thank you.

 6             Thank you, both.

 7             And I did give you both a little extra time,

 8      because this is why we're here; to hear your

 9      stories, and not just talking points from government

10      functionaries, but from real people who are -- have

11      real stories to tell.

12             And, Agnes, I see you in our community

13      multiple times a week.

14             You truly are an amazing advocate for people

15      with extravagant differences, and all of us,

16      honestly.

17             And your son, whose name I should know, and

18      I don't, but who does wonderful work as well.

19             I honor both of you.

20             And I don't really have a question.

21             I get to talk to you-all the time.

22             But I do thank you for lifting up the Fair

23      Pay for Home Care, and the other ways that we are

24      trying to invest in care in this state, because it

25      is, obviously, so important to allow people to be







                                                             260
 1      independent as long as they possibly can and want

 2      to.

 3             So your independence is a beacon for so many

 4      people, about what our programs should be doing,

 5      what home care should be about.

 6             And so thank you for coming all this way to

 7      help us understand that.

 8             And, Marcella, also, we've worked together

 9      a lot.  And the work you've done on visitation in

10      nursing homes.

11             I wanted to ask you, as somebody who's been

12      in the facilities on such a regular basis:

13             One of the reasons I was so determined to

14      advocate for helping people get in to visit their

15      loved ones is a belief of mine, that when you don't

16      have family members coming in, that it allows some

17      of the facilities to kind of conceal what is really

18      going on; or, at least family members were concerned

19      that, because they weren't able to get in.  It

20      wasn't just that they couldn't visit their loved

21      ones, but they couldn't see what the conditions were

22      inside the nursing homes.

23             And I'm wondering if you -- to what extent

24      you feel the visitors are kind of a complimentary to

25      the staff, and necessary to the staff, in the sense







                                                             261
 1      of providing the whole continuum of care that people

 2      need in the nursing homes?

 3             MARCELLA GOHEEN:  Well, at this stage in the

 4      game, we're essential at this point.

 5             My experience is showing me that, when

 6      I first got in in December, it was all neurocare for

 7      my husband.  But now it's eight months later, and

 8      I'm doing 70 percent regular care that is not his

 9      neurocare, and 30 percent neurocare.

10             So that's a very micro model of my experience

11      as a consumer.

12             But, at this point, you need the families in

13      there because there is no staff.

14             There is 1 nurse to 45 patients.

15             I'm getting calls where there's -- as you've

16      heard before today, where there's no staff.

17             Nurses are working two floors.

18             There are 2 aides for a floor of 30.

19             How do you feed, clothe, bathe, get them out

20      of bed?

21             Forget getting them out of bed.  They're not

22      getting out of bed, so now you have people in bed

23      all day.

24             So it's an accelerated decline:  Bed sores.

25      Escalating potential for blood clots.







                                                             262
 1             It's a disaster.

 2             When I use the word "disaster," I thought it

 3      might be too strong to use for the Senate.  But

 4      I think it's actually accurate.

 5             So for a facility to not let family members

 6      in at this point, it's, actually, you're asking us

 7      to hurt our vulnerable yet once again.

 8             So you're not letting us in because you're --

 9      you're letting us in an hour at a time.  Our loved

10      one needs more than an hour at a time.

11             So if that answers your question.

12             It's a beautiful collaboration; the model

13      works.

14             The personal caregiver bill is spot-on.

15             And I hope -- I wish the facilities would

16      acknowledge it, and not continue to take what parts

17      of it fit conservatively to not letting us in, but

18      to letting us in.

19             I'm in a unique position where I was able to

20      advocate for my husband.

21             And this is my husband in December when I

22      finally got in, who was very happy to see me, who is

23      nonverbal.

24             SENATOR MAY:  Well, thank you for bringing

25      him here.







                                                             263
 1             MARCELLA GOHEEN:  But he's able to -- that's

 2      why I brought him, Robert Viteri.  And he's actually

 3      starting to talk a little bit again, saying, yes,

 4      no.  And we're getting him up in his standard.

 5             So, yeah.

 6             SENATOR MAY:  That is wonderful to hear.

 7             SENATOR RAMOS:  He's so lucky to have you.

 8             SENATOR MAY:  Yeah, he is, lucky to have you.

 9             And please give him our best, too.

10             Okay.  Anyone else have anything to say?

11             No?  We're good?

12             Okay.

13             Well, thank you both for coming, and for your

14      very powerful testimony.

15             Have a safe trip home, Agnes.

16             All right.  Our next panel is...

17             All right.  So that was the conclusion of our

18      nursing and assisted-living section, although, as

19      everyone can see, they run together, and it's not

20      that easy to separate them out.

21             But we are up to the "home care" thing.

22             I think we're going to go ahead without a

23      break, but we'll take a break in -- at some

24      likely -- or, in the afternoon.

25             SENATOR RAMOS:  We have to stretch.







                                                             264
 1             Occupational hazards of our own.

 2             We've got to stretch.

 3             SENATOR MAY:  You want to take a stretch now?

 4             No, let's keep going.

 5             But I'm going to have to get up and leave for

 6      a few minutes at some point.

 7             So this is Panel 1 of the "home care"

 8      section.

 9             And we have Rona Shapiro, and

10      Lilieth Clacken, Jason Brooks, and Martha Davila.

11             Let's start with Rona.

12             MARTHA DAVILA:  Okay.  Good afternoon.

13             And thank you, Senator May; thank you

14      Senator Ramos; thank you my friend Gustavo Rivera,

15      for being fighters for social justice, and to make

16      the lives of home care workers and the people they

17      serve better.

18             And, of course, I have to give my love to my

19      senator, Shelly Mayer, who is from Yonkers.

20             So I'm executive vice president with 1199.

21             I lead the union's home care division,

22      representing over 60,000 home care workers across

23      the state.

24             And I appreciate the fact that you have given

25      one of the first hearings on home care workers in







                                                             265
 1      the Senate.

 2             I would also --

 3             I'm joined today by three workers,

 4      Lilieth Clacken, who is 1199 SEIU rank-and-file

 5      leader; along with Jason B. Brooks; and

 6      Martha Davila, who are home care workers, who will

 7      share with you their experience as home care

 8      workers.

 9             I think that there's no stronger testimony

10      than you just heard from Agnes McCray, of why we

11      have to transform the home care system in

12      New York State.

13             And I think this is a task that is way

14      overdue, and that, together, we can do it to make it

15      a better system.

16             The challenge that we face is how we make

17      home care a more attractive profession, so workers

18      will come back to the job, and new ones will take up

19      the job of a home care worker.

20             We can do this, but it will take resources

21      and a commitment to elevating home care workers to a

22      valued part of the larger health-care delivery

23      system.

24             If we are serious about preparing for the

25      increased demand for home care, we cannot just







                                                             266
 1      assume workers will be available to fill vacancies.

 2             We must transform these jobs, or we will not

 3      meet the demand, and we will continue to lose

 4      workers to better-paying jobs, or even lower-paying

 5      jobs with consistent full hours.

 6             We can no longer just talk about this.

 7             We have to actually make the changes in

 8      New York State that can change the job of the

 9      home care worker.

10             What we're doing in 1199 -- and I've been

11      doing this a long time.  And working with home care

12      workers has been the honor of my life to do that.

13             And while we fought many years for pennies,

14      "for pennies," we finally did get to a $15 minimum

15      wage with wage parity.  And that was three years

16      ago, and the workers have gotten no raise since that

17      time.

18             In 1199, we're fighting like hell to get

19      billions of dollars -- federal dollars into home

20      care workers and home care services around this

21      country.

22             We just had a rally in New York City, with

23      Hakeem Jeffries, pushing for the Better Care Better

24      Jobs Act.

25             We have our own home care training fund,







                                                             267
 1      1199 training fund; the best in the country.

 2             We are using the monies that we get.

 3             There's not enough money, to upscale the job,

 4      to upscale the workers.

 5             We're creating pilots.

 6             We're working with managed-care companies,

 7      like Healthfirst, who actually is investing in

 8      pilots with one of our 1199 agencies, Premier, who

 9      is in the room, to figure out how we create new and

10      different jobs and tasks for the home care worker

11      that produce better health-care outcomes.

12             In the Healthfirst model, the workers will be

13      paid more, they'll have a Chrome tablet, and they

14      will be able to, in real time, talk about what is

15      going on to the client, so we can intervene in any

16      emergencies.

17             The home care workers are the eyes and the

18      ears, and the lifesavers, of many of their clients.

19             And we do not take advantage of the skill,

20      the language, the culture [indiscernible] that they

21      have with these clients, and the time.  They spend

22      more time than most families do with the client.

23             And, unfortunately, they're still invisible.

24             We're making sure that the $2 billion slated

25      for home care services in New York State gets







                                                             268
 1      dedicated to hazard pay and other initiatives, for

 2      transportation, pilots for guaranteed hours.

 3             We're working with the training fund and our

 4      agencies to figure out, how do we recruit new

 5      workers?

 6             Many of the agencies that we work with do not

 7      have enough money because they actually follow

 8      wage-parity laws to hire expensive people to do

 9      advertising for recruitment of workers.

10             The training fund, we're talking about

11      building a hiring hall so that we can both help the

12      workers and the consumers get clients.

13             What do we need to do together?

14             We need to make family-sustaining wages.

15             We need to pass the Senator May and

16      Gottfried's Fair Pay for Home Care workers, calling

17      for wages of $22.50 plus wage parity.

18             We need guaranteed hours of work so home care

19      workers can maintain a steady income.  And we need

20      pay differentials for personal care assistants

21      working with high-need consumers.

22             SENATOR MAY:  Okay.  I have to cut you off.

23             Sorry, Rona.

24             RONA SHAPIRO:  Okay.  Thank you.

25             So I would like to introduce my beloved







                                                             269
 1      sister Lilieth.

 2             LILIETH CLACKEN:  Good afternoon to my

 3      elected -- or, elected leaders, and to all the

 4      visitors here today.

 5             My name is Lilieth Clacken, and I am a home

 6      health aide worker, a very proud 1199 member, and a

 7      delegate.  And I work for two major agencies in

 8      New York.

 9             My mission today is on behalf of thousands

10      of home health aides who are advocating, and we need

11      better pay, compensation for essential tasks we

12      perform, along with other health-care workers,

13      before the COVID-19 pandemic, during the pandemic,

14      and, hopefully, long after the pandemic is gone.

15             I would like to take a few moments to detail

16      for you my job description which goes beyond and

17      above these tasks mentioned.

18             The patient in my care presently is a stroke

19      victim who has been rendered immobile on one side.

20             This unfortunate health challenge has

21      significantly reduced her capacity of taking care of

22      her personal needs, which also diminishes her sense

23      of dignity and independence.

24             I endeavor to restore some of her dignity by

25      practicing the training given to me by my employers







                                                             270
 1      during initial training and ongoing in services,

 2      which enable me to maintain certification in

 3      caregiving to a level of professionalism.

 4             I assist her out of bed.

 5             I assist her with toileting, bathing, and

 6      more importantly, safely transporting her around the

 7      house.

 8             I make her meals.

 9             I accompany her to doctors' visits when

10      needed.

11             Supervise her taking her medication, and

12      simply being beside her, to take her to the bathroom

13      whenever she needs to.

14             I'm a passionate caregiver who believes in

15      keeping my patient comfortable, clean, and as happy

16      as is possible under the circumstances of her not

17      being capable anymore of taking care of herself.

18             My patient cannot be left alone.

19             The importance of me being there is

20      undoubtedly the key to her living a dignified life.

21             Her family have an important peace of mind,

22      knowing their loved one is in the hands of a

23      capable, trained home care worker which puts no

24      monetary value.

25             The companionship I provide is invaluable.







                                                             271
 1             And so I urge you to provide us home care

 2      workers with a better salary so that we can, in

 3      turn, take care of our own families in a very

 4      acceptable, responsible way.

 5             During the pandemic, I refused to stay home,

 6      knowing my patient need me, and I wanted to be able

 7      to provide for my own family.

 8             While we appreciate the applause and the

 9      lip service of thanks, we demand hazard pay from

10      the 1.6 billion slated for New York on the

11      American Rescue Plan of 2021.

12             We worked in our patients' home during this

13      fearful period, and so we're expecting compensation.

14             We demand better pay, as we should be able to

15      take care of our own families while providing care

16      for other families.

17             And this is the heart of most issues facing

18      home health aides.

19             The work is undervalued and underpaid, and it

20      creates hardship for the aides who stick with the

21      work, and makes it harder to find new workers.

22             We have a rapid aging society, and so this

23      should be taken into account as we meet the needs of

24      our most vulnerable seniors who have served this

25      country, and should be given the right to stay in







                                                             272
 1      the comfort of their homes while we professionally

 2      take care of them.

 3             I now take a moment to thank my greatest

 4      union, 1199, because they have provided.  When our

 5      agency could not provide the PPE, they were assisted

 6      to us.  And I thank them.

 7             I'm a great, proud union member.

 8             We need the federal Better Care Better Jobs

 9      Act passed so our home care workers can continue to

10      provide this crucial service, and attract younger

11      workers in this field.

12             Thank you so very much for allowing me to

13      address you, and I anxiously await your response to

14      our cries.

15             Thank you.

16             SENATOR MAY:  Thank you.

17             Jason, as we move on.

18             JASON B. BROOKS:  Good afternoon, everyone.

19             I'm a little nervous.

20             I look up to all y'all, I'm just being

21      honest.

22             Every single person on this panel, thank you,

23      for one.

24             Good afternoon.

25             My name is Jason Brooks/Jason B. Brooks.  I'm







                                                             273
 1      a home health-care worker from Rochester, New York.

 2             I appreciate the opportunity to share my

 3      experience as a PCA with you.

 4             I started doing care work eight years ago

 5      when a friend's mother got cancer and needed a

 6      tracheotomy tube.  My friend told me I would be

 7      perfect to care for his mom, due to the reason that,

 8      my patience and my humbleness.

 9             Everything went right.  I cared for her for

10      two years.

11             After this experience, I decided to see if

12      I could keep going in home care and make a living

13      doing this work.  Actually, more of a career is what

14      I wanted it.

15             I have to be honest with you, it was right;

16      it was the right decision, but it's been a struggle

17      for six years for me.

18             I've worked for a lot of agencies, and all of

19      them, non-union.  And each time, you have to fight

20      for more hours, stable hours, better pay, or even

21      just getting paid for the work that you do at hand.

22             I've never had health insurance through my

23      job in all these years.  Really, it's just hard to

24      get.

25             I'd like to work with just one agency, but







                                                             274
 1      you really can't.  We are constantly looking for

 2      that extra quarter or those extra hours we need to

 3      get by.

 4             I'm usually working for more than one agency

 5      at a time, and doing per diem work where I can find

 6      it.

 7             I can't even imagine what it's like to work

 8      40 hours and be able to support yourself.

 9             And if the client you are caring for goes

10      into the hospital or dies, your assignment is over.

11             This happens regularly.

12             Then you are out of a job until the agency

13      finds another client, and this can take a couple

14      weeks, a few weeks, maybe even a month, particularly

15      for men, because most people are more comfortable

16      having a woman as their home care aide.

17             This really is one of the hardest parts of my

18      job.  You spend months, or even years, taking care

19      of somebody in the day out, and they pass, and

20      you're out of work.

21             No thanks for all you do.

22             Keep on pay -- well, you don't keep on the

23      payroll until we find another client.

24             Instead, you just wonder how long you're

25      going without a paycheck.







                                                             275
 1             The other frustrating part of this is, the

 2      work is always having to fight the agencies to get

 3      all the pay that you have worked, that you have

 4      earned.

 5             I'm regularly cheated out of hours just

 6      recently.

 7             I've worked, and I've always -- you know,

 8      I asked for a raise, or need a raise.  And the

 9      agencies, they ignore it.  They ignore it.

10             Sorry, I'm getting a little emotional.

11      Sorry.

12             SENATOR MAY:  That's all right.

13             JASON B. BROOKS:  I'll make it quick.

14             So, again, did I make the right decision

15      six years ago?

16             I have to say yes, but...

17             Yes, but we can't go on like we have been.

18             We can't be forced to always search for more

19      hours to get a paycheck big enough to take care of

20      our needs.

21             We can't be forced to work for agencies that

22      provide no health benefits.

23             We shouldn't have to look at our paycheck

24      every two weeks to see if the agency is paying us

25      correctly.







                                                             276
 1             We're human beings taking care of

 2      human beings.

 3             We need to take care of ourselves in order to

 4      take care of others.

 5             And that's so big on me right now.

 6             I'm exhausted now from working three shifts,

 7      12 hours, back-to-back, so...

 8             So we need the legislators; we need you, we

 9      really do.  We really do.

10             Me, myself, I can say that I'm crying out for

11      you guys' attention, and your help, because we need

12      you to make sure that the money that we get in our

13      agency goes to the PCAs, and make sure that the

14      agencies pay a living wage; make them provide health

15      care; we need guaranteed hours; we need support

16      agencies that employ unionized workers.

17             Otherwise, each year will be a struggle for

18      PCAs, and each year, more and more will decide they

19      can't take it another year.

20             So I thank you.

21             I thank every last one of you on the panel,

22      and everyone in their rightful place.

23             Thank you for listening.

24             SENATOR MAY:  Thank you.

25             And, Martha.







                                                             277
 1             MARTHA DAVILA:  (Witness speaking a foreign

 2      language.)

 3             (Translated to English by an interpreter, as

 4      follows:)

 5             Good afternoon.  My name is Martha Davila.

 6      I work for Preferred Home Care.

 7             I'm having working there for around

 8      four years.

 9             And thank you for giving me the opportunity

10      to be talking today.

11             And, right now, I am an employee, and

12      recovering from COVID-19.

13             MARTHA DAVILA:  (Witness speaking a foreign

14      language.)

15             (Translated to English by an interpreter, as

16      follows:)

17             Back in January, my agency sent me to do a

18      replacement, and to take care of an elderly person.

19             When I arrived, I saw two people instead of

20      one, and they were sick.

21             Two days later I started getting a headache

22      and a little fever, I was dizzy.

23             I went to see my doctor to do the test.

24             It was positive with COVID-19.

25             Also, I heard that the other two home care







                                                             278
 1      workers who were also taking care of these patients

 2      was positive, too, with COVID.

 3             Now, after more than six months later on,

 4      I still feel dizzy, afraid, and with fatigue.

 5             MARTHA DAVILA:  (Witness speaking a foreign

 6      language.)

 7             (Translated to English by an interpreter, as

 8      follows:)

 9             The agency that I work for never provide us

10      with the PPE equipment.  We had to buy our own

11      masks, gloves, even gowns.

12             Before I got sick, the agency stopped also

13      provide us the health insurance.

14             Most of the time my paycheck was not correct.

15      It always missing days and hours.

16             I always had to push to get my full hours

17      paid, and this happened not only with me.  It also

18      happened with the other aides.

19             MARTHA DAVILA:  (Witness speaking a foreign

20      language.)

21             (Translated to English by an interpreter, as

22      follows:)

23             Okay.  Right now I am getting ready to go

24      back to work, but I am still terrified of getting

25      sick again.  I feel so nervous.







                                                             279
 1             But I feel the agency who we work for need to

 2      do better job of taking care of the workers and the

 3      clients.

 4             The State should clamp down on the agency

 5      that don't treat workers fairly, and put the health

 6      of us aides and the clients at risk.

 7             I feel afraid, but just tell the government

 8      to do something for us because, some agencies, they

 9      didn't take care of us like they are supposed to be.

10             Thank you for your help.

11             SENATOR MAY:  Thank you.

12             Thank you-all for your testimony.

13             I just have a couple of quick questions.

14             One of them was for Rona.

15             You talked about how agencies had a trade-off

16      between investing in recruitment and paying the

17      workers.

18             Was that you who brought that up?

19             So, like, either they were going to spend

20      money on advertising, and that sort of thing, or

21      they were going to put it to worker pay.

22             So do you have a sense of what it -- what the

23      costs are of recruitment and advertising and -- just

24      so that we can figure out what we need to add into

25      what -- to reimbursements for these agencies?







                                                             280
 1             RONA SHAPIRO:  Well, thanks for the question.

 2             My point was that, you know, the horror

 3      stories that you hear from home care workers, and

 4      that you've heard today, you know, unfortunately, we

 5      continue to throw Medicaid dollars at them, and

 6      we -- I don't feel provide the proper oversight.

 7             And I'm hoping that when new monies come in,

 8      that we are very protective of that Medicaid

 9      dollars, because, as Senator Rivera said, the

10      budgets get cut, and the agencies that continue

11      putting money in their own pockets and not in the

12      workers' pockets, such as who Martha works for, they

13      continue to get money from the managed-care

14      companies.

15             So my point was that, our 1199 agencies,

16      I know how much money they spend because they have

17      to spend 1909.  They signed a collective bargaining

18      agreement.  There's not a lot of fat.

19             As a matter of fact, the agencies that do the

20      right thing are suffering to be able to pay the

21      workers' health care, pay the benefits, and pay the

22      money.

23             There's no excess money to, like, if they

24      wanted to advertise for recruitment, if they wanted

25      to, you know, do like some of the for-profit bad







                                                             281
 1      actors do, then they would not have that money.

 2             But the training fund, we're going to --

 3      we've already done a pilot, with an online thing,

 4      trying to recruit new workers.

 5             The problem is, there's not enough money

 6      being offered to workers.  That is just the fact.

 7             We can talk whatever we want.  But

 8      [simultaneous talking; indiscernible] --

 9             SENATOR MAY:  Let me follow up on that,

10      because we tried -- the Senate Majority tried to get

11      $624 million into the state budget this year, to

12      supplement the wages of home care workers.

13             And what we were told was, that there was no

14      way to guarantee that that money would actually go

15      to the workers.

16             We could pay it, but it would go to the

17      agencies, and they would do with it what they

18      wanted.

19             So I'm wondering, what's the solution to

20      that?

21             How do we earmark the money specifically so

22      that it goes to the workers?

23             RONA SHAPIRO:  Should I say it should go to

24      1199 agencies?

25             That's probably not what some of the other







                                                             282
 1      folks in the room want to hear.

 2             But there has to be ways of oversight.

 3             You know, you can just -- you know, and we've

 4      talked to various people in the state.

 5             There has to be oversight.

 6             So when you give -- when the managed-care

 7      companies give money to an agency, they have to

 8      prove that this money is going into workers'

 9      pockets.

10             Now, they will sign attestations, and just

11      lie and say yes.  And if nobody, you know, checks it

12      out.

13             But I think we all have more responsibility,

14      the managed-care companies, the state legislature,

15      to make sure that there is oversight, and there's

16      qualifications for this money.

17             There is a key vac [ph.] program, where some

18      of the agencies got extra money, because they had

19      health insurance, because they had training

20      programs, because they proved to be quality

21      agencies.

22             I think agencies who show that they're

23      investing in workers, I think managed-care plans who

24      show that they're willing to invest in the

25      workforce, should get dollars to do that.







                                                             283
 1             If you hear of plans who are not doing

 2      anything, we should, you know, question it.

 3             I don't even know why we need so many

 4      managed-care plans in New York State.

 5             Everybody is taking a piece of the little

 6      money that is given for home care from the home care

 7      worker.

 8             Everyone gets their piece except the home

 9      care worker.

10             And that's why we're here today.

11             And I couldn't think of a better group of

12      senators to talk to help us win this fight.

13             I'll give you-all an 1199 hat if you'll help

14      us.

15                [Laughter.]

16             SENATOR MAY:  Yeah, I got to say, Jason,

17      there's a union that wants you, I'm sure.

18             I was just going to say, if when I get the

19      point of needing home care, I hope it's the Lilieths

20      and Jasons and Marthas who are there to take care of

21      me, because you-all are very impressive, and what

22      you have to say is really powerful.

23             Is there anybody else --

24             SENATOR RAMOS:  Yes.

25             SENATOR MAY:  Oh, all right.







                                                             284
 1             Senator Ramos.

 2             SENATOR RAMOS:  Hello.  Good afternoon.

 3             You know, it's really overwhelming for me,

 4      and I think everyone, to see the inevitable human

 5      and emotional connection that there is between the

 6      home attendant, or nurse, and your patient.

 7             And I really admire the work that you do.

 8             And I can only hope that we can figure out

 9      how to make sure that we are honoring your vocation

10      monetarily; that you're properly compensated, that

11      you're afforded, you know, the ability to live the

12      life that you deserve.

13             And so I wanted to understand a little bit

14      that was mentioned, I think it was you, Jason,

15      about, upon a patient passing, I imagine there's a

16      lull in between a new assignment to another.

17             How does that work?

18             If you're -- if you're -- if the person who

19      you're caring for passes away, do -- is that when

20      you stop being paid?

21             Do you not get paid until you get a new

22      patient to care for?

23             How does that work?

24             JASON B. BROOKS:  Basically what happens is,

25      if a patient goes into the hospital or if they







                                                             285
 1      decease, everything stops.

 2             Your pay stops.

 3             You don't get another client until, speaking

 4      for myself, it's usually hard for me due to the fact

 5      that I'm a male.  So have I to do male-on-male

 6      clients.

 7             So it's a little harder.

 8             So a few have passed away from me.  And it

 9      took like three weeks, maybe a month, to find

10      something else.

11             In the meantime, I had to jump-start myself

12      to another agency to keep living.

13             SENATOR RAMOS:  So you rely on yourself to be

14      able to either plan ahead, if you can, because,

15      unfortunately, these things also happen

16      unexpectedly, I assume.

17             JASON B. BROOKS:  Yes.

18             SENATOR RAMOS:  So if you don't have a plan,

19      or if you weren't expecting the person to pass away

20      at that time, what do you do?

21             JASON B. BROOKS:  There's really nothing too

22      much to do.

23             You're working for the agency.  So, at that

24      time, like I said, if they do go into the hospital

25      or they do decease, it's up to the agency to really







                                                             286
 1      replace you.  And they really don't replace you as

 2      they should, so you're just in limbo, honestly.

 3             SENATOR RAMOS:  That's some very difficult

 4      uncertainty, and it seems like that's the theme.

 5             There's a lot of uncertainty, actually, with

 6      this work, which is really ironic, because you

 7      yourself are a health benefit to another human

 8      being.

 9             You are a health benefit.

10             That's incredible.

11             You know, something -- a piece of legislation

12      that I tried to get passed, and I was not successful

13      in the last session, was the Corona Presumption

14      bill.

15             And I guess this mostly affects you, Martha,

16      you know, the ability for a worker to be able to

17      qualify for workers' comp, if and when you get hurt

18      on the job, which, of course, you know, getting

19      infected with coronavirus, or anything else, for

20      that matter, while on the job in the course of your

21      work should be covered by workers' comp, in my

22      opinion.

23             But that's not something that we were able to

24      obtain.

25      ///







                                                             287
 1             SENATOR RAMOS:  (Speaking in foreign language

 2      to Martha Davila.)

 3             I just said that I wanted to apologize to

 4      her, because I still believe it was the right thing

 5      to do, for her to be able to, you know, obtain lost

 6      wages, and be able to provide for herself and for

 7      her family, because she got hurt while she was on

 8      the job.

 9             I want to hear more about the wage theft.

10             You know, I carry the sweat bill.  I carry --

11      we just passed a construction wage-theft bill.

12             But you're actually the first to mention it

13      here at this hearing today.

14             SENATOR RAMOS:  (Speaking in foreign language

15      to Martha Davila.)

16             I want to know how prevalent the wage-theft

17      practice is in this industry.

18             You're the first to mention it here among all

19      of our panels.

20             MARTHA DAVILA:  (Witness speaking a foreign

21      language.)

22             SENATOR RAMOS:  (Speaking in foreign language

23      to Martha Davila.)

24             MARTHA DAVILA:  (Witness speaking a foreign

25      language.)







                                                             288
 1             SENATOR RAMOS:  (Speaking in foreign language

 2      to Martha Davila.)

 3             MARTHA DAVILA:  (Witness speaking a foreign

 4      language.)

 5             SENATOR RAMOS:  That's not chump change.

 6             $3,000 is not chump change.

 7             She said that she -- that she -- do you want

 8      to translate for her?

 9             THE INTERPRETER:  No.  You can do it.

10             SENATOR RAMOS:  That she -- you know, really,

11      she went to her union in order to find recourse for

12      filing a claim with the Department of Labor.

13             But, you know, by and large, she has felt

14      ignored by the DOL.  And it's not really been easy,

15      or it's been practically impossible, in order for

16      her to recover her lost wages.  And that over the

17      course of about three years, she lost $3,000 in

18      overtime pay.

19             MARTHA DAVILA:  (Witness speaking a foreign

20      language.)

21             SENATOR RAMOS:  (Speaking in foreign language

22      to Martha Davila.)

23             MARTHA DAVILA:  (Witness speaking a foreign

24      language.)

25      ///







                                                             289
 1             SENATOR RAMOS:  (Speaking in foreign language

 2      to Martha Davila.)

 3             MARTHA DAVILA:  (Witness speaking a foreign

 4      language.)

 5             SENATOR RAMOS:  Preferred Home Care?

 6             MARTHA DAVILA:  (Witness speaking a foreign

 7      language.)

 8             SENATOR RAMOS:  So I'm learning that there

 9      are now several wage-theft claims made against this

10      employer called Preferred Home Care.

11             RONA SHAPIRO:  Non-1199, Senator Ramos.

12                [Laughter.]

13             SENATOR RAMOS:  Not surprised.

14             Not surprised, Rona.

15             Not surprised.

16             Okay.

17             (Speaking in foreign language to

18      Martha Davila.)

19             MARTHA DAVILA:  (Witness speaking a foreign

20      language.)

21             SENATOR RAMOS:  Okay.

22             So she's saying that there's also malpractice

23      with the patients, not just the employees.

24             And I think that that's a really important

25      point for everyone to understand.







                                                             290
 1             And just to translate what I said earlier:

 2             I just want to thank you for being here.

 3             Your voice is really important.  So much of

 4      this work is done by Latinas, especially

 5      [indiscernible] women like you and me.  And you're

 6      the only one who's testifying here today amongst

 7      everyone.

 8             So thank you for taking the time to do so.

 9             SENATOR RIVERA:  Thank you.

10             And I will also underline that she made clear

11      that, because of the way that they were treating,

12      not only the workers, but the patients, she felt it

13      was necessary to speak up.

14             And she stepped up in that regard.

15             (Speaking in foreign language to

16      Martha Davila.)

17             Next we'll have Senator Rachel May.

18             SENATOR RAMOS:  Shelly.

19             SENATOR RIVERA:  Huh?

20             SENATOR RAMOS:  Shelly Mayer?

21             SENATOR RAMOS:  I'm sorry.

22             Shelly Mayer, because Rachel May is not here.

23                [Laughter.]

24             SENATOR RAMOS:  This was a test, and you

25      passed it.







                                                             291
 1                [Laughter.]

 2             SENATOR RAMOS:  Shelly Mayer.

 3             SENATOR MAYER:  Thank you, Chair.

 4             First, I want to thank all of you, the actual

 5      providers of care, because you truly, particularly

 6      during COVID-19, as you described, you know, you

 7      really took extraordinary risk, personal risk, and

 8      had consequences.

 9             And we -- I know I speak for all my

10      colleagues, we take it very seriously, and know that

11      you are owed more than you got; and that's our job

12      to fight.

13             But I have a question for you, Rona.

14             The agencies that, basically, failed to do

15      the right thing, that still get state Medicaid

16      dollars, either through managed-care plans or in

17      some other direct route, when 1199, or anyone,

18      complains to the Department of Health about their

19      conduct, is there a response?

20             RONA SHAPIRO:  Justice moves slowly and in

21      strange ways in the New York State Department of

22      Health.

23             So we have reported several agencies, and we

24      have fought with several agencies.

25             And, unfortunately, they are still in







                                                             292
 1      business, and collecting dollars.  And when we have

 2      proof, we talk to the managed-care companies.

 3             You know, we have a lot of stories, to

 4      Senator Ramos's point, like Martha, because when we

 5      organize non-union agencies, we hear these stories.

 6             And the City of -- the Consumer Affairs and

 7      the City has taken on some of the agencies for not

 8      paying sick time, or doing that.

 9             But there has not -- they're still receiving

10      Medicaid dollars.

11             SENATOR MAYER:  So there's work for to us do

12      in pushing state -- the State, and I don't mean the

13      legislature, I mean the Department of Health and our

14      colleagues in government, to ensure that when state

15      dollars are going out to these agencies, it comes

16      with the responsibility of doing the right thing;

17      not to cheat the workers, not to put their patients

18      at risk.

19             And so we have to work together to push that

20      further along than it's gone so far.

21             But thank you-all.

22             RONA SHAPIRO:  And thank you.

23             SENATOR RIVERA:  We have a last quick aside

24      from Senator Ramos.

25             Go ahead.







                                                             293
 1             SENATOR RAMOS:  I totally have more

 2      questions.

 3             Sorry.

 4             I wanted to ask you, Rona, about organizing,

 5      you know, because we touched upon that a little bit

 6      with your colleagues over on the other side of the

 7      industry.

 8             How does it work with a much more isolated --

 9      you know, with isolated workplaces?

10             How can you organize someone like Martha?

11             RONA SHAPIRO:  Well, actually, we got very

12      creative during COVID.

13             It's hard enough to find workers when COVID

14      is not on.

15             But we organized Concepts of Independence,

16      which is the largest consumer-directed, and the

17      oldest in New York State, 7,000 workers, and we

18      organized them virtually.

19             And I don't know if any are here today.

20             And we've organized another agency through

21      Zoom, and through house visits, and finding the

22      workers.

23             And some of the employers have begun to find

24      us, and to realize that we really partner with our

25      agencies that do the right thing.







                                                             294
 1             And so some of the agencies have found us,

 2      and are interested, because they want to do the

 3      right thing, and they want to win for their workers.

 4             And so we've actually -- we tried to organize

 5      Preferred, and Edison, and Isabelle Leichter [ph.]

 6      was the organizer, and they were not nice.

 7             I say it that way.

 8             So it is very difficult, but I think Jason is

 9      very interested in helping to organize workers.

10             SENATOR RAMOS:  Oh, my God.  You're a natural

11      organizer.

12             SENATOR RIVERA:  Yeah.

13             SENATOR RAMOS:  You're a natural organizer.

14             RONA SHAPIRO:  He is.

15             SENATOR RAMOS:  Now I'll put you on the spot.

16             RONA SHAPIRO:  He is, he is.

17             Okay.

18             So -- any way, so we continue to organize

19      workers.

20             And I think COVID kind of shone the light on

21      the inequities.  And I think your hearing is helping

22      to do that.

23             SENATOR RAMOS:  And what's the union density?

24             SENATOR RIVERA:  Senator Ramos.

25             SENATOR RAMOS:  Is it like -- do you know







                                                             295
 1      what percentage of the industry?

 2             I'm going to ignore Senator Rivera.

 3             What percentage of the industry is -- is the

 4      union density high?

 5             RONA SHAPIRO:  Yeah, about -- no.  Not home

 6      care organizing.

 7             It used to be -- I'm not going to make it up.

 8             I'll get back to you on that.  Let me ask my

 9      lawyer.

10             SENATOR RIVERA:  Thank you, Senator Ramos.

11             And thank you-all for being here today.

12             RONA SHAPIRO:  Okay.

13             SENATOR RIVERA:  Moving on to the second

14      panel of the --

15             RONA SHAPIRO:  Gustavo, are you from

16      The Bronx?

17                [Laughter.]

18             SENATOR RIVERA:  Just a little bit.

19             And I will also say, for the record, that

20      I will apologize to you, because I have been

21      referring to last year as "the Rona."

22             And that's -- and now, just when you sat

23      down, I'm, like, Oh, I have been...

24             Okay.

25             RONA SHAPIRO:  It's okay.  I'm used to it.







                                                             296
 1             SENATOR RIVERA:  Thank you so much.

 2             Good Rona.  You're the good Rona.

 3             The next panel will be:

 4             Ilana Berger from the Caring Majority;

 5             Agnes McCray, board president of ARISE -- oh,

 6      I'm sorry.  Agnes McCray was already with us.

 7             A reader for Sandra Moore Giles from the

 8      Senior Home Care Consumer;

 9             Sandra Abramson, family caregiver --

10             Please make your way down.

11             -- and, Mildred Garcia Gallery,

12      Ageless Companions.

13             You may start when you are down.

14             Thank you so much.

15             ILANA BERGER:  Should I start?

16             All right.

17             Hi.

18             So thank you, first, to Chairs May, Rivera

19      and Ramos; to all the staff who worked really hard

20      on this hearing, for the opportunity to testify.

21             My name is Ilana Berger.  I'm the New York

22      director of Hand in Hand, the domestic employers

23      network, which is a sister organization to the

24      national Domestic Workers Alliance.  And I help

25      coordinate New York Caring Majority.







                                                             297
 1             New York Caring Majority is a coalition of

 2      older adults, disabled people, family caregivers,

 3      home care workers, and home care agencies and

 4      providers from across the state, organizing to make

 5      long-term-care services and supports affordable and

 6      accessible to all New Yorkers, and to make home care

 7      jobs living-wage jobs.

 8             So like many others here today, I am also

 9      here to talk about the importance of investing in

10      home care; specifically, raising home care worker

11      pay through passing Fair Pay for Home Care.

12             I wanted to start with just a short quote

13      from an official in the Nassau County Health

14      Department, reflecting on the home care workforce

15      shortage, and they said:

16             "Until we can offer home care aides a sense

17      of worth, a sense of recognition, a fair salary,

18      fringe benefits, and some sort of career-type

19      mobility, we're going have a problem getting

20      sufficient aides and retaining them."

21             It's a great idea, I'm sure we all agree.

22             There's one issue with that, it's from 1987:

23      We never solve this problem.

24             So in the eighties, home care was growing as

25      an alternative to institutional care, and the







                                                             298
 1      population of older adults had started to grow.

 2             As a result, the demand for home care workers

 3      began to rise.  But like today, the pay was low,

 4      conditions were challenging, and it was hard to find

 5      and retain workers.

 6             So almost 35 years later, the challenges are

 7      still with us.

 8             And by not solving these challenges over the

 9      past three decades, we have let them develop into a

10      full-blown crisis.

11             "The Rona" has only made matters worse.

12             Sorry, Rona.

13             So I'm strongly here to advocate for the

14      passage of Fair Pay for Home Care, to increase

15      worker pay to 150 percent of minimum wage.

16             There are so many reasons to support it.  And

17      I'm not -- but hearing from workers, hearing from

18      consumers, and the compelling stories are the most

19      important.

20             So I want to talk today about the economic

21      argument.

22             I'm going to be an economist today, although

23      I am not one in real life, and sort of focus on a

24      report that was done recently by a CUNY researcher,

25      Isaac Jabola-Carolus, and Professors Stephanie Luce







                                                             299
 1      and Ruth Milkman, who couldn't be here, who did a

 2      study called "The Case for Public Investment and

 3      Higher Pay for New York State Home Care Workers."

 4      It was published just earlier this year.

 5             And they find that lifting wages, like what

 6      we would do with Fair Pay for Home Care, would

 7      require a substantial public investment, but the

 8      resulting savings, revenues, and economic benefits

 9      would far exceed the cost.

10             So the CUNY report begins with the same sort

11      of demographic story we already know.

12             Between now and 2040, New York's overall

13      population is projected to grow only 3 percent, but

14      the number of adults aged 65 and over will grow by

15      25 percent; and the age of 85 and over by

16      70 percent.  And that continues to the point where,

17      between 1970 and 2030, the over-65 population will

18      have doubled its share, growing from about 1 in 10

19      to 1 in 5 New Yorkers.

20             Additionally, the Center for Disease Control

21      and Prevention says a quarter of the state's

22      population has a disability likely to increase

23      because of COVID long-haulers.

24             They just published this week a study that

25      found that, potentially, 1 in 5 COVID-19 patients







                                                             300
 1      will leave a hospital with a new disability.

 2             So based on this projections, between 2018

 3      and 2028, the number of home health and personal

 4      care aide jobs is going to grow by an average of

 5      over 26,000 a year.

 6             Every year these occupations add as many jobs

 7      to the state economy as the next 40 largest

 8      occupations combined.

 9             This is good news, which means home care is a

10      vital growth sector.  But these jobs are going

11      unfilled because people cannot make a living on the

12      pay.

13             So the steady flood of workers leaving these

14      jobs adds to another 72,000 openings, which is far

15      more than any other occupation.

16             The exits, the people leaving the workforce,

17      is much higher than any other sector.  In total, we

18      face about 100,000 openings each year in home care,

19      adding up to nearly a million job openings over a

20      decade.

21             So CUNY looks at what would happen if you

22      invest in something like Fair Pay for Home Care.

23             It would lift the wages of 85 percent of home

24      care workers statewide, about 200,000 people.

25             It would cost about $4 billion, which is a







                                                             301
 1      lot of money; although, in perspective, it's only

 2      about 1 percent of total spending within New York's

 3      health-care system.

 4             What they find is, despite the cost, what we

 5      would get back from economic spillover, which is the

 6      money from higher wages in communities; new sales

 7      tax revenue from that spending; new income tax

 8      revenue; savings in public assistance; and then

 9      productivity gains because of less turnover, result

10      in about 7.6 billion in money coming back to the

11      state, totaling about 5.4 billion overall, given the

12      investment in.

13             So it would also create about 20,000 new home

14      care jobs every year, and then 18,000 jobs in other

15      sectors because of this economic spillover.

16             So it's a huge economic benefit.

17             I'm going to be like 30 more seconds, just to

18      say, in addition to the economic benefit, we also

19      want to see who's benefiting.

20             So there's 200,000 home care workers who are

21      90 percent women, 75 percent Black, Hispanic, and

22      Latino -- and Asian, and 67 percent born outside the

23      United States.

24             So public investment and higher pay is also a

25      powerful tool to advance equity in race, gender, and







                                                             302
 1      immigration status.

 2             And then for folks who need the care, just,

 3      if you look again at the aging population, the

 4      number of adults age 65 and over has grown much more

 5      among Black, Latino, and especially Asian residents.

 6             So solving the home care shortage is also a

 7      crucial piece in ensuring that care is available to

 8      communities of color.

 9             So I will leave it there, just to say that

10      it's a great economic investment.  It's an

11      investment in equity.

12             Please support Fair Pay for Home Care, as

13      well as the Home Care Jobs Innovation Fund, and

14      eliminating the global cap.

15             Thank you.

16             SENATOR MAY:  All right.  Thank you.

17             So it says, "A reader for

18      Sandra Moore Giles."

19             Is that you?

20             Okay.

21             MARGARITA SEINE [ph.]:  Yes, my name is

22      Margarita Seine [ph.].  I live in Saugerties,

23      New York, and I am reading Sandra Moore Giles'

24      testimony.

25             I know Ms. Giles from the New York Caring







                                                             303
 1      Majority.  We advocate alongside each other.

 2             And I just want to say, she's a remarkable

 3      person who puts her body and soul into this work.

 4             She is featured in an outdoor art

 5      installation currently in Freedom Plaza in

 6      Washington, D.C.  And she traveled to D.C. earlier

 7      this month to speak, and to cut the ribbon with

 8      Secretary of Labor Marty Walsh.

 9             And the only reason she's not here today is

10      because, for reasons of her health, her doctor told

11      her she should not make the trip from Kingston into

12      Albany today.

13             So I have been asked to read her testimony,

14      and I am really honored to share her story in her

15      words with you today.

16             (Statement of Sandra Moore Giles read, as

17      follows:)

18             My name is Sandra Moore Giles from Kingston,

19      New York.  I am 75 years old.

20             I have served and cared for my community my

21      whole life.

22             I was a foster mother for 106 children, and

23      adopted 4 children.

24             I have worked as a chaplain on Rikers Island

25      and in our prison system.







                                                             304
 1             I run the food pantry at my church.

 2             I'm on the board for the Office of The Aging

 3      in Ulster County.

 4             I'm getting older now, though, and now I can

 5      no longer do that because of my health.  Now I need

 6      help.

 7             I just received a letter from Fidelus and my

 8      doctor, saying, I need 20 hours a week of home

 9      health care.  I can't even fill five hours a week.

10             Because of the stress and the strain of not

11      having a home health aide, last week I was

12      hospitalized for a blockage in my heart.

13             I wish I could be with you-all today, but I'm

14      getting heart surgery tomorrow.

15             Who is going to take care of me when I get

16      out of surgery?

17             No one wants to do home care -- home

18      health-care work now because the pay is too low.

19             You can make more working in fast-food than

20      you can taking care of a human being like me.

21             I need help.  I need an aide.

22             Who is going to help me?

23             I do not want to end up in a nursing home.

24             And I'm not alone.

25             I live in a senior building.  Many of my







                                                             305
 1      neighbors are going through the same struggle.

 2             We need to make home care jobs good jobs.

 3             We need to support seniors to live

 4      independently.

 5             We need you to pass Fair Pay for Home Care as

 6      soon as possible.

 7             Thank you.

 8                       -- Sandra Moore Giles.

 9             SENATOR MAY:  Thank you.

10             And thank you for being here to do that.

11             Sandra.

12             SANDRA ABRAMSON:  Hello.  My name is

13      Sandra Abramson.

14             Thank you, Senators --

15             Better?

16             Thank you -- no?

17             Can you hear it now?

18             SENATOR MAY:  Yes.

19             SANDRA ABRAMSON:  Okay.

20             My name is Sandra Abramson.

21             Thank you Senators Rivera, May, Ramos.

22             I'm a 75-year-old senior, living alone in

23      Senator Benjamin's district in New York City.

24             I'm here to tell you my story, and about why

25      it is so important to have a well-paid and trained







                                                             306
 1      home care workforce to care for seniors and people

 2      with disabilities in New York.

 3             In 2006 it became increasingly clear that my

 4      partner, Terry DeFiore, later to become my wife in

 5      2011 when we were permitted to marry in

 6      New York State, was having increasing physical,

 7      psychological, and emotional difficulty with

 8      day-to-day activities.

 9             She was losing her balance and falling.  She

10      would break into laughter in appropriate --

11      inappropriate times.

12             She, who had been able to problem-solve with

13      ease, was continually making errors in judgment.

14             It took us nearly three years to learn that

15      she had progressive supranuclear palsy, or "PSP," a

16      degenerative neurological disease that would render

17      her progressively incapable of care for herself.

18             However, we were very lucky.  In 2002 we had

19      decided to look into purchasing long-term-care

20      insurance.

21             No insurer would sell me a policy, as I had

22      had a stroke several years earlier.  But Terry was

23      in perfect health, and was able to purchase the

24      platinum policy, long-term care, from Genworth.

25             It covered her for life, and had a high







                                                             307
 1      monthly payment.

 2             Little did we know that Terry's perfect

 3      health condition wouldn't last for more than

 4      four years.

 5             Genworth didn't know that either.

 6             By late 2008, Terry, who had worked in the

 7      construction field as a site safety manager, began

 8      to show increased signs of her illness.

 9             Her task was to keep workers and others safe.

10             As her disease progressed, however, she could

11      barely keep herself safe, let alone care for others.

12             She stopped working on December 1, 2008, and

13      in 2009, of April, Genworth started covering the

14      cost of caregiver to be with Terry during the day,

15      as I was still working, and Terry needed someone

16      with her so she would be able to attend our local

17      senior center, go up and down stairs, eat, and do

18      all the things she could still do.

19             In 2010, when Terry moved downstairs, she

20      need 24-hour care so that I could get some sleep,

21      and be able to do what I needed to do to care for

22      myself as I supervised her care.

23             We were working with Visiting Nurse Service

24      of New York (VNS) to find and supply caregivers.

25             VNS supervised the caregivers, and charged us







                                                             308
 1      a little more than $20 an hour, while they paid the

 2      workers about $9-plus an hour.

 3             Genworth's reimbursements, totaling nearly

 4      $13,000 monthly, covered Terry's care costs and

 5      other essential costs.

 6             We had several caregivers over the years

 7      through VNS.  They were generally competent, caring,

 8      and compassionate.

 9             However, at some point I began to consider

10      asking some of the caregivers if they would work for

11      us privately.

12             We could offer them nearly twice what VNS was

13      paying them.

14             After some back-and-forth, one agreed.

15      I found someone else.

16             From 2011, on, I supervised a caregiving

17      staff of three-plus women who were wonderful

18      caregivers.

19             I did all the scheduling, the invoicing to

20      Genworth, as well as the payroll and tax payments.

21      We were able to pay them over $18 an hour.

22             After living with this horrendous disease for

23      nearly seven years, Terry died in 2013.

24             Genworth had paid out more than $600,000 to

25      cover her caregiving costs, although she paid less







                                                             309
 1      than $15,000 in premium.

 2             Had she not had the insurance, as well as

 3      other disability insurance and Medicare, we would

 4      have had to sell our home and other assets to pay

 5      for her care, or she would have been declared

 6      indigent and gone on Medicaid.

 7             Terry's story would not be my story if I were

 8      to contract a debilitating disease.  As I said,

 9      I don't have any of the insurance coverage that

10      Terry had.

11             I would have almost none of the support or

12      income that she had.  And I have no one to care for

13      the daily, weekly, monthly tasks that I performed

14      for her at no cost to anyone but us.

15             We were able to keep Terry at home.

16             In all that time, she never went to the

17      hospital for nearly seven years as she struggled to

18      live with dignity.

19             We were lucky to have the funds and a home

20      that we could transform into a workplace and living

21      space for caregivers working 24/7.

22             New York is the epicenter of a national

23      income care worker shortage, with the projected

24      shortage of 50,000 workers by 2023, and over

25      83,000 by 2025.







                                                             310
 1             This shortage means tens of thousands of

 2      New Yorkers are currently at risk because they

 3      cannot receive the services that they need to live a

 4      high-quality life in the community, with hundreds of

 5      thousands more on the brink of disaster.

 6             Low wages are the reasons for this crisis.

 7             Governor Cuomo claims that New York is the

 8      most age-friendly state in the nation.

 9             While we appreciate the sentiment, if

10      Governor Cuomo wants New York to lead in this area,

11      we have a long way to go.

12             I'm now 75.

13             As I age, I wonder how I will live if I get

14      sick and need the kind of care Terry needed.

15             Without fair pay, where will we be able to

16      find the kind of caregivers that Terry had.

17             Thank you.

18             SENATOR MAY:  Thank you.

19             MILDRED GARCIA GALLERY:  Senators, and Senate

20      committee members, my name is Mildred Gallery;

21      Mildred Garcia Gallery.  I'm a proud Latina.

22             I have been a home care worker for more than

23      30 years, and the founder of Ageless Companions, a

24      Long Island-based staffing agency.

25             I was introduced to home care at 19 while







                                                             311
 1      I worked United Cerebral Palsy.

 2             One client, a young man in particular, named

 3      Perry, truly impacted my views on home care.

 4             He was wheelchair-bound, and he was in a

 5      special program for eating.  One day during lunch he

 6      began to choke and he turned blue.

 7             Although I was scared, I jumped into action.

 8      I suctioned him, dislodged the piece of food, and,

 9      thank goodness, he began to breathe.

10             We both sighed in relief.

11             I was shaken, but I felt capable and

12      competent, and I hadn't felt that at that age -- at

13      that time.  And it really gave me direction.  It

14      made me want to do better and be better.

15             It changed the direction of where -- or, the

16      projection of where I was going to go in life,

17      because I was not one of those -- I wasn't -- my

18      circumstances did not allow me to go to college

19      directly out of high school.

20             So home care actually saved me, in a sense.

21             I would like to continue on so...

22             I continued to provide the best possible care

23      for all of my clients.

24             One of the most memorable clients was

25      Ralph Ciprioni [ph.], a 95-year-old World War II







                                                             312
 1      veteran, and his wife, Christine [ph.].

 2             Ralph, when I met him, was 98 pounds, but his

 3      will to live was as strong as my will to care for

 4      him.

 5             I learned much about life from Ralph.

 6             I learned about patience.

 7             I learned about the value of human contact

 8      and human interaction, and how much that does feed

 9      and nurture a person.

10             Together we worked tirelessly.

11             His doctors were impressed with the amount of

12      progress he made in such a short period of time.

13             Our growing friendship encouraged him to

14      fight a little bit longer.

15             Unfortunately, Ralph lost his battle, but on

16      his own terms, at home, with dignity, with love and

17      support.  And I was proud to be a part of it.

18             And I am proud to still currently care for

19      his wife.  And they were married for 71 years.

20             And anyone knows, being married that long, a

21      loss like that can actually take you down.

22             But it didn't, because she has us, and we

23      have her.

24             This has been my life's passion -- my life's

25      work passion, but the pay -- with the low pay,







                                                             313
 1      I wonder every day, how can I stay?

 2             How can I continue to stay in a profession

 3      that does not value me?

 4             How can I support my family, my three

 5      daughters.  I'm trying to put them through college.

 6             This work makes me feel wonderful, but it

 7      doesn't pay the bills.

 8             I know that I am one of thousands of people

 9      who love home care work, but the feeling -- but

10      we're feeling forced to leave a profession because

11      of its low wages.

12             So I am here to ask you, to beg of you, to

13      say "this is the time."

14             We need it more than ever.

15             We -- the families need it, they need our

16      care, but we need to be cared for.

17             To go on to continue to care in a way that

18      you care for your own family; but yet, to go home,

19      and to come home to your own empty pantry, to not be

20      able to provide for your children the things that

21      you want, that you see maybe the families that

22      you're caring for.

23             It really is about the humanity.

24             I feel that we have lost that sense of

25      humanity, where possessions and things mean so much,







                                                             314
 1      and at the cost of our loved ones' lives, of how we

 2      care for them.

 3             We have got to put that first, because,

 4      without human compassion, and us coming together to

 5      solve this problem, I don't know what else is going

 6      to happen.  I don't know who else to ask for.

 7             We have exhausted every area.  Every area.

 8             And this is a job that I and many others are

 9      so proud to do.

10             And there are all these misconceptions about

11      us.  And that's -- those are stigmas, and that's not

12      the majority of us.  It is the minority.

13             I speak for all of the ones that love to do

14      this, and we don't want to leave.  We want to stay

15      and do this work that we've been doing for long, or

16      people who just came into it.

17             We want more people to come and join us, but

18      they're not going to for this pay, when they can go

19      to Holly [sic] Lobby, or wherever, and make more

20      money.

21             So what are we saying?

22             That the value of our loved ones is not that

23      much.

24             SENATOR MAY:  Thank you.

25             Thank you so much.







                                                             315
 1             Thank you, all of you, for just reminding us

 2      how important this is.

 3             Ilana, I wanted to follow up with you,

 4      because you talked about 100,000 openings a year;

 5      and all of you talked about what this job means.

 6             One of the things it means, if we have

 7      100,000 people who are looking for care and not

 8      getting it, is that there are a lot of families that

 9      are stepping in and doing that care.

10             There are a lot of people who are putting

11      their own lives on hold, in one way or another,

12      stepping away from the workforce, or, you know,

13      going part-time, or all of those kinds of things.

14             I have a bill to create a family caregiver

15      tax credit, but it's a tiny drop in the bucket in

16      terms of what the costs are.

17             So I'm just wondering, when you talked about

18      the $7.6 billion return on a $4 billion investment,

19      I'm very familiar with that.

20             We have the bill, Investing in Care Act, that

21      is specifically designed to activate that -- that

22      investment.

23             I'm wondering, was this also considered in

24      there, the opportunity cost of all of the home --

25      the family caregivers who are going to step in, or







                                                             316
 1      neighbors or whoever was going to step in, and do

 2      this work voluntarily because somebody had to do it?

 3             You know?

 4             Is that calculated in there?

 5             ILANA BERGER:  It's not in the -- the CUNY

 6      report that looked at those numbers does not look at

 7      that.

 8             So that's an even additional economic benefit

 9      that is not quantified, at least in that report.

10             And from all of the numbers I've seen about

11      the amount of money taken out of the economy,

12      because of family caregivers, it's, you know,

13      billions.

14             So I think -- I would say that the CUNY

15      report's numbers are fairly conservative in terms of

16      the economic benefit of investing in this workforce.

17             SENATOR MAY:  It would be great to fold that

18      in so that we can be telling the whole story when we

19      are advocating.

20             ILANA BERGER:  As I said earlier, I, in fact,

21      only have a college degree, and I'm not an

22      economist.  So we can set the economists back on

23      that one.

24                [Laughter.]

25             SENATOR MAY:  Perfect.







                                                             317
 1             ILANA BERGER:  But I do also want to say to

 2      that, in terms of the -- you know, the numbers and

 3      the shortage that we're hearing, and you'll hear

 4      more from people, that, you know, on the daily,

 5      we're getting calls from folks who -- sometimes

 6      family members step in, and sometimes people don't

 7      have family members.  And they're actually -- the

 8      only option is either, you know, we have members who

 9      are staying in bed for 24 hours, who can't get out

10      of bed without an aide.

11             And, ultimately, if you can't find somebody,

12      your only option is an institution.  And that is not

13      where people want to go.

14             So we're in a real crisis right now.

15             SENATOR MAY:  Right.

16             And to Sandra, I wanted to say thank you for

17      explaining how long-term-care insurance can work.

18      But what we're hearing is that a lot of the

19      companies are going belly-up.

20             People have invested in those, and they

21      aren't going to get the insurance anyway; or it's

22      not what it was cracked up to be.

23             So that's a whole nother area of health care,

24      where what we really need is the New York Health

25      Act.







                                                             318
 1             But we have to look at that, like what --

 2             SANDRA ABRAMSON:  We knew how lucky we were.

 3             SENATOR MAY:  -- provisions can people make?

 4             Sorry?

 5             SANDRA ABRAMSON:  We truly knew how lucky we

 6      were.

 7             I mean, when I said it was the platinum

 8      policy, they didn't know what they were getting

 9      into.  I mean, we didn't know what they were getting

10      into either, obviously.

11             Sorry.

12             We didn't know what we were getting in --

13      they didn't know what they were getting into.

14             They paid out over $630,000.  It really was

15      the platinum policy.

16             No one can get that anymore.

17             SENATOR MAY:  Don't feel sorry for them.

18             They were getting premiums from a lot of

19      other people.

20             SANDRA ABRAMSON:  They were part of

21      General Electric.  I don't feel sorry for them.

22                [Laughter.]

23             SENATOR MAY:  Anyway, thank you-all.

24             Does anyone else have questions?

25             SENATOR SERINO:  Thank you, all.







                                                             319
 1             SENATOR BENJAMIN:  Sure.  Yes.

 2             SENATOR MAY:  Don't go anywhere.

 3             SENATOR BENJAMIN:  I'm sorry.  I was -- I'm

 4      sorry I didn't...

 5             No, first of all, I want to thank you for

 6      this testimony.

 7             And I -- obviously, to Sandra, I really

 8      appreciate hearing how much you did for Terry.  And,

 9      you know, in my heart, I believe that you should

10      have been compensated as well.

11             I do -- you know, I feel very strongly that

12      family caregivers, when possible, because I do

13      accept the fact -- I do understand that some don't,

14      is what you're looking for.

15             You know, my father-in-law passed.  And his

16      wife and my wife were able to take care of him at

17      the end.  And there's just -- there's the love that

18      you bring to that.

19             And so I want to just thank you for your

20      testimony, and for being here to help us as we're

21      figuring out the steps forward.

22             And, obviously, I'm a proud supporter of

23      fair pay for home care workers.

24             So thank you for being here.

25      ///







                                                             320
 1             IGNACIA REYES:  Now you can go.

 2             All right.  We have Panel 3 next, which is:

 3      Mary Lister, Ignacia Reyes, and JoAnn Lum.

 4             SENATOR RIVERA:  By the way, folks -- folks?

 5             By the way, just as a quick thing, folks

 6      after you're done, you don't have to go up the

 7      stairs again.  There's actually an elevator a little

 8      bit outside that door, because I want to make sure

 9      that you're good.  You know?

10             MARY LISTER:  Thank you.

11             SENATOR MAY:  All right.  Let's start with

12      Mary.

13             MARY LISTER:  Good afternoon.  My name is

14      Mary --

15             SENATOR MAY:  Touch the button.  Make sure

16      the light's on.

17             SENATOR RIVERA:  Say something.

18             One more time, just hit it once, and then say

19      something.

20             Say something, one more time.

21             Try it one more time.

22             MARY LISTER:  Am I supposed to --

23             SENATOR MAY:  Do it again.

24             SENATOR RIVERA:  Press it slow, like, just a

25      little bit, just a little touch, just a little tap.







                                                             321
 1             MARY LISTER:  Hello?

 2             SENATOR RIVERA:  There you go.

 3             I'll say it once again:  We need to get new

 4      damn mics.

 5             SENATOR RAMOS:  The austerity budget does not

 6      allow for new technology.

 7             MARY LISTER:  Hi.  My name is Mary Lister,

 8      and I'm a home care worker from Buffalo, New York.

 9             I'm a founding member of the Queens City

10      Workers Center, and I organize with other home care

11      workers throughout the state with the Ain't I a

12      Woman?! campaign.

13             I've been a home care worker now since 2013.

14             During this time I have served in so many

15      roles for so many different people.

16             I have been a community habilitation worker

17      for a young woman with cerebral palsy, assisting her

18      in achieving her career goals.

19             I've been a consumer-directed aide for an

20      older, non-verbal man who uses a wheelchair, helping

21      him get dressed every day, cooking him meals, and

22      cleaning up around the house.

23             One of the people I currently serve is an

24      older woman with advanced Alzheimer's who requires

25      assistance in every single task of daily living,







                                                             322
 1      from eating, to toileting, to walking.

 2             Not a single person goes into home care

 3      because it pays well.

 4             I've stayed in home care so many years

 5      because I love it.

 6             I enjoy assisting people to live the life

 7      that they want with dignity and as much independence

 8      as possible, and I'm good at it.

 9             Most of my years as a home care worker

10      I earned minimum wage.

11             But I urge you to consider what is truly

12      necessary to grow the home care workforce, and to

13      make possible a real minimum-wage increase: an end

14      to the 24-hour workday.

15             Long work hours in any field are correlated

16      with increased workplace mistakes and on-the-job

17      accidents.

18             Many studies have found that, in the medical

19      field specifically, rates of injuries and mistakes

20      skyrocket during shifts longer than 12 hours.

21             In home care there is no such thing as a

22      small mistake.

23             A mistake in medicine could mean health

24      complications for the person receiving care.

25             A mistake in a transfer could mean a broken







                                                             323
 1      hip.

 2             And a mistake that injures the worker

 3      themself can take us out of the field permanently,

 4      creating this issue of a home care workforce

 5      shortage to get worse.

 6             The incidence of disability suffered by home

 7      care workers is confirmed by a study by the

 8      University of New Hampshire Institute on Disability

 9      Statistics.

10             They found that home care was the industry in

11      New York City with the most workers to become

12      disabled.  And New York State, home care was fourth.

13             24-hour shifts is causing more people to

14      become disabled and need in-home care.

15             Why this difference between New York City and

16      New York State, in general?

17             In Buffalo, where I'm from, and other upstate

18      cities, the 24-hour shift is not yet common.

19             Care recipients requiring around-the-clock

20      care have generally managed to get split shifts

21      rather than one worker doing 24 hours.

22             But if, as we are all hoping today, the

23      minimum wage for home care workers increases,

24      upstate home care agencies will have a huge

25      incentive to start implementing 24-hour shifts for







                                                             324
 1      13 hours' pay.

 2             This has got to stop.

 3             If we want an end to the home care workforce

 4      shortage, if we want a sustainable and a thriving

 5      economy of care, then we have to put an end to

 6      treating home care workers like disposable machines

 7      to be used up and thrown out.

 8             We need to not only raise the wage, but end

 9      the 24-hour workday.

10             Please immediately support Assembly

11      Bill 3145, Senate Bill 359; legislation supported

12      by, and created in large part due to, the organizing

13      of home care workers that are here today.

14             Thank you.

15             SENATOR RIVERA:  Could you please repeat the

16      bill number?

17             MARY LISTER:  A3145, and Senate 359.

18             SENATOR RIVERA:  359.

19             MARY LISTER:  I will double-check that; but,

20      yes --

21             SENATOR RIVERA:  Thank you, ma'am.

22             SENATOR MAY:  Ignacia.

23             IGNACIA REYES [ph.]:  (Witness speaking a

24      foreign language.)

25             THE INTERPRETER:  I'm going to translate for







                                                             325
 1      Ignacia.

 2             My name is Ignacia Reyes.  I have been a home

 3      attendant for 23 years; most of that, 24-hour

 4      shifts.

 5             And I come here to speak on behalf of all

 6      workers -- home care workers who work 24-hour

 7      shifts.

 8             We can't continue with this.  Many of us have

 9      come out of this injured.

10             We've got to stop.  It is inhumane.  The

11      24-hour shift is inhumane.

12             And on top of that is the wage theft.

13             Cuomo didn't sign the bill that would have

14      helped to stop it.  But this still goes on.

15             So we have got to stop both the wage theft

16      and the 24-hour shifts.

17             Thank you.

18             IGNACIA REYES [ph.]:  (Witness speaking a

19      foreign language.)

20             (Translated to English by an interpreter, as

21      follows:)

22             Right now I am so injured, I can't go back up

23      those stairs.  And I'm a member of 1199.  They

24      really haven't done anything for us.

25      ///







                                                             326
 1             IGNACIA REYES [ph.]:  (Witness speaking a

 2      foreign language.)

 3             (Translated to English by an interpreter, as

 4      follows:)

 5             To the senators, please call Governor Cuomo.

 6      Tell him he's got to sign that bill to stop the wage

 7      theft.

 8             IGNACIA REYES [ph.]:  (Witness speaking a

 9      foreign language.)

10             (No translation provided.)

11             JOANN LUM:  Thank you, Senators, and other

12      participants, for convening this.

13             As you can see, people feel very passionately

14      about this question.

15             My name is Joanne Lum, and I'm here with the

16      National Mobilization Against Sweatshops, and part

17      of the campaign called "Ain't I a Woman Campaign,"

18      which Mary and Ignacia and I are all part of.

19             This is a campaign that's statewide, and it

20      includes workers groups, disability rights groups,

21      student group, women's groups, and others.  And we

22      have been organizing for 20 years or so around the

23      valuing of caregiving and against long hours of

24      work.

25             And we're here today because we agree that







                                                             327
 1      it's urgent for the government to address -- take

 2      action to address the shortage of workers in home

 3      care.  And to value the work of caregiving, raising

 4      wages is critical, it's needed.

 5             But to make this wage increase real, we need

 6      to end the wage theft that happens, for instance, in

 7      24-hour shifts.

 8             So many workers, like Ignacia, work 24-hour

 9      shifts, don't sleep, and are paid for only 13 hours.

10             That means 11 hours for free.

11             So this renders the minimum-wage law

12      meaningless, this type of wage theft.  So even if

13      you raise the wage, it just -- it also means more

14      wage theft.

15             We also, as part of the -- we need to end the

16      24-hour shift, also as Ignacia said, more

17      fundamentally; and at the same time, we need to hold

18      the scofflaw employers accountable.

19             As some previous people have spoken about,

20      there are a lot of agencies that don't comply with

21      the law, that don't do right by the workers.

22             And, actually, we've worked with hundreds and

23      hundreds of home care workers to file lawsuits and

24      labor complaints at the Department of Labor, exactly

25      for that reason, to recoup stolen wages, wages that







                                                             328
 1      weren't paid, especially in these shifts of

 2      24 hours.

 3             And some of the workers have also initiated

 4      protests against their agencies.

 5             For instance, right now, the workers of the

 6      Chinese-American Planning Council (CPC) have been

 7      leading protests against their agency because they

 8      still have not been able to recoup their stolen

 9      wages after waiting six years, seven years almost,

10      you know, with a claim.

11             There are so many more with the same story,

12      and these are at union and non-union agencies, it's

13      so prevalent.

14             So we've already heard a little bit from

15      Ignacia about these 24-hour workdays.  And Mary has

16      spoken to it also.

17             But we began in our campaign to see home care

18      workers coming forward about six or seven years ago.

19             At first it was about the wages not paid; the

20      overtime, the hours that weren't paid.  But then,

21      more and more, they began talking about how the

22      24-hour shifts destroyed their health, as Ignacia

23      mentioned, destroyed their families; destroyed their

24      lives, basically.

25             And for those with no work or not enough







                                                             329
 1      hours, these 24-hour workdays negatively impacted

 2      them, too, because some people were overworked, and

 3      then leaving other people with not enough

 4      employment.

 5             It also, these 24-hour workdays, sends a

 6      message that there's no floor; that caregiving work

 7      is so devalued that a woman can be made to work

 8      every single hour of a day.

 9             You know, it's no wonder so many refused to

10      be subjected to these conditions.

11             People earlier spoke about the pandemic, and

12      how it's made it worse for home care workers and us.

13      We've certainly seen that.

14             We saw so many home care workers come in to

15      us for PPE.

16             And we lost a few members to COVID in our

17      organization.

18             And because of the lack of protection in

19      their work, a lot of workers have decided not to

20      continue working in home care.

21             Also, many others, because of health problems

22      and illnesses as a result of years of working

23      24-hour shifts, they've decided to retire early.

24             Even before the pandemic, home care workers

25      were made to work 24-hour shifts for days on end at







                                                             330
 1      half the pay.

 2             And it's made them -- it made it hard -- many

 3      people talked about how it's made it hard to provide

 4      proper care --

 5             We were talking about it earlier with some

 6      other participants.

 7             -- when you're sleep deprived, when you're

 8      stressed.

 9             SENATOR MAY:  JoAnn, can you wrap up?

10             JOANN LUM:  Sure.

11             So I just want to reiterate, then, that we

12      call on legislators and participants here today to

13      unite, to join forces, to call for wage increase, an

14      end to the wage theft, and an end to the 24-hour

15      shift, so that we can really show that we value the

16      work of caregiving.

17             Thank you.

18             SENATOR MAY:  Thank you.

19             SENATOR RAMOS:  Thank you so much.

20             I was wondering, JoAnn, if you could provide

21      a little more context for those at home who may be

22      watching, and are not aware about the 13-hour rule,

23      and how many home attendants are, you know, working

24      24 hours a day around the clock to care for these

25      folks.







                                                             331
 1             Because, of course, even if the patient is

 2      sleeping, sometimes they get up in the middle of the

 3      night, they have needs, they need to use the

 4      restroom, they need -- right?

 5             So the home attendant has to get up as

 6      well -- right? -- and do their job.

 7             Can you talk about -- a little bit about the

 8      court decision that took place, and kind of a little

 9      back story?

10             JOANN LUM:  Hello.

11             So at first there were -- back several years,

12      maybe six years, there were three court cases, state

13      court, where the workers -- there were workers who

14      were working 24-hour shifts, and bringing claims for

15      their owed wages, where the courts decided in these

16      three cases, it doesn't matter if you slept or not,

17      you should be paid all 24 hours.

18             And we celebrated.

19             But then, immediately, that -- the

20      Department of Labor issued emergency regulation to

21      say, no, no, no, that's going to bankrupt the

22      industry.  We need to keep the 13-hour rule.

23             And so, subsequently, there were appeals to

24      those court decisions.  It went to the highest court

25      in the state, and the highest court overturned the







                                                             332
 1      lower-court decision.

 2             So basically the law now, is that if you --

 3      it's okay to work a 24-hour shift.  You're entitled

 4      to eight hours of sleep, five hours of which -- at

 5      least five hours uninterrupted; plus three hours

 6      uninterrupted meal break.

 7             So it's very clear the law, actually.

 8             But the problem is that, in reality, when

 9      workers can't get that five hours' uninterrupted

10      sleep, and they report it, then they're either

11      ignored or they're threatened.

12             And there have been cases where agencies have

13      told the home care worker, put the patient to bed at

14      9 p.m., and just, you know, in the night, you know,

15      just go to sleep, because we're not paying you for

16      the night.  And if there's a problem, call 911.

17             So there was one case, where the worker, of

18      course she is not going to ignore the -- I mean,

19      you're there to work, to be there on call.

20             And so she went as usual to help the patient.

21             And she reported that the next morning to the

22      agency, that she had to get up to help the patient,

23      and she was fired.

24             We subsequently were able to work with her to

25      get reinstated.







                                                             333
 1             But this is just an example of what -- how,

 2      on the ground, what is really happening, so that

 3      workers are pressured to not report that you didn't

 4      sleep.

 5             SENATOR RAMOS:  So do we know approximately

 6      how many workers have been victim of this 24-hour

 7      shift, and how many workers are owed wages?

 8             JOANN LUM:  You know, I don't have numbers.

 9      Our worker center is very small, and we work with

10      other small worker centers.

11             But I would say, I mean, we have seen, like

12      I say, hundreds and hundreds and hundreds of

13      workers.

14             And we've filed claims for probably, in our

15      campaign, maybe more than a dozen agencies,

16      different agencies.

17             And like I say, some are unionized, some are

18      not unionized.

19             And those that are unionized are in different

20      unions.  Some are Local 1303.  Some are 1199.  Some

21      are some other that I haven't really heard of.

22             But, anyway, it's a mixed bag.

23             But we have heard from others that

24      the percentage of overall cases that are 24 hours is

25      very small because -- and partly because the







                                                             334
 1      managed-care companies don't really want to give

 2      that a lot of times.

 3             I mean, it's a big fight sometimes to be able

 4      to get those hours for those who need it.

 5             And so -- but now we hear that more and more

 6      workers are actually feeling emboldened -- and maybe

 7      it's because of the campaign -- but feeling more

 8      emboldened to say no.

 9             But the problem is that, all along, workers

10      have said that they took 24-hour shifts, not because

11      they like them, but because --

12             SENATOR RAMOS:  They were pressured.

13             JOANN LUM:  -- yeah, like --

14             SENATOR RAMOS:  How -- how -- sorry, because

15      we do have limited time.  Right?

16             How do you propose that not-for-profit

17      organizations with limited -- a limited operation

18      budget be able to, you know, compensate the workers

19      for their lost wages?

20             JOANN LUM:  That -- they should just -- they

21      take on, that's the law, compliance with the law.

22      And maybe the government needs to help them on it.

23             But, I mean, one shouldn't operate a business

24      if you can't comply with the basic minimum wage and

25      overtime law.







                                                             335
 1             SENATOR RAMOS:  No, I agree with you.

 2             I'm just thinking that if -- that if, you

 3      know, an organization were to pay out, and then the

 4      organization were to fold, then what happens to the

 5      actual industry?

 6             I'm just trying to think, you know, kind of

 7      one thing after the other, chronologically.

 8             So workers get the money that they are

 9      owed -- that they're rightfully owed, but some of

10      these organizations and/or actual for-profit

11      businesses fold.

12             Then what happens to the industry?

13             JOANN LUM:  Maybe they should work --

14             MARY LISTER:  I can -- okay.

15             For at least some of these non-profit

16      agencies, there's a false misconception that they're

17      strapped for cash.

18             Some of them are very good at fundraising

19      money.

20             I'm sure some of them are strapped for cash.

21             But some of the worst -- the ones who have

22      stolen the most wages from their workers are

23      building a new building right now that's very

24      luxurious and nice, and their CEOs are making

25      upwards of six figures a year.







                                                             336
 1             So it's hard for me to -- you know, I think

 2      that the bottom line is, we are coming from worker

 3      centers, and the law supports that we should get the

 4      minimum wage for the time that we're working.

 5             And that's not happening.

 6             And so if --

 7             SENATOR RAMOS:  I understand.

 8             But my question is about the future of the

 9      industry.

10             So, again, you guys got your money --

11      right? -- assuming, you guys got your money, what --

12      who then -- and these organizations fold,

13      for-profit, not-for-profit, how does the industry

14      rise up because people will still need care?

15             So how would that -- I'm trying to -- I'm

16      trying to find the rebuttal to the DOL's assertion

17      that their emergency clause after the Court

18      decision, where they said, no, no, no, but wait a

19      minute.

20             What's the rebuttal to that?

21             JOANN LUM:  Well, first of all, like I say,

22      there should be compliance of the law, and so they

23      should figure it out.  And they should look into

24      maybe the profits of the managed-care companies.

25             You know, we've asked several different







                                                             337
 1      venues, government agencies, to look -- investigate

 2      into the money stream; Medicaid going to managed

 3      care, going to the home care agency.

 4             We can never get any numbers, so, who knows?

 5             Like this was the redesigned -- Cuomo's

 6      redesign of Medicaid back in 2012, was it?

 7             SENATOR RIVERA:  2011.

 8             JOANN LUM:  2011?  Thank you.

 9             And so that's where -- when the introduction

10      of the managed-care company into the system came in.

11             So maybe we should look at the profit margins

12      of that.

13             But I think it's problematic that many -- I'm

14      not saying you are, Senator Ramos, but many justify

15      the maintenance of these 24-hour workdays on these

16      women, you know, subjecting these women --

17      immigrants, women of color -- to 24-hour workdays

18      because we can't -- there's no money.

19             And that -- if -- if we're here -- I mean,

20      I think many of us here want to end violence against

21      women; we want to address racism and sexism in our

22      society; and then we subject 24 -- you know, women

23      of color, immigrants, to 24-hour workdays, what does

24      that say about us as a society?

25             SENATOR RAMOS:  And how far back would you







                                                             338
 1      want to go?

 2             JOANN LUM:  Well, the state labor law allows

 3      five years going back, the statute of limitations.

 4             So it's -- this is just the minimum, the bare

 5      minimum.  We're talking about just the minimum wage

 6      and overtime that's owed.

 7             So when we're talking about raising the

 8      minimum wage, that's why we say, to make it real, we

 9      need -- the law needs to be enforced.

10             And if it's not enforced already, then it's

11      just going to mean there's going to be more wage

12      theft.

13             That's our concern.

14             SENATOR RAMOS:  Okay.  A very valid concern.

15             Well, in my last 30 seconds, I want to assure

16      you that every Democrat on this dais right now is a

17      co-sponsor of S359, the bill that you are advocating

18      for for fair pay.

19             And we hope that the other senator joins us

20      too.

21             Thank you.

22             SENATOR MAY:  Yeah, thank you so much.

23             I just have one comment that I want to make,

24      which is about the calling 911, if they said, you

25      know, if your sleep is interrupted.







                                                             339
 1             And that's just a way of passing the cost on,

 2      again, to the taxpayers.

 3             I mean, if taxpayers are supporting the home

 4      care, we're supporting the police at a much higher

 5      level, and especially if they're getting overtime if

 6      it's in the middle of the night.

 7             And so the idea that you would just say, pass

 8      that cost on over there, it all comes home to roost

 9      with us as taxpayers.

10             So, all together, a broken system.

11             Thank you for bringing that to our attention.

12             SENATOR RIVERA:  I've got a couple.

13             SENATOR MAY:  Oh.  Okay.

14             SENATOR RIVERA:  Just -- I'm glad that

15      Senator Ramos pointed out we are all co-sponsors.

16      I am as well.

17             I wanted to ask you something about it,

18      though.

19             Is it -- it's perspective in nature; is that

20      correct?

21             Because if we're talking about the -- it's --

22      we can all agree that the 24-hour rule is a problem.

23             And we can also agree that it's the State

24      that's messing up, that -- by not changing the law.

25      Right?







                                                             340
 1             The decision that was made regarding the

 2      current state of affairs --

 3             And correct me if I'm wrong, obviously,

 4      because you know this much -- about this much

 5      more -- more deeply than I do.

 6             -- but the current state of affairs, that

 7      decision that was made, basically said, the State

 8      has to change the law to make sure this is -- that

 9      this happens.

10             And so we're the ones messing up.

11             By passing -- if I'm not mistaken, if we pass

12      the bill, 359, it would solve the problem going

13      forward.  It wouldn't necessarily serve to address

14      the issue of past salaries.

15             Is that correct?

16             JOANN LUM:  Yeah, the law to prohibit 24-hour

17      shifts moving forward means split the shift, 12/12,

18      for two people; so, moving forward.

19             And it would indirectly address what has

20      happened in the past, because now there's less

21      chance of the wage theft because you have two people

22      working 12-hour shifts who need to get paid 12 hours

23      each.

24             But, right, as far as the compensation for

25      the six years going back, in those claims, that's







                                                             341
 1      for each agency to resolve, to pay, pay it up.

 2             You know, the workers were owed this amount

 3      of money.  They filed lawsuits, they filed

 4      complaints, at the Department of Labor to resolve

 5      those.  Pay the workers.

 6             SENATOR RIVERA:  Got you.

 7             And as far as the -- 'cause it's obviously --

 8      it's -- I mean, I just want to make sure -- it's,

 9      obviously, we're the ones that are messing up.

10      Right?  The State is doing this.

11             By not passing this bill, we're making it so

12      that this is just -- that bad actors can then get

13      away with abusing their staff in a much easier

14      fashion?

15             JOANN LUM:  That's true.

16             At the same time, we need to hold those bad

17      actors accountable, too.

18             I mean, for already actions already taken,

19      because there are, you know, very prevalent

20      violations of the minimum-wage basic wage law.

21             SENATOR RIVERA:  But is it possible as well

22      that there are good actors who are caught in the

23      middle because the law is what it is right now?

24             MARY LISTER:  So as JoAnn had mentioned

25      before, even under this law that we want to change







                                                             342
 1      and we want to turn into split shifts, even right

 2      now, the law says that, if a worker does not get

 3      eight hours of sleep at night, or does not get five

 4      hours uninterrupted sleep, you must be paid for all

 5      24 hours.

 6             And agencies still aren't doing that.

 7             And so I think part of what we feel, is that

 8      not only do we need to pass this bill to make sure

 9      that, going forward, workers are not, literally,

10      worked into the ground; but, also, that for the

11      agencies who are flouting the law as it currently

12      stands, firing workers when they report having to

13      work at night, telling their workers not to help the

14      clients when it's during the nighttime hours, they

15      are breaking the law as the law stands.

16             And so I think that, for the workers working

17      for those agencies, they feel like, you know what?

18      This is day in, day out.

19             If any of these home care workers were to

20      break the law day in, day out, not only would they

21      be fired, they'd be in jail.

22             But, instead, these agencies are making

23      record-breaking profits, some of them.  I know some

24      of them are struggling.

25             But, for us, the law is part of it, yes, the







                                                             343
 1      State needs to step up, we need split shifts.

 2             And, also, these agencies that are blatantly

 3      breaking the law, and not paying the workers the

 4      amount that they're owed when they're not able to

 5      sleep, need to be held responsible as well.

 6             SENATOR RIVERA:  Okay.  Thank you.

 7             Thank you, Madame Chair.

 8             SENATOR MAY:  Thank you-all.

 9             Mucho gracias.

10             All right, Panel 4 is Rebecca Preve,

11      Tara Klein, and Carlyn Cowen.

12             And we're going to ask Carlyn Cowen to go

13      first, if possible.

14             SENATOR SERINO:  Can I ask you guys a

15      question --

16             SENATOR MAY:  Yes.

17             SENATOR SERINO:  -- on 359, because I'm not

18      on that committee?

19             So has that moved out of committee?

20             I don't know, Senator Ramos, do you have it?

21             SENATOR RAMOS:  No, it has not.

22             SENATOR SERINO:  Okay.  That's why I didn't

23      know about it.

24             But I'm willing to take a look at it.  I am

25      the sole Republican up here.







                                                             344
 1                [Laughter.]

 2             SENATOR MAY:  Appreciate it.

 3             SENATOR SERINO:  Send that towards me.

 4             SENATOR RAMOS:  Thank you for your

 5      consideration.

 6             SENATOR SERINO:  It hasn't moved, though, so

 7      that's why I didn't know about it.

 8             SENATOR MAY:  So, Carlyn, can you go first?

 9             SENATOR RIVERA:  Just press it once, really

10      quickly.

11             SENATOR MAY:  Really lightly.

12             CARLYN COWEN:  Hello?

13             SENATOR RIVERA:  There you go.

14             CARLYN COWEN:  Good afternoon.

15             Thank you for the opportunity to testify at

16      today's hearing.

17             My name is Carlyn Cowan, pronoun saying she,

18      and I'm testifying on behalf of the Chinese-American

19      Planning Council (CPC) today.

20             I'm going to start with a personal story.

21             When I was 11, my mom got sick, like,

22      "couldn't get out of bed" sick.

23             She had to go on disability, and it took

24      years of doctors visits, PT, and more, before she

25      could do simple things like walk or change her







                                                             345
 1      position unassisted.

 2             My dad and I had to figure out care for her,

 3      my chronically ill younger brother, and the

 4      household, while, of course, still managing work and

 5      school.

 6             I tell this story because we all have a

 7      "care" story here today.  And if you don't have one

 8      right now, you probably will.

 9             Seven out of ten us are going to need

10      long-term care at some point in our lives, and it's

11      often earlier than we think.

12             New York State is aging rapidly.

13             By 2030, 5.2 million people in the state will

14      be 60 or older, not to mention more than 1 million

15      disabled New Yorkers that need care to live in their

16      homes with dignity.

17             The good news is that New York State is

18      constitutionally mandated to provide these services

19      to all New Yorkers because of the U.S. Supreme Court

20      Olmstead decision.

21             The bad news is that the State severely

22      underfunds the non-profit organizations and workers

23      they outsource these services to, and New York is

24      now the epicenter of the home care workforce

25      shortage crises, with a projected workforce shortage







                                                             346
 1      of 83,000 workers by 2025.

 2             The cause of this workforce shortage is

 3      chronic low wages and poor working conditions

 4      pervasive throughout the sector, a direct result of

 5      State funding decisions.

 6             According to the New York State Department of

 7      Labor, the median annual salary for home care aides

 8      is $24,800.

 9             The low wages chronic to the sector are

10      deeply rooted and directly connected to the systemic

11      devaluation of care work as work that is

12      traditionally performed by women; historically,

13      enslaved Black women in the United States.

14             Today the home care workforce in

15      New York State is 90 percent women, 75 percent

16      people of color, 67 percent immigrant, and the State

17      continues to enshrine the devaluation of care work

18      in its programs, practices, and reimbursement rates.

19             CPC, as well as its affiliated home care

20      organization, CPC Home Attendant Program, or

21      "CPC HAP," have four core recommendations to reform

22      the home care sector and build a just and caring

23      New York.  CPC has been advocating on these issues

24      since 2017.

25             Number one:  End the Department of Labor







                                                             347
 1      24-hour rule.

 2             One of the most urgent issues in the home

 3      care sector is the 24-hour rule, where home care

 4      workers are assigned 24-hour live-in shifts, and are

 5      paid for 13 hours of work, with 8 hours allocated

 6      for sleep, and 3 for meals.

 7             This is based on a Department of Labor rule

 8      that was upheld in a 2018 Court of Appeals decision.

 9             CPC believes that no worker should have to be

10      away from their home for 24-hour shifts, and that

11      workers should be paid for all hours they work.

12             The State must immediately end the 24-hour

13      rule in favor of 12-hour split shifts, where home

14      care workers are fully compensated for each hour

15      worked, which can only be accomplished through

16      passing A3145, Assembly Member Epstein's bill;

17      S359, Senator Persaud's bill.

18             This will cost a billion dollars a year,

19      which is a fraction of the New York State

20      $212 billion budget.

21             Non-profit home care organizations, like

22      CPC HAP, are 100 percent Medicaid-funded, required

23      to comply with all of their state contractual,

24      legal, and union agreements, and must provide the

25      type and hours of care assigned to each client by







                                                             348
 1      Medicaid.

 2             They cannot simply drop existing 24-hour

 3      cases due to the Patient's Bill of Rights.

 4             CPC HAP and many other nonprofits have

 5      stopped accepting 24-hour cases, and strongly seek

 6      authorization for 12-hour split shifts for existing

 7      cases, but are more often than not denied by the

 8      State.

 9             This neither solves the problem for workers

10      who must work these shifts or people that need

11      round-the-clock care.

12             This is why the system must change to make

13      12-hour split shifts the standard instead of a rare

14      exception.

15             Number two:  Pass Fair Pay for Home Care,

16      S5375, A6329.

17             Fair Pay for Home Care would raise home care

18      worker pay to 150 percent of the highest regional

19      minimum wage across the state, allowing workers to

20      remain in rewarding critical-care jobs instead of

21      making impossible decisions about moving to

22      higher-wage jobs in different fields.

23             It would also wipe out the home care

24      workforce shortage in less than five years, creating

25      20,000 additional jobs per year for the next decade,







                                                             349
 1      according to a recent report.

 2             Number three:  Remove the arbitrary spending

 3      cap on Medicaid, and fully fund Medicaid to meet the

 4      needs of more than one-third of New Yorkers that

 5      rely on it.

 6             Rather than removing the spending cap, the

 7      governor chose to cut a billion dollars in Medicaid

 8      funding in the middle of a global pandemic.

 9             Rather than remove the spending cap, the

10      governor has chosen to depress home care wages

11      through reimbursement rates and cause a workforce

12      shortage crisis.

13             By removing it, we can both fully fund our

14      home care workers and the people that need care.

15             And, number four, last, but absolutely not

16      least:  Pass the New York Health Act, and guarantee

17      universal long-term care from day one for all

18      New Yorkers.

19             New York State has rationed care for far too

20      long, prioritizing government austerity and private

21      profits over our quality of life and dignity.

22             As a result, workers have suffered, older

23      adults have suffered, and disabled New Yorkers have

24      suffered, disproportionately women, people of color,

25      immigrants, and low-income New Yorkers.







                                                             350
 1             But it doesn't have to be this way.  New York

 2      has the resources to fully fund Medicaid and

 3      long-term-care services to meet their growing need

 4      and its constitutional obligation to provide for it.

 5             We don't have to choose.

 6             We can, and we must, build a robust

 7      long-term-care system, with good jobs where workers

 8      can thrive, and seniors, disabled New Yorkers, and

 9      everyone of us who needs home care can receive the

10      full care that we need in our homes with dignity.

11             Thank you.

12             SENATOR MAY:  Senator Ramos has to leave at

13      4:00, and she has specifically asked [simultaneous

14      talking; indiscernible] --

15             SENATOR RAMOS:  I apologize.  I just -- you

16      know, I wanted to kind of see the whole of the

17      issue.

18             And I agree, I mean, a big part of the

19      conundrum of this money, you know, especially for

20      not-for-profit organizations, and not our for-profit

21      agencies -- right? -- is the fact that, you know,

22      the big guy on the second floor just insists on

23      chipping away at the money that we need in order to

24      care for each other.

25             So I'm wondering, is there anything else,







                                                             351
 1      aside from that, that we can help -- that we can do

 2      to help not-for-profits achieve the solvency they

 3      need in order to do the right thing for the workers?

 4             And I'm wondering if your organization has an

 5      idea of how many of your home attendants are

 6      impacted by this 13-hour rule, 24-hour shift.

 7             CARLYN COWEN:  Absolutely.

 8             So CPC HAP, which is an affiliated

 9      organization --

10             I'm at CPC, the social services agency, just

11      to clarify.

12             -- has fifty-four 24-hour cases that are

13      staffed by about 130 workers.

14             There are about 11,000 cases across New York

15      State, staffed by about 33,000 workers.

16             So while it is, you know, a small portion of

17      home care across the state, it's still a very urgent

18      issue because, as you heard from the previous

19      testimonies, we have workers working under these

20      conditions that they shouldn't be, and in homes for

21      24 hours without getting compensated for all the

22      hours of their labor.

23             So non-profit home care agencies, like

24      CPC HAP, as I mentioned, are 100 percent

25      Medicare-funded [sic], which means all of the







                                                             352
 1      funding is tied to Medicaid rules and

 2      reimbursements, and then, of course, they're subject

 3      to union agreements, Department of Labor laws,

 4      et cetera.

 5             CPC has been advocating -- first, we were

 6      actually advocating, when the court cases were going

 7      through the Court of Appeals decision that

 8      I mentioned, for the State to pay back wages for the

 9      workers to make up for the gap between the 13 hours

10      that Medicaid pays for the time in home, and then

11      the remaining hours that, you know, Medicaid calls

12      "sleep, and break, mealtime, hours" and doesn't pay

13      for.

14             So at CPC HAP, if a worker gets interrupted,

15      at the first reported interruption, CPC HAP pays out

16      the full hours for between the 13 and the 24.

17             But that's not the standard across the

18      industry.  And I think that those are some of the

19      problems that you heard about in the previous panel.

20             And the only way to make it a standard across

21      the industry is to have a standardized across

22      Medicaid rates.

23             So we were initially advocating for the state

24      to fund back wages, which would have cost

25      $6 billion.







                                                             353
 1             The Court of Appeals decision essentially

 2      meant that the State was upholding its own

 3      Department of Labor law.

 4             And so, since then, we've been pushing on the

 5      A3145, which is the bill to end the 24-hour rule.

 6             That would solve the issue going forward,

 7      but, of course, it would not deal with retroactive

 8      compensation.

 9             I think that -- I'm not a legal scholar, I'm

10      a humble advocate, but I think that there's a very

11      difficult path, legally, to what that would look

12      like, based on the Court of Appeals decision.  But

13      I think there a lot of people that are more expert

14      than me on that.

15             But that's why we're really focusing our

16      efforts on moving forward ending the 24-hour rule

17      and increasing wages for home care workers.

18             Thank you.

19             And I apologize that I have to run, but

20      I have to go back to the city.

21             Thank you.

22             Good to see you-all.

23             Good to see you, Tara.

24             SENATOR MAY:  Next we have Becky Preve.

25             And you're not going to read your testimony;







                                                             354
 1      right?  This is like 90 pages here.

 2             So -- okay.

 3             REBECCA PREVE:  Is this on?

 4             Perfect.

 5             No, Senator May, I would never do that to

 6      you.

 7             First and foremost, I want to say thank you

 8      to Senator May, Senator Rivera, and Senator Ramos

 9      for hosting what is really a very important hearing

10      on this issue.

11             My name is Becky Preve.  I'm the executive

12      director of the Association on Aging in New York.

13      We're a not-for-profit membership organization that

14      represents the 59 Offices for the Aging throughout

15      New York State.

16             Our network leverages over

17      1200 community-based organizations, and I'm here

18      today on behalf of this network, and the massive

19      issue we are facing with a lack of direct support

20      professionals for our community.

21             The services provided by local Offices for

22      the Aging are predicated on ensuring individuals are

23      able to age in place with autonomy, dignity,

24      self-direction, and respect.

25             Our home care services are part of Medicaid







                                                             355
 1      prevention, which is something that hasn't been

 2      talked about at length today, that I think is very

 3      important.

 4             We provide home care services for individuals

 5      that do not qualify for Medicaid, but don't make

 6      enough money to actually privately pay for those

 7      services.  So we're able to provide Personal Care

 8      Level 1 and Personal Care Level 2 services for

 9      anyone over the age of 60 that qualifies for our

10      programs and services.

11             This distinction is important, as our

12      services have been proven to prevent future Medicaid

13      costs, which is what a lot of us have been talking

14      about for years.  And we also include a significant

15      cost share to the State, as far as what skilled

16      nursing facility placement costs for nursing home

17      residents, and the State's share of New York State

18      Medicaid to that program.

19             Our average client is actually an 83-year-old

20      female who lives alone, who has substantial

21      limitations taking care of activities of daily

22      living, such as bathing, toileting, dressing, meal

23      preparation, grocery shopping, et cetera.

24             The average client also has four or more

25      chronic conditions, and they typically qualify for







                                                             356
 1      skilled nursing facility-level care.

 2             Another alternative that we see in the

 3      community is some individuals who are forced to

 4      actually spend down to Medicaid or MLTC services in

 5      order to access them.

 6             And our network knows from our own client

 7      data that about 10 percent of people who are waiting

 8      for services through our network in New York State

 9      go directly to a skilled nursing facility without

10      ever touching another level of care, at a very high

11      cost to the Medicaid system.  An additional

12      6 percent are forced to spend down all of their

13      resources to access MLTC plans in their community.

14             We do know that the state savings to Medicaid

15      just for this 10 percent equals about 70 million

16      per year, and that the home care workforce crisis

17      is impacting our network significantly across

18      New York State.

19             We utilize the same home care-licensed

20      agencies as Medicaid providers, and we're already at

21      an unlevel playing field when we start for home care

22      services, as our traditional authorizations are much

23      lower than Medicaid, and we attempt to serve as many

24      individuals as possible under a fixed-budget

25      structure.







                                                             357
 1             A lot of people have talked about the

 2      demographics of aging today.  I think it's really

 3      important.

 4             New York State is actually fourth in the

 5      nation with the over-60 population.

 6             And as referenced earlier, since this data

 7      has indicated that the fastest growing segment of

 8      that population is actually the 80-plus, and when

 9      you look at the overall growth projection through

10      2040, New York State's going to grow by about

11      1.3 percent, but the population over the age of 80

12      is going to see a 42 percent growth in that time

13      period.

14             We also know that about 70 percent of the

15      older population will need some form of home care

16      during their lifetime, and that these home care

17      services prevent emergency department utilization

18      and transitions to skilled nursing facility care.

19             In addition to the explosion of the aging

20      population, we're faced with a massive direct-worker

21      shortage.

22             The number of home health aide and personal

23      care jobs projected to rise from about 440,000 to

24      over 700,000 by 2028.

25             In addition to this need, home care agencies







                                                             358
 1      have to recruit an additional 70,000 aides just to

 2      replace those leaving the field each year.

 3             In a survey done in the fall of 2020,

 4      85 percent of participating agencies indicated

 5      worsening staff shortages.

 6             This data is staggering when you take into

 7      account the growth in our aging population, the

 8      demand for workers, and the unbelievable shortages

 9      that we're seeing across the state.

10             In an effort to focus data-informed metrics

11      regarding the economic impact of the home care

12      workforce crisis, we worked on two research

13      projects, which I did provide in the written

14      testimony.  They have been cited today, the CUNY

15      report and Cornell report.

16             I wanted to touch base very quickly on the

17      Cornell University report from 2018, that looked at

18      safety net programs that direct workers are

19      dependent upon, based on their annual salary of

20      about $20,000 per year.

21             The annual savings, if workers are paid a

22      living wage of $35,000, just in Medicaid and SNAP

23      alone, would be 665 million.

24             In addition, the 2020 CUNY study looked at

25      the economic spillover of increasing direct-worker







                                                             359
 1      wages in two areas, so we looked at different

 2      benchmarks.

 3             Target one was, to raise workers in

 4      New York City to $40,000, 35,000 for Long Island and

 5      Westchester, and 30,000 for the rest of the state.

 6             Again, this was referenced earlier, the cost

 7      to implement these wage increases would be

 8      $4 billion, but the economic turnaround benefit is

 9      $7.6 billion in return.

10             Target two of the study took this a step

11      farther, which I wholeheartedly agree with.  They

12      looked at $50,000 for New York City, forty-five for

13      Long Island and Westchester, and $40,000 for the

14      rest of the state.

15             Cost is 6.3 billion, but when you look at the

16      economic benefit, we're over 12.9 billion in return.

17             So you're looking at a net gain between

18      3.7 and 6.6 billion.

19             I also wanted to just mention, Senator May,

20      that we have about 4.1 million unpaid caregivers in

21      New York State.  Their economic value is worth

22      $32 billion.

23             The economics of this issue are extremely

24      important; however, numbers do not take into account

25      the human and emotional toll that a lack of







                                                             360
 1      workforce causes.  This is one issue that all

 2      service providers, regardless of payer source or

 3      population base, are in agreement on.

 4             The disability and aging communities are both

 5      dealing with an overwhelming lack of direct support

 6      professionals that leave us paralyzed to help those

 7      we were tasked with advocating for.

 8             These workers are caring for our friends and

 9      loved ones, and are responsible for assisting with

10      the most intimate personal-care needs.  They have to

11      be passionate about their work, extremely caring,

12      and extremely patient.  And for far too long this

13      workforce has been marginalized and underpaid.

14             They are heroes, need to be paid a living

15      wage, to ensure we are able to care for our most

16      vulnerable populations with compassion.

17             SENATOR MAY:  I'm going to ask you to wrap

18      up.

19             REBECCA PREVE:  It's wonderful to see that

20      our minimum wage has increased in both the public

21      and private sector.

22             Everyone deserves a living wage; however,

23      I find it troubling that I paid more to wash my car

24      this morning than a direct worker is paid for an

25      hour of their time.







                                                             361
 1             Now it's time to do something about this

 2      issue.

 3             Thank you very much.

 4             TARA KLEIN:  Thank you, and good afternoon.

 5             Thank you so much for hosting this hearing.

 6             My name is Tara Klein.  I am a senior policy

 7      analyst with United Neighborhood Houses (UNH).  We

 8      are a policy and social-change organization that

 9      represents 44 neighborhood settlement houses across

10      New York.

11             My testimony will focus on the economic

12      crisis facing non-profit home care providers due to

13      state funding and policies that perpetuate near

14      poverty wages, and unfairly pit home care workers

15      and employers against one another.

16             Three UNH member organizations provide

17      non-profit home care services to their communities

18      as State-licensed home care services agencies,

19      including CPC -- and I will echo a lot of what

20      Carlyn shared in their testimony -- as well as

21      St. Nick's Alliance, and Sunnyside Community

22      Services.

23             Together, every year, these settlement houses

24      provide services to over 4500 individuals and nearly

25      7500 workers throughout New York.







                                                             362
 1             While the home care industry is comprised of

 2      both for-profit and non-profit home care agencies,

 3      these community-based organizations serve distinct

 4      roles.

 5             Embedded in settlement houses, these

 6      organizations serve their neighborhoods with

 7      culturally competent care, and offer many important

 8      wraparound services and programs beyond home care,

 9      including early childhood education, youth

10      development programs, adult literacy classes, senior

11      centers, and more.

12             New York's home care industry is at a crisis

13      point.

14             The number of older adults is growing, while

15      demand for home care is increasing as the preferred

16      method of care.

17             Meanwhile, there is a looming workforce

18      shortage due to a systematically underpaid workforce

19      comprised largely of women of color and immigrants.

20             These poor wages are predominantly due to

21      state policies, including low Medicaid and MLTC

22      reimbursement rates, a 1 percent cut to the sector

23      last year as part of the MRT2 process, as well as

24      the Department of Labor's 13-hour rule of 13 hours

25      of pay for a 24-hour shift.







                                                             363
 1             Non-profit home care providers in particular

 2      are stymied by these policies, unable to pay the

 3      fair wages they know their workers deserve due to a

 4      lack of funds.

 5             I want to share a couple of recommendations

 6      that UNH offers to stabilize and strengthen the

 7      sector, while ensuring non-profit providers are able

 8      to remain financially viable.

 9             These recommendations are all going to

10      require some financial investments, but it's the

11      State's responsibility to do this, and they really

12      need to step up to the plate here.

13             So, first, we need to eliminate the Medicaid

14      global spending cap.

15             Any significant home care payer form is going

16      to require additional funding and Medicaid support.

17      This can't happen without eliminating the global

18      cap.

19             Next, UNH supports the Fair Pay for Home Care

20      bill sponsored by Senator May, which we've heard

21      about today.

22             This would ensure that home care workers are

23      paid uniform and fair wages across the state.

24             Really critically, this bill includes a

25      funding mechanism by establishing a fund and







                                                             364
 1      subsidizing Medicaid payment rates when necessary.

 2      This will ensure that pay rates are funded through

 3      reimbursement rates and do not unfairly fall on the

 4      providers.

 5             UNH also supports the split-shifts bill,

 6      which we've been talking about, by Senator Persaud

 7      and some [indiscernible], which would cap home care

 8      worker shifts to 12 hours in most cases.

 9             This would really help rectify the problems

10      with the 13-hour rule, by capping the number of

11      hours an employee -- an employer can require a

12      worker to work at 12 hours; cumulatively, 50 hours

13      per week.

14             This would massively reduce, if not totally

15      eliminate, the number of 24-hour shifts.

16             We also -- we need to end the 13-hour rule

17      and fully fund 24-hour care.

18             While we believe that 24-hour shifts should

19      be the rare exception and not the norm, and

20      absolutely never forced, home care workers simply

21      should be paid for every hour they work; it's very

22      simple.

23             This is going to require the Department of

24      Labor ending the 13-hour rule so Medicaid and MLTCs

25      can legally reimburse for all 24 hours in a 24-hour







                                                             365
 1      shift.

 2             The State must also increase Medicaid funding

 3      and reimbursement rates to cover the full and actual

 4      hours worked, including potential overtime hours,

 5      and this needs to be done through the budget.

 6             Next, there is a need for the State to do

 7      better data collection and evaluation.

 8             We also believe there's a role for

 9      industry-wide oversight that can be looked at,

10      including a short-term task force, and possibly a

11      permanent oversight office or position.

12             And then, finally, a little off-course here,

13      but I wanted to mention that homebound older adults

14      and people with disabilities require a continuum of

15      services and interventions to live healthy and

16      meaningful lives.

17             Many people who receive home care services

18      also, at some point, rely on local

19      home-delivered-meals programs to combat food

20      insecurity and receive additional supports.

21             But, unfortunately, the state's

22      home-delivered-meals programs are systemically

23      underfunded, leaving the workforce in a similar

24      position as the home care workforce, with non-profit

25      employers unable to pay fair wages or maintain







                                                             366
 1      stable programs due to unjust budget -- government

 2      budgeting and policy decisions.

 3             And so we wanted to thank the legislature for

 4      including $8 million in this year's budget to

 5      address some of the unmet needs for home-delivered

 6      meals and other services.

 7             But advocates estimate that the full unmet

 8      need this year was closer to $27 million.

 9             And so we hope, moving forward, the State

10      will make a serious investment into this workforce,

11      as well as the home care workforce.

12             So thank you very much.

13             SENATOR MAY:  Great.  Thank you-all so much.

14             I don't want to take a lot of time, but

15      I want to ask Becky something about, it's kind of a

16      follow-up to what Tara was saying.

17             So home-delivered meals, for example, are,

18      seemingly, a pretty simple intervention that can

19      keep some people in their homes.  Right?

20             It could be just that, or one or two services

21      like that; that if they could just get access to

22      them, then the savings -- just speaking

23      economically, the savings to Medicaid would be

24      enormous, because they wouldn't end up having to go

25      into institutional care.







                                                             367
 1             So what happens when an older adult, say,

 2      needs one or two of those services, and can't get

 3      them?

 4             REBECCA PREVE:  So what we have seen,

 5      especially throughout COVID, is, essentially,

 6      a 70 to a 90 percent increase in the demand for

 7      aging services.

 8             So that's something that we were able to turn

 9      on with some federal dollars, as well as the

10      additional State investment.

11             What I can tell you, as far as access to very

12      basic services:

13             So, in many instances, a discharge plan from

14      an acute-care facility may require a daily check-in.

15             Well, that's your home-delivered meal

16      program.

17             Could we also put in a personal response

18      system?

19             Very, very low-budget items.  Correct?

20             But what happens is, when you, essentially,

21      have that client, and you can't turn the service on,

22      you then stopped the safe-discharge plan for

23      miniscule dollars per day.

24             When we talk about the home care lens, what

25      we have really struggled with across the network is,







                                                             368
 1      you know, we really try and prevent spend-down to

 2      Medicaid, because Medicaid, obviously, has a place

 3      that is very expensive.  And we can support our

 4      customer who qualifies for skilled nursing

 5      placement, between six and nine thousand dollars per

 6      year, on aggregate.

 7             The problem that we're running into,

 8      especially with licensed home care agencies, is --

 9      you know, there's been a lot of conversation about

10      the direct workers themselves.  But a lot of these

11      licensed home care agencies are nearing bankruptcy

12      and they can't, you know, hardly make payroll.

13             And so what they are telling us, this

14      actually just happened in Ontario County this

15      morning, they are no longer taking Office for the

16      Aging-authorized cases.  They're only taking

17      Medicaid cases with extended authorization periods.

18             So it puts the aging network, who's

19      predicated on saving Medicaid dollars in the

20      long term, at a huge disadvantage, because now we

21      don't even have access to the same number of home

22      care workers.

23             And so that's something, you know, we're

24      really working closely together as advocates.

25             I think this is probably the first time we've







                                                             369
 1      had a consolidated "disability, aging, payer source"

 2      conversation, because we're all saying the same

 3      thing, is that this is a massive issue.

 4             And, you know, I know many of us were here

 5      back in 2016 when we had two hearings -- one in

 6      Albany, one in New York City -- that went well over

 7      10 hours, talking about the exact same issue, which

 8      is, we don't have a robust workforce.

 9             "The New York Times" said in 1987, we were

10      headed to a crisis.

11             We're now in 2021, we're at a crisis.

12             And we really need to facilitate some type of

13      change, not only because of the economic cost, but

14      because of the human cost to these individuals who

15      are told, You're authorized for this service, but,

16      we're sorry, we can't serve you.

17             It's unjust for the community.

18             SENATOR MAY:  Right.  Well, thank you.

19             I have to say, when I -- I joined the

20      Health Committee this year, and one of the shocking

21      things was to learn that there really are two health

22      budgets when we do -- there's the budget that is the

23      public health budget, that is all the preventive

24      side of things, and then there's Medicaid budget.

25      And we don't get to, like, do cross-accounting.







                                                             370
 1             So if you're -- if you know, if you invest

 2      more in prevention, you're going to save way more

 3      than that on the Medicaid budget, it doesn't matter;

 4      we can't make that argument.

 5             So we have to figure out how to do the smart

 6      budgeting.

 7             REBECCA PREVE:  Well, I do like to highlight

 8      the fact, that if you look from an economic

 9      standpoint, and my colleague Ilana raised this,

10      we've all become economists -- right? -- because how

11      else do you talk about this issue to get some teeth

12      behind it?

13             And the economic lens is really something

14      that has gained attention.

15             And, you know, when we worked with CUNY on

16      the CUNY report, it is startling data, that you're

17      going to double your money in the billions by an

18      investment.

19             To me it seems, like, stop being reactive to

20      these issues, and losing nursing home beds, and

21      licensed home care agencies going bankrupt.

22             Why not do the investment on the front end to

23      gain long-term gains, which is exactly what I know

24      you support, as well as your colleagues.

25             So, thank you.







                                                             371
 1             CARLYN COWEN:  Can I add to that as well?

 2             SENATOR MAY:  Uh-huh.

 3             CARLYN COWEN:  So CPC's social services

 4      agency has a home-delivered-meals program for

 5      seniors that we've done for years.  And it's been

 6      chronically underfunded by the City and State, for

 7      years, to the extent that our senior services

 8      director calls it "Meals on Heels" because we cannot

 9      actually get the funding to repair the trucks that

10      we would, theoretically, deliver Meals on Wheels in.

11             And there have been seniors on the wait list

12      for those services for years.

13             And during the pandemic, we were immediately

14      flooded with calls from, you know, hundreds and

15      thousands of seniors that needed delivery.  And

16      there was no funding for it.

17             And CPC and other nonprofits found donations.

18             We had all of our staff running around all

19      five boroughs, delivering meals to people; money

20      that we'll never get reimbursed by the City or by

21      the State.

22             And nonprofits have been doing that for years

23      and years.  But, during the pandemic, it grew to a

24      whole other level.

25             So when we talk about the cost of







                                                             372
 1      underfunding, you're not even talking about how much

 2      the State is actually underfunding the program,

 3      because you're not even considering all of the work

 4      that nonprofits are doing that will never get

 5      reimbursed.

 6             And we have so many seniors that are on the

 7      wait list for services, whether it's for meals,

 8      whether it is for home care, or more, and it's,

 9      literally, someone's life on pause.

10             And we do, you know, thousands of welfare

11      calls every week to our community members.

12             And we know that if we lose touch with

13      someone because they weren't able to pay their phone

14      bill, or whatever else, that they might not be

15      getting the services they need; and it's, literally,

16      someone's life on the line.

17             And that's not even taking into account when

18      we talk about how much it's underfunded.

19             SENATOR MAY:  Right.

20             TARA KLEIN:  And I can just quickly add that,

21      in New York City, we have analyzed that

22      home-delivered-meals programs are reimbursed by the

23      City about 20 percent less than their actual cost of

24      doing business.

25             So programs are actually losing money on







                                                             373
 1      this -- on these programs.  In some cases it's

 2      hundreds of thousands of dollars.

 3             And I think, as Carlyn just mentioned, during

 4      COVID it's gotten much worse, even with the GetFood

 5      program in New York City.

 6             And so this is really a longstanding program

 7      that is bubbling up and getting worse right now

 8      during COVID as more people are experiencing food

 9      insecurity.

10             So we really need to make those investments

11      now.

12             SENATOR MAY:  Okay.  Well, thank you.

13             Thank you-all for the work you do.

14             And anyone else have --

15             SENATOR RIVERA:  I just will make one quick

16      comment.

17             Thank you for being here.

18             And to -- you -- I think all of you

19      underlined something very basic, which is that we --

20      you know, it's been said a thousand times, but

21      I guess it needs to be said one more time:

22             In this state, unfortunately, and it has to

23      do with the executive, let's call it what it is, we

24      have been consistently penny wise and pound foolish.

25             The idea that there is so much money that we







                                                             374
 1      could be saving if we actually invested the money up

 2      front is not an expense; it is investment.

 3             An investment in things like, funding the

 4      workforce the right way, funding those service

 5      providers who are actually doing -- were actually

 6      doing the work, that will actually -- investing in a

 7      program like providing meals to seniors, et cetera,

 8      all of these things are not expenses.  They're all

 9      investments that will get us better communities,

10      better quality of life for those communities.

11             And if we only had somebody to follow the

12      long-term, and not just about the budget right this

13      second, we would actually be in a better place.

14             Would that be accurate to say?

15             Okay.

16             I said it.

17             I said it, sir.  Hi.

18             They're watching, so, Hi.

19             Thank you, Madam Chair.

20             SENATOR MAY:  Okay.  Thank you.

21             Thank you-all.

22             And as I keep saying, thank you for the good

23      work you do, too.

24             So we have five more panels to go, and about

25      18 more people.







                                                             375
 1             I want to urge folks, I value what you have

 2      to say, but if you can, like, not repeat things that

 3      have been said before, and really focus us on what

 4      new you have to contribute, that would be really

 5      helpful.  And I will try to keep my questions to a

 6      minimum, too.

 7             So our next panel is Claire Pendergrast,

 8      Melissa Wendland, and Jean Moore.

 9             Why don't you just get started, Claire.

10             MELISSA WENDLAND:  Thank you for today's

11      conversation.

12             As you mentioned earlier, this is overarching

13      with long-term care and home care, and that's

14      exactly what we're looking at in Rochester and the

15      Finger Lakes Region.

16             Thank you for your visit a couple of years

17      ago as we were talking about the health-care

18      workforce and what we were looking at in terms of

19      home care.

20             I'm Melissa Wendland.  I'm the director of

21      strategic initiatives at Common Ground Health,

22      formerly Finger Lakes Health Systems Agency.

23             We are a health research and planning

24      organization that has served the nine-county

25      Finger Lakes Region for over 40 years.







                                                             376
 1             We work to collaborate with leaders in health

 2      care, insurance, government, business, consumers,

 3      and look at the region's most pressing health

 4      challenges.

 5             Analysis of quantitative and qualitative data

 6      is the core of our work, and foundational to driving

 7      a fact-base understanding of issues that foster our

 8      planning and programs.

 9             We track trends; raise awareness to the

10      health inequities of our region faced by

11      marginalized communities in rural, suburban, and

12      urban areas.  This includes our growing aging

13      population and those that serve this population.

14             Ten years ago, in 2011, Common Ground Health,

15      then Finger Lakes Health Systems Agency, convened

16      the Sage Commission to development a comprehensive

17      long-range plan for aging-health services in the

18      Finger Lakes.

19             Central to that plan at the time were

20      objectives at creating person-centered care that

21      accommodated those 65 and older, taking into

22      consideration their preferences to live in the

23      least-restrictive setting, delay institutional care,

24      and allow older adults to remain in the community as

25      long as possible.







                                                             377
 1             We worked with partners developing an

 2      interactive modeling tool that looked at the

 3      economics of what would be required in 2030.

 4             Ten years into it, we're looking at what

 5      we've done, that's worked well, what's been

 6      successful, what's changed in the community, and

 7      what we need to focus on moving forward.

 8             You have my report.

 9             We've talked a lot about earlier testimony,

10      looking at the multiple challenges that we're

11      facing.

12             The key for us was, 10 years ago, we

13      underestimated the severity of the impact of our

14      growing population, the decline in available family

15      caregivers, the fragmented and unsustainable methods

16      to pay for our care, the workforce shortage, and the

17      health-care disparities that exist among our elders.

18             The number and percentage of people of color

19      in the older population is increasing even faster,

20      and serious health-care disparities exist among our

21      Black and Brown communities.

22             The city of Rochester has a 36 percent

23      increase in its older adult population over the past

24      decade.  It's the highest rate of increase of any

25      major city in New York State.  With the highest







                                                             378
 1      poverty rate of any city, at 31 percent, the number

 2      of older adults in poverty in Rochester has

 3      increased by 38 percent.

 4             Poverty among older adults is rarely

 5      discussed, and the impact to the community is

 6      magnified as these seniors are often caregivers for

 7      multigenerational families.

 8             This is significant right now for us,

 9      particularly given what has happened as a result of

10      COVID.

11             There has been strides that have been made

12      and recognized by the State from our first report in

13      2011, but we have a long way to go -- "a long way to

14      go."

15             And we would like to take this opportunity to

16      say a crisis is a terrible thing to waste.

17             We would love the opportunity to come

18      together and partner with you.

19             I thank you for sharing and reading the

20      report.

21             There's two things that I want to walk away

22      with today.

23             The highest demand in health care in our

24      Finger Lakes Region is home health aides.

25             It is essential for fair pay and competitive







                                                             379
 1      wages for these essential workers.

 2             The continuation of the decade-long struggle

 3      to fill direct-care positions and stabilize our

 4      essential workforce needs to improve.

 5             I'd also like to say that we recognize

 6      long-term-care costs are unsustainable for

 7      governments, and the vast majority of people lack

 8      the resources to privately pay.

 9             We have recommendations of what to do, and

10      that's included in my report.

11             Finally, I would like to say, long-term care

12      needs to be a person-centered coordinated and

13      seamless across all various care-delivery sites,

14      with a focus on supporting those that we are serving

15      in our most vulnerable populations.

16             Thank you.

17             SENATOR MAY:  Thank you.

18             And, Claire.

19             CLAIRE PENDERGRAST:  Hello.

20             Senator May, Senator Rivera, such an honor to

21      be here.  Thank you for the opportunity to testify.

22             My name is Claire Pendergrast.  I'm a Ph.D.

23      student in sociology at Syracuse University.  I'm

24      also a graduate fellow for the Lerner Center for

25      Public Health Promotion.







                                                             380
 1             My research focuses on the aging network,

 2      which as Ms. Preve just described, is a

 3      comprehensive network of service providers that aim

 4      to keep older adults in their homes and communities

 5      as long as possible.  And, often, that is something

 6      like a home-delivered meal, or a home repair, that

 7      can enable someone to be more mobile around their

 8      house, rather than having a fall that could end them

 9      up in the hospital or in a nursing home.

10             And so in my remarks today I will summarize

11      my recent research on the value of community-based

12      services for older New Yorkers, their families, and

13      their communities, and public budgets.

14             Per request to skip redundant things, I will

15      not tell you about exactly how much the population

16      is aging.

17             I will say it is aging faster in rural areas.

18             And that that's an important conversation

19      because, when a larger share of the population is

20      older, and also the working-age population is

21      declining, folks moving away for work opportunities

22      or education, there's often a growing care gap,

23      where family members who would love to support their

24      relatives simply are not there.

25             And, similarly, as we see demographic trends,







                                                             381
 1      there is a growing care gap amongst the population

 2      as a whole, because folks having fewer children

 3      means the ratio of potential caregivers to folks in

 4      need of care is just untenable.  And that requires

 5      us to acknowledge the unpaid care that family

 6      members have been providing for so long.  And that

 7      will fall onto formal services.

 8             And so community-based services address a

 9      continuum of care needs, and I think that's really

10      important because, for many folks it is in-home care

11      that is on a daily basis; but, for others, a very

12      small investment that can provide these supports,

13      can keep someone from having this precipitating

14      health crisis, requiring institutionalization,

15      which can also reduce strain on family caregivers

16      who often are doing a lot work, but simply can't

17      shoulder it all by themselves.

18             And research also supports that that is

19      skillful and emotional labor, particularly

20      navigating dynamics with family members who are

21      there, encouraging folks to accept services they

22      might be initially averse to accepting, because it

23      acknowledges a lack of independence, and that's

24      challenging.

25             So the interviews I've done, I've just been







                                                             382
 1      pretty struck by the trust that is built from kind

 2      of an objective source of information, who can

 3      recommend the appropriate care, and kind of guide

 4      people through that process.

 5             Or, I did an interview with someone who had a

 6      client with a raccoon that was coming up through her

 7      trailer, and she needed a repair.  And the process

 8      of getting her to the appropriate repair agency was

 9      a whole ordeal.  And she was patient and kind, and

10      felt as though her support with that solved a

11      problem that otherwise never would have been solved,

12      and could have been a precipitating health crisis.

13             And per previous conversations, several

14      studies have shown that there is definitive Medicaid

15      savings from investments in the Older Americans Act,

16      home-delivered meals specifically, and also in-home

17      care.

18             A Brown University study found that

19      Title III, which includes meals, spending on

20      Title III programs saved $109 million in the

21      Medicaid budget.  And that's probably increased

22      since that study was done by keeping low-care-need

23      folks out of nursing homes.

24             And it is also really important, as we have

25      heard a lot, that investing in the home care







                                                             383
 1      workforce is critical to keeping folks in their home

 2      communities -- homes and communities.

 3             That's especially important in rural areas,

 4      per previous conversations, that family members

 5      might be less available there, but, also, there are

 6      fewer working-age folks to hold those jobs.

 7             Also in my interviews I have heard that,

 8      given the low wages home care-makers receive, they

 9      often can't maintain vehicles in the way that they

10      would like to.

11             There are long travel times between clients.

12      Folks mentioned care workers not being paid for

13      their travel time.

14             And so all of these add up to what is already

15      a crisis.  And I think that a holistic policy

16      solution is needed, but specific attention to the

17      needs of rural communities is really important.

18             In summary:

19             New York State's population is aging, and so

20      this increasing demand means we need more home care

21      workers, and just community-based services.

22             And investing in those proactively is

23      critical.  They have been underfunded, and that is a

24      real cost just to people's everyday lives.  Their

25      families who will pick up those care needs when they







                                                             384
 1      possibly can, and that is a cost to family members,

 2      as COVID has shown us.

 3             And, thank you for the opportunity to

 4      participate in your deliberations on this important

 5      topic.

 6             SENATOR MAY:  Great.  Thank you both.

 7             Any questions?

 8             SENATOR RIVERA:  I'm good.

 9             SENATOR SERINO:  Thank you.

10             MELISSA WENDLAND:  Thank you.

11             CLAIRE PENDERGRAST:  Thank you.

12             SENATOR MAY:  Okay.  Appreciate your waiting

13      till this point in the day to do your testimony, and

14      being timely about it.

15             Are you Jean?

16             Is Jean Moore here?

17             No.

18             Then we'll go on to Panel 6:  Bryan O'Malley,

19      Tania Anderson, and Heidi Siegfried.

20             Just jump right in, Bryan.

21             BRYAN O'MALLEY:  Hi.  Good afternoon.

22             It's a pleasure to see you-all in person,

23      finally.

24             Bryan O'Malley with the Consumer Directed

25      Personal Assistance Association of New York State, a







                                                             385
 1      statewide association working to improve access to

 2      and the quality of the state's consumer-directed

 3      personal assistance program.

 4             I want to thank you for having these

 5      hearings.  They are an important continuation of the

 6      Senate's critical leadership on this issue.

 7             And, you know, New York's status as the

 8      epicenter of a national home care workforce crisis

 9      is well-documented, and the real-world impact of

10      that is readily apparent.

11             The full scope has been detailed by others,

12      and I'll only reinforce one point:  That in many

13      counties there is no longer even a pretense that

14      Medicaid recipients have a choice of their home care

15      services.

16             People are referred only to consumer-directed

17      personal assistance, whether they want that or not,

18      whether they're a good fit for that or not, and the

19      home care just is not an option in the traditional

20      personal-care side.

21             We obviously support consumer-directed, but

22      it is not for everyone, and we think people should

23      get the services they want and need.

24             Federal dollars are critical to this

25      conversation, but they're not the only part of the







                                                             386
 1      conversation.

 2             Unfortunately, we saw that with DOH's recent

 3      application to CMS on how it proposes to spend the

 4      previously increased federal funds under ARPA.

 5             These funds demonstrate that they're not

 6      merely aware of this problem, it is likely an

 7      intentional barrier that's been put in place to

 8      artificially limit the growth of these services.

 9             Indeed, the DOH argued that they should be

10      allowed to use $415 million of this funding to pay

11      for the, quote, natural growth of CDPA and personal

12      care because, and I quote:

13             "While the growth rate of these programs has

14      remained high, structural fractures, such as

15      workforce capacity limitations, have served to limit

16      that growth.

17             "However, by permitting New York to address

18      many of these structural factors, and promote the

19      capacity and accessibility of HCPS, funding under

20      ARPA will work to create natural growth in PCS and

21      CDPAS based on pertinent minimum-needs criteria."

22             In other words, people who are otherwise

23      eligible will actually be able to get the services

24      they're eligible for.

25             These structural barriers were recently made







                                                             387
 1      worse by the increase in the fast-food minimum wage

 2      outside of New York City.

 3             In anticipation of the July 1 increase

 4      upstate, CDPAANYS surveyed consumers, and published

 5      an issue briefly detailing its impact, as well as

 6      the impact of various potential solutions.

 7             What we learned was that nearly 90 percent of

 8      workers upstate earned less than the fast-food

 9      minimum wage, with two out of three earning the

10      standard minimum wage, totaling $2.50 per hour less.

11             70 percent of consumers cited low wages as

12      the reason that their PAs quit, and almost half of

13      the PAs in the region have warned their consumers

14      that they plan to leave in the near future

15      specifically for higher-paying jobs in fast-food.

16             These low wages are the result of an overall

17      disinvestment in home care that's seen Medicaid

18      reimbursement rates stagnate for over a decade.

19             Fee-for-service reimburses below cost, while

20      managed-care plans operate with little

21      accountability or transparency, and routinely cut

22      rates to unsustainable levels, insisting that

23      agencies pay minimum wage, and failing to pay for

24      basic legal requirements such as overtime or wage

25      parity.







                                                             388
 1             Additionally, within CDPAANYS, the

 2      "per member per month" reimbursement rate,

 3      implemented with no distinction between the inherent

 4      cost differences on where in the state an FI is

 5      operating, has meant agencies are forced to further

 6      cut wages.

 7             And to be clear, this was the goal.

 8             In fact, the purpose of all of this

 9      disinvestment has been to force down wages and

10      create structural factors that limit natural growth,

11      and it has worked exceedingly well.

12             Fixing this requires a bold investment in the

13      entire home care system.

14             Fair Pay for Home Care accomplishes this.

15             Others have detailed the specifics of the

16      legislation, but the establishment of a minimum home

17      care wage of 22.50 per hour is critical.

18             A recent issue brief identified that

19      90 percent of consumers upstate and 80 percent of

20      those in Long Island and Westchester said that an

21      increase in wages would be more effective at helping

22      them recruit and retain PAs than increases in

23      benefits or the provision of transportation or

24      training, other policy ideas currently being

25      discussed.







                                                             389
 1             Fair Pay for Home Care is also important

 2      because it invests in the entire home care system,

 3      for the first time ensuring that the wage increases

 4      are fully funded by both DOH and managed-care plans,

 5      using data already filed by providers to create a

 6      minimum rate of reimbursement based on an average of

 7      actual costs in a region.

 8             It also funds other expenses incurred by the

 9      providers, but I will wrap it up.

10             SENATOR MAY:  Okay.  Thank you.

11             HEIDI SIEGFRIED:  Uh, yeah, hi.

12             Good afternoon.

13             I'm Heidi Siegfried.  I'm the health policy

14      director at Center for Independence of the Disabled

15      in New York, and our goal is to ensure full

16      integration, independence, and equal opportunity for

17      all people with disabilities by removing barriers to

18      full participation in the community.

19             And so while our mission is to help people

20      access the care and services they need to live

21      independently in the community, and our Open Doors

22      program specifically gets people out of nursing

23      facilities, we also advocate for elderly and

24      disabled people in nursing homes, assisted-living,

25      and other residential settings to ensure their







                                                             390
 1      rights to quality of care, quality of life, and

 2      dignity.

 3             So because -- you're not going to find many

 4      independent living centers that aren't going to

 5      advocate for long-term-care, but our main mission is

 6      still the home care workforce, though.  That's what

 7      I'll try to talk about first.

 8             Yesterday we marked the 31st anniversary of

 9      the signing of the Americans with Disabilities Act,

10      and that's our civil rights statute, that gives us

11      the right to participate and benefit from all

12      aspects of society to the same extent as our

13      non-disabled peers.

14             And, of course, the landmark Supreme Court

15      decision, Olmstead versus L.C., written by

16      Ruth Bader Ginsburg, further requires that that care

17      be delivered in the most integrative setting in the

18      community, which New York has really been struggling

19      to meet its obligations under most integrated

20      settings.

21             People with disabilities need access to a

22      readily available and robust home care workforce in

23      order to exercise these rights.

24             And, unfortunately, we've had to exercise

25      these rights in an environment of increasing







                                                             391
 1      austerity, going on for decades, actually, caused by

 2      tax cuts for the wealthy.

 3             So 10 years ago we began dealing with the

 4      global spending cap in the Medicaid program, and,

 5      also, dual eligibles that needed long-term care were

 6      required to enroll with managed long-term-care

 7      companies.  And they -- that's really been what has

 8      driven sort of the lack of access to home care.

 9             I mean, it is also the workforce, but it's

10      also the managed long-term-care companies that are

11      denying adequate hours to care, and that's the care

12      that's needed to avoid institutionalization.

13             So the thing is, though, when you do the

14      appeal, get your right to care, you get the hours

15      authorized, the question becomes, then how do you

16      fill those hours?

17             So it's still a problem; it's a problem that

18      has spread from upstate down to New York City, and

19      it has, you know, real consequences.

20             Now, we've had a couple -- in the past few

21      years, we've had a couple of different stakeholder

22      groups.

23             We had one in New York City, we had one in

24      New York State, plenty of meetings down in Meeting

25      Room 6, and all over the place, and all the







                                                             392
 1      stakeholders were there, but they were still

 2      operating within that box of austerity.

 3             No additional money, you know, and all of the

 4      recommendations always had to be sort of around the

 5      edges.

 6             And that's what we're still seeing for

 7      recommendations.  Right?

 8             So, I mean, we really feel that there has to

 9      be this investment.

10             Sydney really did join the Fair Pay for Home

11      Care campaign this year in a big way.

12             And I'm glad that Bryan mentioned about the

13      American Rescue Plan, because we finally -- you

14      know, we've been saying all year in our spring

15      meetings, you know, Watch this, how they plan to

16      spend this billions of dollars coming into New York

17      State.

18             Because we saw, with the Community First

19      Choice option money that we -- disability community

20      fought for that money, that we never were able to

21      find out whether or not that was spent correctly.

22             And New York threw that money down, and, you

23      know, we don't know what happened to it.

24             So Bryan mentioned one of the problems.

25             We've also seen the other problem that we







                                                             393
 1      just exploded over, was the giving $55 million to

 2      nursing homes to, supposedly, train workers to

 3      recognize clinical improvements, to allow discharge.

 4             That is not a criteria for getting out of a

 5      nursing home, "clinical improvement."

 6             And it just shows that the Department of

 7      Health does not really understand this issue.

 8             So they did say that, in giving out this

 9      money, you know, hundreds of millions of dollars to

10      managed-care companies to do these little

11      around-the-edges things, that they would have some

12      kind of criteria, some kind of quality measurement,

13      for them to be able to access these dollars.

14             And people with disabilities should be

15      included in that quality-measurement piece, so that,

16      you know, they really know what they're doing, and

17      you know, that they're measuring the right things

18      before the money is distributed.

19             So that's -- I mean, I really haven't gotten

20      to the nursing home care, but I will say, you know,

21      we also are concerned about the dumbing-down of the

22      safe staffing bill which we worked on this year.

23             And, you know, we're monitoring what's going

24      to happen with the requirement to pay 70 percent of

25      your dollars on direct care, and -- well,







                                                             394
 1      70 percent -- the 70/40 that they're -- we're going

 2      to have to monitor that.

 3             And the final thing is that, the Public

 4      Health and Health Planning Council approves when

 5      these nursing homes, nursing facilities, change

 6      ownership, merge, close, whatever.

 7             And, you know, I go to those meetings.

 8             And there are very few consumer reps on that

 9      body.  It's is mostly industry-dominated.

10             SENATOR MAY:  Okay.  I need you to wrap up.

11             HEIDI SIEGFRIED:  But it should -- I mean,

12      that is a place where we could oversee these nursing

13      facilities.

14             And they are now sending to the

15      long-term-care ombuds program when these nursing

16      facilities file.

17             So it will be interesting to see what happens

18      with that, because that will be an opportunity to,

19      you know, follow it up.

20             SENATOR MAY:  Okay.  I need to cut you off.

21             Thank you, though.

22             Tania.

23             TANIA ANDERSON:  Hello.

24             I got the trick microphone.

25             But, nice to see you.  Thank you.







                                                             395
 1             Thank you for having these very important

 2      hearings.

 3             My name is Tania Anderson.  I'm the CEO of

 4      ARISE.  We're the independent living for

 5      Central New York.

 6             And we, since 1979, have served more than

 7      7,000 people annually of any age and any disability.

 8             At ARISE we actively work to transition

 9      people out of institutional settings, and give them

10      the supports they need to stay in the community.

11             And we save New York State at least

12      $1.5 million annually.

13             Collectively, our ILC Network saves New York

14      $125 million each year.

15             Even during the pandemic, ARISE's Open Doors

16      transition center was able to bring 48 people out of

17      nursing homes in 2020.

18             Much of the focus on this hearing has been on

19      the dedicated workers providing assistance with

20      respect to medical needs and activities of daily

21      living.  And that crisis is certainly in those

22      areas.

23             I want us to be mindful that the crisis of

24      care also extends to staff who are supporting

25      individuals with developmental disabilities to have







                                                             396
 1      access to their community.

 2             The work of ARISE really depends on direct

 3      support professionals.

 4             And let me join in the chorus of voices that

 5      are saying that increased pay for this work is

 6      absolutely necessary.

 7             I want to give you some examples about how

 8      this crisis is impacting the programs at ARISE.

 9             We're one of the founding providers of the

10      CDPAP program, and we are the fiscal intermediary

11      for about 300 consumers.  And when these workers

12      disappear, there's a crisis.

13             For example, we had a consumer in our CDPAP

14      program.  He was approved for 80 hours of support.

15             When COVID hit, two of his three staff left

16      because they could make more on unemployment.  So he

17      was left with one staff person and 40 hours a week.

18             Couldn't get the care.

19             ARISE tried to find staff, and failed.

20             He went to another fiscal intermediary, tried

21      to find staff, and failed.

22             This man was actually, during the transition,

23      left without any services for a period of nearly a

24      week.

25             He had a health crisis, ended up in the







                                                             397
 1      hospital, then transitioned to a nursing home, and

 2      that's where he still is.

 3             That's one tragedy of many during this

 4      crisis.

 5             And every -- we currently have 30 people that

 6      are approved for hours, and are not receiving any

 7      services because we cannot find the staff.

 8             We have tried direct hiring, we've tried

 9      bonuses, we've tried referral programs.

10             Competitors -- providers are competing

11      against each other for a pool that isn't there.

12             At least twice a month we get referrals from

13      managed-care companies, offering us 30 to

14      40 consumers if we can find the staff, because they

15      cannot find the staff.

16             ARISE also operates the regional resource

17      development center across eight counties, and this

18      program serves 400 people, and has a network of

19      50 providers, [indiscernible] traumatic brain injury

20      and nursing home transition and diversion waivers.

21             This program also is designed to keep people

22      with adequate supports in their community, and this

23      program also is struggling to staff the cases.

24             There are at least two folks in this program

25      that have gone to nursing homes because we couldn't







                                                             398
 1      find the staff.

 2             Families are filling in the gaps at their own

 3      personal expense to their careers and their lives.

 4             It's just not sustainable.

 5             We've got staff that have been in this

 6      program from the beginning, and they say this is

 7      clearly the worst it's ever been.

 8             And what they're hearing universally is the

 9      lack of pay.

10             We have programs that support people

11      one-to-one in the community with developmental

12      disabilities.

13             And we have 120 people who are qualified to

14      receive services, that we cannot find the staff.

15      That's 42 percent of the people that we serve in

16      this program.

17             And these are people that are sitting at home

18      rather than working, or accessing the library, or

19      shopping, or gaining the independent living skills

20      that they need with a little support.

21             And these are not high-cost cases at all.

22      These are people that maybe have as few as one to

23      four hours a week of direct-support professional

24      care.

25             One of those people is actually my daughter







                                                             399
 1      who has a developmental disability.

 2             And I can tell you firsthand, the struggle in

 3      terms of finding direct support professionals to

 4      support her; but more importantly, can I tell you

 5      about the very critical work that these people do.

 6             You've heard very compelling testimony from

 7      the workers themselves.

 8             They are not in this for the money.

 9             They're in this because they care very

10      deeply.

11             This is highly skilled work, and our society

12      is not recognizing it as such.

13             I also want to touch on the impact on ARISE

14      as an employer.

15             450 of our staff are direct-care

16      professionals, and our turnover rate is 30 percent.

17             At a cost of onboarding staff between 4,000

18      and 6,000 a piece, the churn is costing us at least

19      675,000 a year in an industry where there is

20      absolutely no margin.

21             I urge you to continue to consider this issue

22      carefully, as I know you have, and thank you very

23      much for your time.

24             SENATOR MAY:  Thank you.

25             Thanks for coming to Albany to share that;







                                                             400
 1      and all of you, thank you so much.

 2             I don't have any questions.

 3             SENATOR RIVERA:  I'm good.

 4             SENATOR SERINO:  Thank you.

 5             SENATOR MAY:  Thank you so much.

 6             Panel 7:  Jeanne Chirico, Katelyn Andrews,

 7      Kathy Febraio, and Al Cardillo.

 8             JEANNE CHIRICO:  Thank you for this

 9      opportunity, Chair May and Chair Rivera.  Thank you,

10      Senator Serino, for being here.

11             My name is Jeanne Chirico, and I'm the CEO

12      and president of the Hospice and Palliative Care

13      Association of New York State, and I understand the

14      crisis of time that we're in.

15             So I'm just going to share a little bit

16      off-the-cuff.  I'm not going to read my remarks to

17      you, because prior to accepting the role as

18      president of this hospice association, I spent the

19      last 25 years -- okay, almost 30 in the health-care

20      arena in various leadership positions.

21             So I feel quite confident in my ability to

22      talk to you regarding the needs of the workforce.

23             I ran a licensed agency for 15 years.

24             I was a hospice administrator for 15 years.

25             I also ran part of the certified home health







                                                             401
 1      agency.

 2             So I understand all the regulations that fall

 3      under the Department of Health line of business.

 4             And I sincerely love the people that worked

 5      with me.

 6             When I first started I had 500 aides under my

 7      licensed agency.  And by the time I was finished in

 8      my role there, we were down to just about 200 aides.

 9             And I feel like we were very progressive.

10      We're in the Finger Lakes Region.  I was a part of

11      the Sage Commission that Melissa spoke of.

12             I met with you, Senator May, when you came to

13      Rochester.

14             We offered health insurance, retirement,

15      tuition assistance.  We offered personal days,

16      vacation.  We kept up with the minimum wage, and

17      went faster than we were required to within upstate

18      New York.  We were at the max, equal to the food

19      workers.  We did not want to risk that.

20             And even with all of that, we could not keep

21      up with the workforce demands, and I think this is

22      for a variety of reasons, and I believe you've

23      touched on many of those already today.

24             But I want to talk as somebody who was

25      responsible for running the organization, and I have







                                                             402
 1      some very real fears about the fair pay wage act.

 2             And I'm -- I believe in it, and I want to see

 3      it happen, but I also realize that if I were running

 4      the licensed agency right now, I would be scared to

 5      death because of the compression factor that would

 6      happen for the rest of my employees when you raise

 7      that wage, and how would you make up that

 8      difference?

 9             It would have to come out of your bottom

10      line, and there isn't one right now.

11             As a hospice worker, I'd be scared to death

12      because this is a Medicaid -- kind of

13      Medicaid-supported initiative, where the

14      reimbursement would come out of the programs under

15      Medicaid, where hospice serves 95 percent of its

16      patients under Medicare.  But you can't divest the

17      two.  You have -- if you're going to get a

18      workforce, it doesn't matter whether it's a Medicaid

19      patient or a Medicare patient, your aides need to

20      receive the same amount of pay.

21             And there is a lack of ability, and there is

22      no reinforcement that's coming, reimbursement that's

23      coming, under Medicare right now.

24             So because of these issues, amongst others,

25      including the -- what's been recently called the







                                                             403
 1      "minimum-wage paradox," where increasing the minimum

 2      wage, as you stated earlier, may result in the State

 3      saving money, because 200 -- excuse me -- about

 4      40 percent of the aide workforce is receiving

 5      benefits through the state for childcare,

 6      food stamps, housing.

 7             Those benefits may go away, or be greatly

 8      reduced.

 9             And in the end, what is the actual benefit to

10      the worker?

11             How much money do they then have to put out

12      for childcare and for other supports?

13             And so what I am suggesting in my proposal is

14      that we do that, plus.

15             That there is some minimum wage efforts that

16      happen, but there's a bigger effort that creates a

17      center, a workforce center, where all of us can come

18      together with these great ideas and be able to work

19      it out so that implementation doesn't devastate, it

20      doesn't harm; it actually helps.

21             Because what if there are recommendations

22      that came out of this center could include things,

23      like, essential workers get a waive on the income

24      limits that are associated with the benefits that

25      they're receiving from the State.  Instead of trying







                                                             404
 1      to make up the money, add the money to that.

 2             So I see an opportunity for all of us,

 3      including the interfaith communities; the CBOs (the

 4      community-based organizations) that were talked

 5      about so eloquently; the associations; the

 6      Department of Health; OHIP, who covers the managed

 7      long-term-care programs; and these things, all to be

 8      a part of this center of excellence for workforce in

 9      the community.

10             So I know that I'm at my time limit already,

11      and I appreciate that.

12             I would love to be a part, our association

13      and our members would love to be a part, of a

14      discussion that helps address some of these gaps

15      that are there.

16             SENATOR MAY:  Thank you.

17             KATHY FEBRAIO:  Hello.

18             Thank you for convening this event.

19      I greatly appreciate the topic being addressed.

20             I am Kathy Febraio.  I am the president and

21      CEO of the New York State Association of Health Care

22      Providers, and we represent the spectrum of home

23      care providers across New York State.

24             I would like to say, first and foremost, that

25      our home care agencies are very proud of the work







                                                             405
 1      that they've been able to do to keep people safely

 2      at home, particularly during this pandemic, with

 3      little to no additional support.

 4             Some of the stories that were mentioned

 5      earlier today were very disturbing and quite

 6      egregious.

 7             And I want to point out that the vast

 8      majority of home care agencies are doing the good

 9      work, and that by doing so, are actually in a very

10      difficult financial position as they comply with

11      labor laws, et cetera.

12             But we also have a once-in-a-lifetime

13      generation -- once-in-a-generation opportunity to

14      make significant improvements to the state's home

15      care system with Washington's investment in FMAP of

16      $1.6 billion in New York State.

17             We would like to recommend flexibility in the

18      use of those funds to meet the unique needs of home

19      care providers and their workers across the state.

20             We recommend that funds be directed, or a

21      direct payment mechanism be set up, to ensure that

22      the maximum amount of funds are made available to

23      workers.

24             Senator May, earlier you mentioned that you

25      have heard that agencies are retaining funds and not







                                                             406
 1      getting them to the workers.

 2             We see a different story, and we don't see

 3      the funds get to the agencies.

 4             But some of the examples we would like to see

 5      for those home care agencies to use with that

 6      flexibility, is to potentially pay workers a bonus

 7      for time spent in initial training, paying

 8      hazard-pay bonuses to aides, or paying retention

 9      bonuses to those that have longevity and made a

10      commitment to the agency.

11             We would also recommend that investments in

12      proven strategies, like ACPs, creating a

13      legacy-of-care mentorship program be allowed for use

14      of these funds.

15             I'm very aware that many of you have made

16      recommendations for DOH to use this additional

17      funding to increase wages for the home care

18      workforce.

19             And we strongly agree that increasing pay for

20      home care workers is of the utmost importance.

21             But I will agree with Jeanne that there are

22      other effects this could have that we have to be

23      aware of.

24             We have to make sure that the employers, the

25      providers, are kept whole, and not expected to dig







                                                             407
 1      into their own pockets to pay the other pieces of

 2      the wage component that unemployment insurance,

 3      FUTA, you know, the list goes on, and unfunded

 4      mandates, where we have to provide training,

 5      orientation, health assessments, in-services, that

 6      are all paid for through this hourly wage that they

 7      contract with, with the MLTCs and the managed-care

 8      organizations.

 9             And the safety net situation Jeanne brought

10      is up critical.

11             We don't want to push people into a position

12      where they are cutting their hours in order to

13      secure their safety net benefits.  And that only

14      increases the number of aides that are going to be

15      needed in this system.

16             A little bit about our mentorship pilot

17      program that we would like to see leveraged, is we

18      created a peer-to-peer program, where experienced

19      caregivers were acting as mentors to newly hired

20      individuals for their first 90 days of employment.

21             And for their services in that program, they

22      were paid a weekly stipend, and given additional

23      recognition at the agency as a leader within their

24      agency.

25             So it was a career-ladder step for those







                                                             408
 1      individuals.

 2             And what we learned through that program was

 3      that turnover rates at the agencies with this

 4      mentorship program experienced 170 percent lower

 5      turnover rate than two dozen agencies without a

 6      mentorship program.

 7             It really provides a connection to the

 8      workforce out in the field back to the agency.

 9             It connects them to someone who's been there,

10      who's done that, and who can provide individual

11      support and recommendations, and care for that new

12      hire.

13             And we would really like to see more

14      investment made in these programs.  It was funded

15      through one of the WIOs.

16             Those WIOs are now gone, so we are seeking

17      grant funding to continue the support, but we think

18      it deserves more than that, and that we shouldn't

19      have to go out and beg, borrow, for funds on a

20      proven program.

21             So thank you.

22             SENATOR MAY:  Thank you.

23             AL CARDILLO:  Thank you very much, Senators.

24             Thank you for holding this hearing today, and

25      inviting Home Care Association of New York State







                                                             409
 1      testimony.

 2             I'm Al Cardillo.  I'm the president & CEO of

 3      the association.

 4             I also want to, you know, really start off by

 5      really thanking you for the work that you've been

 6      doing the last number of years in support of this

 7      field.

 8             You've really made this -- this field really

 9      has needed a champion, and you're all really working

10      extensively to try to champion these causes.

11             They are very complex causes, and I think

12      from the testimony that you've heard today, it's

13      been really clear, all of the various factors that

14      really go into producing the challenges that exist

15      in our workforce.

16             Now, in my testimony I presented you with

17      some statistics, I presented you with lots of

18      recommendations for how we might go forward.

19             And I would like to just frame that in a

20      couple of ways here in this opportunity here now.

21             What we're hearing from providers across the

22      state, and professionals, is that, you know, there

23      has been a workforce shortage in home care probably

24      since the '80s.

25             I mean, I know I worked on a task force







                                                             410
 1      related to home care shortage in 1986 and '87.

 2             So it's never really gone away, and one of

 3      the reasons is actually a good reason:  It's because

 4      home care works.

 5             Home care has been worked, in a state like

 6      New York, into the fabric of the system where it's

 7      not just long-term care, although that's a big part

 8      of it.

 9             Home care provides post-surgical services,

10      preop services, maternal and child health, major

11      medical management, public health services, asthma

12      screening.  You know, really across the continuum of

13      need, home care is providing services.

14             It's aides, it's nurses, it's therapists,

15      it's social workers, and case managers, and so on.

16             So it's really a very extensive team.

17             So because the system works so well, and

18      because policies have really been created to try to

19      divert patients from hospitals, and nursing homes,

20      into home care, the demand is burgeoning; and it's a

21      good demand.  But there's been really a chronic

22      understaffing of the system.  This has gone on and

23      on.

24             In the pandemic it's really reached emergency

25      proportions.  And no matter who I talk to in the







                                                             411
 1      state, and we've been speaking to providers and

 2      groups around the state for the last month, they

 3      describe this as an emergency.

 4             A provider told me today that he's had one

 5      recruit in four months walk into the office to seek

 6      training, or to seek potential position.

 7             And, again, we know this really cuts across

 8      all of the different disciplines.

 9             In looking at the situation, our

10      recommendations focus on the need for some immediate

11      help, immediate relief.

12             What kinds of things can we start doing now

13      to make a difference?

14             At the same time, we need to look at, really,

15      a multitiered plan.

16             Something that looks -- clearly, we've heard

17      a lot about funding today, but there's issues of

18      funding.  Issues of creating interest in entering

19      this field from the beginning; pipelines from

20      high school, from college, from professional

21      schools, to be interested in coming into the field.

22             Regulations in state programs, which ones are

23      counterproductive to the workforce, and

24      counterproductive to the efficiency of the staff,

25      versus being supportive of that arrangement?







                                                             412
 1             What provisions do we have for technology,

 2      and the support of technology for workers, for

 3      patients, and so on?

 4             So, truly, it really cuts across the entire

 5      board in terms of a comprehensive plan.

 6             I also think -- you know, as you approached

 7      the hearing, you've looked at nursing homes,

 8      assisted living, home care, other.

 9             I think, in the case of some of the

10      responses, it would be really important to determine

11      what kinds of responses are common across those

12      fields that the legislature and government could

13      support, so that we have more of a unified kind of a

14      program to assist wherever that patient is, if

15      they're in a nursing home or home, because what we

16      don't want to do is maybe pay them more in one

17      setting, so now they can't get into the other

18      setting because you don't have competitive salaries.

19             So I think it's important to look across

20      that; look at the training, look at the educational

21      requirements, and then also look at the very unique

22      aspects that relate to home care, assisted living,

23      adult homes, nursing homes.

24             And I think from that, I think a very good

25      package of ideas and proposals, you know, can







                                                             413
 1      emanate.

 2             Some of the things that could be done right

 3      now, Senator Rivera, you have legislation that would

 4      provide support for home health agencies that have

 5      not had a base-year increase in five years, and are

 6      trend factor increase in over ten.  And Jeanne spoke

 7      to that issue.

 8             There's also the situation where, you know,

 9      in the case of your legislation, you know,

10      Senator May, that is really looking at, how do you

11      increase the target amounts that we should be

12      providing to workers so that they're working for a

13      wage that really reflects the value of the care and

14      the meaning of the care that they provide?

15             Senator Serino, you've sponsored legislation

16      that creates a multistate agency task force to look

17      at the marketplace, and try to decide, well, what

18      should the wage be set at to really help it make a

19      difference?  And how do we promote interest in this

20      field across the state?

21             These are things that are very, very much

22      within our grasp now.

23             I want to mention one other thing.  It seems

24      a little off-topic, but it's not, and just this one

25      last piece.







                                                             414
 1             You've heard a lot in the budget process

 2      about the request for offers (the RFO) for licensed

 3      agencies and fiscal intermediaries.

 4             That RFO has not been released yet.

 5             That is going to create a calamity in the

 6      system if -- if -- once that starts being

 7      implemented, and licensed agencies start actually

 8      being cut out of the Medicaid program.

 9             We would ask you -- we asked if you would

10      repeal the RFO, but at least table that, and let

11      there really be a -- I think a more rational look at

12      how to regulate the agency supplying the state, so

13      we don't undo the workforce and don't undo the

14      patients.

15             As the same with the FI.

16             I will conclude.

17             SENATOR MAY:  Thank you.

18             And I will just respond about the wage

19      compression, that -- I can't remember, I think it's

20      in the Investing and Care Act, that we really

21      thought about that issue, and how do you bring up

22      those at the bottom without disadvantaging the

23      next-level workers, and that sort of thing?

24             So it's on our radar, for sure.  But

25      I appreciate you bringing that up.







                                                             415
 1             JEANNE CHIRICO:  Thank you.

 2             Just --

 3             SENATOR MAY:  Senator Serino, go ahead.

 4             JEANNE CHIRICO:  -- well, I just wanted to

 5      add the disappointment in the Department of Health

 6      proposal, from the recent determination of how

 7      they're going to use the home and community-based

 8      services money, that hospice was not even mentioned

 9      within that.  And home care got a little wink and a

10      nod of opportunity to apply for a grant under

11      transportation.

12             I understand that doesn't diminish the needs

13      in all the other areas that were in there, but I'm

14      just bringing it up as, a lot of work left to be

15      done on the other side.

16             SENATOR MAY:  Thank you.

17             Go ahead.

18             SENATOR SERINO:  And thank you so much,

19      Jeanne and Kathy and Al.

20             Al, you're always the hero here, with

21      everything that you bring up.

22             And, Jeanne, what you said like with hospice,

23      how we've had -- you know, you had 500 people at

24      first, and now you have 200.

25             And I think that everyone here agrees that







                                                             416
 1      the wages and benefits must increase to attract and

 2      keep the workers.

 3             But like you said, we need to ensure that, in

 4      trying to help one group, we're really not

 5      inadvertently hurting the New Yorkers who utilize

 6      these services, our seniors, our most vulnerable.

 7             And I really appreciate you reminding

 8      everyone of the need to proceed expeditiously, but

 9      in a way that we don't have inadvertent

10      consequences.

11             And I love what you said, too, Jeanne, about

12      the center for excellence for workforce.

13             You know, you guys, you guys, all have skin

14      in the game.  And, really, to get something done,

15      I think we really need to have a unified front and

16      hear from everybody.

17             You know, like we heard some stuff today, but

18      to have these conversations, and really delve down

19      into it to see what we can do.

20             JEANNE CHIRICO:  And I think it is unfair to

21      ask the legislature to understand all the nuances

22      of -- and the implications that are in this

23      workforce.

24             And to have you be a part of conversations,

25      larger, with all the other stakeholders would be







                                                             417
 1      amazing.

 2             SENATOR SERINO:  It would great.

 3             Thank you very much.  Appreciate everything

 4      that you do.

 5             SENATOR MAY:  Thank you, all.

 6             All right, we're up to Panel 8:  Dana Arnone,

 7      Honorable Christine Pellegrino, Faigie Horowitz, and

 8      Jim Hurley.

 9             Start with Dana.

10             DANA ARNONE, RN:  Sure.

11             Thank you very much for the opportunity to

12      sit before you and have this conversation, and it's

13      been very, very long overdue.

14             My name is Dana Arnone.  I am a former home

15      health aide who put herself through

16      Suffolk Community College.  I am a registered nurse

17      for more than 30 years.  I am the proud owner of

18      Reliance Home Senior Services, which is a small

19      LHCSA, with about 300 home health-care employees,

20      and we are proud members of 1199 union.

21             And I'm very happy Rona's here, and she's on

22      my side.  So...

23             My history as a former nurse's aid gives me a

24      unique perspective and understanding, as well as a

25      great empathy for both the patients and the







                                                             418
 1      employees.

 2             I have devoted my entire career, and my life,

 3      to home health care and its total reform.

 4             I am here in solidarity with the caring

 5      majority, and stand by my employees, in support of

 6      fair pay for home health caregivers.

 7             It is beyond frustrating that we are sitting

 8      here debating the concept of human infrastructure.

 9             It's unbelievable to me, every time I hear

10      that bus drivers may receive 23 to 26 dollars an

11      hour, the fast-food workers receiving $15 an hour,

12      and we have to beg for our aides and our workers who

13      care for human lives to make at least a living wage.

14             The pandemic has brought to light many issues

15      that have been swept under the rug for years, the

16      most important being that there's just not enough

17      caregivers for the number of homebound patients.

18             The need is growing exponentially, and it is

19      only going to get worse unless extreme action is

20      taken.

21             It really is the perfect storm.

22             A recent statewide survey of home health-care

23      agencies found about 23 positions were left unfilled

24      due to staff shortages and, as a result, agencies

25      have been unable to accept nearly 30 percent of new







                                                             419
 1      cases.

 2             How are we, the agencies, supposed to

 3      survive?

 4             And I just want to add, as I'm sitting,

 5      listening to the testimony, my office -- I'm having

 6      a conversation with the director of my office, and

 7      from today, until this weekend, we are down

 8      50 workers that we have to staff the cases.

 9             And we don't have them.

10             So what's going to end up happening is, we're

11      going to end up calling our families that we care

12      for, that they're going to have step in, and either

13      take care of their patient -- or, their loved ones,

14      or go to work, or abandon them.

15             So we have this constant -- we sit down and

16      talk to them every week, and we're begging them to

17      stay with us and ride through storm together.

18             Once they hear that we can't staff their

19      cases, a lot of families think that they're going to

20      have more opportunity for workers on other agencies,

21      and then they find out that it's the same situation

22      across the board.

23             So that's just, as I'm texting back and

24      forth, I'm listening to them, they're, like,

25      panicking in the office.  We sometimes stay there







                                                             420
 1      until 8:00 or 9:00 at night, trying to staff these

 2      cases for our families, and it's impossible.

 3             So -- let me just go back.

 4             So with the decrease of the employees, that

 5      we still have to care for our patients.

 6             Overtime in my office is up about 20 percent.

 7      It is unsustainable.

 8             So you're going to find more and more

 9      agencies, especially small LHCSAs like myself,

10      they're going to be closing.

11             The governor constantly references that we

12      are New York [indiscernible] -- "New York Tough,"

13      but we really should be "New York Cares."

14             I find it completely unacceptable that across

15      New York State -- I'm going to cry -- the elderly,

16      disabled, and homebound are going without water,

17      food, medication; they're not being dressed, bathed,

18      and they lack basic human contact.

19             People wonder why we have such a high

20      hospitalization and re-hospitalization rate among

21      this population.

22             They are not being cared for.

23             I can attest that my agency is doing

24      everything that we can to retain and attract home

25      health aides.







                                                             421
 1             Reliance, my company, provided an extra $2 an

 2      hour to each aide as soon as we were granted the

 3      PPP funds.

 4             We participated in the 1199 union successful

 5      transportation pilot program, which they're still --

 6      my aides are talking about.

 7             We Uber aides to hard-to-staff outlying

 8      locations just to provide safe, consistent care to

 9      our families.

10             We provide scholarships to PCA school for

11      those interested but are unable to afford the

12      certification.

13             I myself have gone so far as to start a

14      not-for-profit called All Things Home Care so that

15      we can help other small agencies like myself, and

16      that are experiencing the same issues.

17             We celebrated our home care workers every day

18      when they were mostly forgotten and abandoned by the

19      media.

20             Home health caregivers are essential to the

21      most fragile, the elderly and the disabled.

22             The homebound deserve to be in their home and

23      deserve consistent care.

24             We need to acknowledge that people matter,

25      the patient as well as the caregiver.







                                                             422
 1             There is no one more essential than that

 2      worker who is caring for you in your home.

 3             Consistent -- oh, I'm sorry.

 4             We believe that there needs to be fair pay

 5      for differentials on Sundays and holidays because

 6      these are the most nearly impossible times to staff,

 7      and the burden falls upon the agency.

 8             We believe that nursing students should be

 9      rotated through home care.

10             As -- we at Reliance took it upon ourselves,

11      we have developed a syllabus.  We presented it to

12      Farmingdale State College.  And we are ecstatic to

13      say that nursing students will be starting their

14      clinical rotation through Reliance Home Care this

15      fall.

16             In addition, we feel that it is valuable

17      to --

18             SENATOR MAY:  I have to ask you to wrap up,

19      Dana.

20             DANA ARNONE, RN:  What?  Wrap it up?

21             Okay.

22             In addition, we feel that it's valuable

23      that --

24             This is actually really important, it's just

25      my last point.







                                                             423
 1             -- that we -- there is an opportunity in

 2      nursing students, when they're going through the

 3      first year of nursing school, they are completing

 4      fundamentals of nursing, which is, basically, the

 5      core curriculum for the PCA home health aide

 6      certificate.

 7             If we can just tap into those nursing

 8      students, we could have an immediate workforce, we

 9      can have a valued workforce, and we can start

10      [indiscernible] nursing students to be given their

11      opportunities with in-home care, and really starting

12      to change the perspective that they have.

13             Thank you.

14             SENATOR MAY:  Thank you.

15             Christine.

16             HON. CHRISTINE PELLEGRINO:  Is it on?

17             SENATOR RIVERA:  One more time.

18             SENATOR MAY:  Just touch it very lightly.

19             SENATOR RIVERA:  One thing you can do is to

20      start -- start talking as you start to --

21             HON. CHRISTINE PELLEGRINO:  There it is.

22             SENATOR RIVERA:  There you go.

23             HON. CHRISTINE PELLEGRINO:  I'm on.

24             Senators, thank you so much for being here

25      for the long haul.  We understand it's been an







                                                             424
 1      extraordinarily long day, and, hopefully, very

 2      productive.

 3             We're grateful to you for working together to

 4      hear about this topic, and for giving me the

 5      opportunity to provide testimony.

 6             My name is Christine Pellegrino.  I'm a

 7      former member of the New York State Assembly, a mom,

 8      and a daughter to aging parents.

 9             I'm currently the board president of

10      All Things Home Care, a not-for-profit dedicated to

11      improving the lives of the elderly, the infirmed,

12      and the disabled.

13             All Things Home Care seeks to work

14      collaboratively and creatively to support and

15      elevate the role of home care workers, to improve

16      their quality of life, and ultimately make a

17      difference in affecting patient outcomes.

18             We believe that everyone should be able to

19      receive the care that they deserve, to live a life

20      of dignity, which makes the shortage of home care

21      crisis -- home care workers a real crisis for

22      parents, patients, their families, and, ultimately,

23      for us all.

24             The shortage of caregivers creates a

25      cascading effect on families and communities,







                                                             425
 1      detracting from the overall productive --

 2      productivity of the local workforce.

 3             When cases can't be regularly staffed or

 4      caregivers unexpectedly miss their assignments,

 5      care, as we've heard often today, for the patient

 6      falls to a loved one who must choose between their

 7      family member and their job.

 8             We cannot ignore the pending workforce

 9      shortage any longer as the crisis is already upon

10      us.

11             Unstaffed cases and missed visits are a

12      direct result of some of the various issues home

13      care workers face, and I would like to talk about

14      that a little bit; namely, home care workers face

15      significant barriers that limit their participation

16      in the workforce.

17             It's often said that it is expensive to be

18      poor.

19             Often, home care workers rely on public

20      transportation.

21             Now, if you've ever been to, or been forced

22      to, commute by public transportation anywhere in the

23      suburbs of New York, particularly on Long Island,

24      you know how woefully insufficient our suburban

25      public transit system is.







                                                             426
 1             Furthermore, roughly 25 percent of

 2      Long Island patients live in areas that are deemed

 3      "hard to staff" because they are not accessible to

 4      public transportation, thus resulting in a situation

 5      where the patients who need essential care in their

 6      home have great difficulty receiving it.

 7             And so the intersection of a subpar public

 8      transit system and low wages means that workers must

 9      choose between spending their personal time on a

10      labor-intensive, hours-long, exhausting commute; the

11      unaffordable cost of ride share options; or simply

12      not working at all.

13             The reality is, that suburban home care

14      workers may be forced to accept fewer assignments

15      than they could because of their low pay, thus

16      magnifying this crisis.

17             Our organization, All Things Home Care, has

18      launched a private transportation initiative for

19      caregivers who need a ride to work, because it gives

20      the caregiver the ability and the incentive to

21      accept work, and, importantly, they are able to keep

22      more of that money in their pocket.

23             Therefore, All Things Home Care is calling

24      for the historic investment in initiatives that

25      offer a broad range of support systems for essential







                                                             427
 1      workers.

 2             We also, as many have, support Fair Pay for

 3      Home Care legislation because we believe that those

 4      who provide essential care should not be relegated

 5      to a lifetime of poverty.

 6             We support Senator May's Home Care Jobs

 7      Innovation Fund, and support appropriation of the

 8      $15 million immediately from the federal Cares Act

 9      funding for initiatives like our home care worker

10      transportation initiative, as well as funding for

11      childcare, broadband, cellular service, and other

12      workforce-related expenses.

13             This innovation fund will create jobs in the

14      human-service sector, such as drivers and childcare

15      providers, and we encourage the unionization of

16      those workers as well.

17             Finally, in order to support home care

18      agencies, often locally-owned small businesses who

19      are themselves significant job creators, we call for

20      an industry-wide pay-rate standardization, and a

21      raise to the reimbursement rate to include the

22      overtime pay and holiday pay for caregivers.

23             Agencies, as we've heard today, operate on

24      very small profit margins, and need to be

25      compensated in a way that allows them, too, not just







                                                             428
 1      to operate, but to thrive.

 2             Thank you.

 3             SENATOR MAY:  Thank you.

 4             FAIGIE HOROWITZ:  Okay.  I think you hear me.

 5             I'm Faigie Horowitz.  I'm with

 6      Caring Professionals.  We are a New York City-based

 7      LHCSA, a home care agency.

 8             But I'm going to talk about all the

 9      stakeholders in this conversation, and, at the end,

10      there's going to be somebody who has not really been

11      mentioned.

12             The first set of stakeholders is, obviously,

13      the Medicaid patients, the consumers, and their

14      families.

15             They need HHAs, PCAs, and personal

16      assistants who will show up, and do show up, and

17      provide quality continuum of care.

18             The silver tsunami of baby boomers is upon

19      us, and the actuarial numbers are really no secret.

20             The second set of stakeholders is obviously

21      the caregivers.  Few are performing this dead-end

22      job -- it's not insulting, but it is factual -- at

23      low rates of pay.

24             And wage improvement is a critical need.

25             And we also need career pathways.







                                                             429
 1             And I think what you just mentioned about

 2      bringing in the nurses, the nursing students is so

 3      true.

 4             I went into a nursing school, because I was a

 5      board member, a couple of years ago, two or

 6      three semesters, nobody knew what I was talking

 7      about, even the dean.  And they weren't really

 8      interested.

 9             But education and teamsmanship will make

10      it -- across the health-care sectors will make a

11      difference.

12             I come out of the workforce world.  That was

13      my start in nonprofits.

14             There are many creative pathways and creative

15      models that do exist to bring people up.

16             But I want to touch on something that hasn't

17      been mentioned.

18             We are in the midst of a large labor shift

19      intensified by corona.

20             And last week's "New York Times" reported

21      that wages and opportunities for some low-wage

22      workers, such as those in the restaurant industry,

23      and those in online retail, are rising since the

24      pandemic.

25             Obviously, people want to go out to eat now,







                                                             430
 1      and have bought a lot online.

 2             Wait staff can move up to managers at

 3      restaurants, for example.

 4             And they do mention home health care.

 5             But, in our system, and in our industry,

 6      workers cannot move up without more training and

 7      additional credentials.

 8             The third set of stakeholders are the LHCSAs,

 9      such -- and the FIs; the providers.

10             We cannot give the workers the wages they

11      deserve with our shrinking margins.

12             There are now increased regulations and

13      safety precautions for which we were not reimbursed,

14      and there are administrative costs to the work that

15      we do.

16             We are not capitalists soaking up government

17      money and exploiting workers.

18             Years back, we had a 2 to 3 percent profit

19      margin.

20             That is long gone.

21             The margins are now minuscule.

22             And, we are a union shop, we pay the top

23      dollars.  We have not had 24-hour shifts in years.

24             And -- there's one more thing I wanted to

25      mention here, but, I forgot it.







                                                             431
 1             Historically, even when money did come down

 2      from the State, for minimum-wage increases on the

 3      LHCSA side, and wage parity on the CDPAP side, no

 4      measures were put in to ensure that the personnel

 5      rates, you know, the unemployment, the workers'

 6      comp, the payroll taxes, et cetera, and general

 7      administrative costs, were included in the rates

 8      paid to us providers.

 9             The managed-care plans decide which providers

10      get increases, and how much.

11             Providers are depleted, forced to manage more

12      things on less dollars.

13             Obviously, New York State is the fourth

14      stakeholder group.

15             New York State, and I remember this, was once

16      a trailblazer in allowing moderate-income seniors

17      and people with disabilities to access Medicaid.

18             Does New York State still care about this

19      sector?

20             There is now a look-back period of

21      2 1/2 years, and there are other barriers to

22      long-term-care services.

23             And now we come to the fifth group of

24      stakeholders: the managed care organizations which

25      operate without transparency.







                                                             432
 1             They're paid with Medicaid dollars, and have

 2      a very big stake in the existing system.

 3             Managed-care organizations normally work on

 4      a capitation basis; it's a simple equation.  But

 5      capitation does not work for long-term care.

 6             You can't make money by investing in the

 7      health of people who require long-term care.

 8             Their care needs increase, and there are no

 9      savings to be had.

10             It doesn't work.

11             But, the managed-care organizations get the

12      increases for home care without accountability for

13      contracts and the rates paid to providers.

14             Take a look at the plan submitted to CMS last

15      week for how to manage the additional FMAP money

16      coming down.

17             The managed-care organizations are going to

18      be devising the accountability measures for the

19      money they receive.

20             This is accountability?

21             Why are they stakeholders in the welfare of

22      poor people with disabilities, and seniors, in

23      New York State?

24             One final point:

25             There are two main differences between these







                                                             433
 1      two populations right now.

 2             And I know -- wait.

 3             I wanted to talk about the workforce.

 4             The workforce issues in home care are similar

 5      to those in the OPWDD world.

 6             And I know, because I'm a 25-year veteran

 7      board member of a medium-sized OPWDD agency in

 8      Brooklyn.

 9             There are two main differences:

10             Number one, just this final point which no

11      one mentioned:  No new barriers have been erected

12      recently to bar eligible people from services in the

13      world of developmental disabilities.

14             Two:  There are no managed-care organizations

15      in the LDD universe.

16             I rest my case at five minutes, exactly.

17             You know you what need to do, you are our

18      champions.

19             Keep on fighting for us.

20             SENATOR MAY:  Thank you.

21             And, finally, Jim.

22             JIM HURLEY:  Hi.

23             I just want to echo the "thank you" to those

24      that hung in there until the end with us.

25             I think it's very important that we do this.







                                                             434
 1             My name is Jim Hurley, and I own Home

 2      Instead, which is a licensed home care agency here

 3      in the Capital District.  We employ about

 4      300 caregivers.

 5             I'm the chair of the New York Chapter of the

 6      Home Care Association of America, and I'm a member

 7      of the New York State Health Care Providers, and a

 8      board member of the Capital Region Workforce

 9      Development Board.

10             And I've chopped a whole bunch out of here.

11             There are a number of reports that I used to

12      put this together.

13             And I'll get you those reports by the end of

14      the week.

15             In those reports, there are recommendations

16      and strategies that everyone seemed to agree on:

17             The strategies to improve recruitment of new

18      caregivers reduced turnover, and ensured that a

19      stable, high-quality workforce will be available to

20      care for older adults with long-term service and

21      support needs.

22             And I'm go going to touch on just two of

23      those strategies.

24             One is, a public campaign which could help

25      expand the pipeline of potential caregivers by







                                                             435
 1      recruiting non-traditional workers to the

 2      long-term-services field.

 3             These workers could include students,

 4      displaced workers, and older adults who want or need

 5      to work past the age of retirement.

 6             We have a good percentage of our workers and

 7      our staff who are in their 60s, 70s, or even

 8      80s, and find meaningful work, and remain

 9      productive members of society, although sometimes

10      there are strict restrictions on what they're able

11      to earn.

12             We have to stop encouraging or incentivizing

13      people not to work.

14             And then, home care, health-care integration.

15             We need to explore reasonable and sensible

16      expansion of the scope of services that LHCSAs

17      (licensed home care service agencies), and

18      particularly aides, are permitted to provide.

19             Well-trained aides, under the supervision of

20      an RN, should be able to do more in the home.

21             The -- if we come up with -- a home aide can

22      provide care in a home, a certified nurse's aide can

23      provide care in a facility, but those two very

24      similar positions can't work in the other's area.

25             Why?







                                                             436
 1             Why not establish a more universal worker to

 2      become a direct-care professional in nursing homes,

 3      assisted-living communities, and home- and

 4      community-based settings?

 5             We just need to identify a common set of

 6      competencies that this universal aide, regardless of

 7      setting, could master and demonstrate.

 8             This role should be able to carry their

 9      credentials across state boundaries also.

10             And that is it.

11             SENATOR MAY:  Wow.  Well done.  Coming in

12      below time.

13             Any questions from anybody?

14             I just want to say thank you for the really

15      important work you're doing, and the good ideas.

16             I'm going to -- did you submit your testimony

17      in writing?

18             I think I've got it here.

19             But, I'm looking forward to seeing some of

20      these really good suggestions that you have.

21             And investments in things like transportation

22      are critical.

23             And the nurses, you know, bringing --

24      rotating the students into, you know, home care

25      seems like a brilliant idea, too.







                                                             437
 1             So thanks so much for bringing all of this

 2      forward.

 3             OFF-CAMERA SPEAKER:  Okay.  Thank you.

 4             SENATOR MAY:  Thank you for your work.

 5             And, the last panel.  All right.

 6             MATTHEW HETTERICH:  Not least.

 7             SENATOR MAY:  Not least.

 8             So we have Christy Johnson -- Johnston,

 9      Matt Hetterich, and Veronica Charles.

10             And you guys should win a prize for being

11      here until the bitter end.

12             OFF-CAMERA SPEAKER:  Thank you for being here

13      to the bitter end.

14                [Laughter.]

15             SENATOR MAY:  Well, and thanks to everyone

16      who stayed, actually.

17             So, Christy, do you want to kick it off?

18             CHRISTY JOHNSTON:  Yes.

19             And the mic is on, so that works well.

20             So, good afternoon, almost evening.

21             And, I just want to thank you for convening a

22      hearing dedicated to such an important and

23      challenging topic, and for your patience in sitting

24      through all of the conversation today.

25             My name is Christy Johnston, and I work for







                                                             438
 1      Premier Home Health Care Services.

 2             And my remarks today, which have been cut

 3      down and edited --

 4             SENATOR RIVERA:  Excuse me one second.

 5             Folks, if you could take the speaking

 6      outside, please, because we can hear it down here.

 7             Thank you so much.

 8             Thank you.

 9             Please continue.

10             CHRISTY JOHNSTON:  And my remarks today

11      reflect those of a number of additional LHCSAs that

12      share similar characteristics.

13             Together, our organizations care for tens of

14      thousands Medicaid beneficiaries in the

15      five boroughs and surrounding counties, and we

16      employ tens of thousands of home health aides who

17      are members of 1199 SEIU.

18             Our organizations invest in training,

19      technology, and career growth for our essential home

20      health workforce, to ensure our patients receive the

21      highest-quality care, and we endeavor to collaborate

22      regularly with our union partners on issues and

23      initiatives that impact our workforce.

24             It's been a long day, and prior speakers and

25      your questions have covered many of the critical







                                                             439
 1      issues.  So I will just hit a few points important

 2      to reinforce at the end of the day.

 3             We are at a critical juncture.

 4             We have a crisis going on in home care right

 5      now, but we also have unprecedented funding

 6      opportunities for home care.

 7             And you-all, your colleagues and the

 8      executive, ultimately must decide how much of an

 9      investment the State will make to address the home

10      care workforce challenges, and how accessible the

11      state wants to make home care services to its

12      citizens.

13             New York has always been supportive of home

14      care sooner and at greater levels than other states,

15      but has not consistently continued to invest in home

16      care.

17             So a couple of the issues.

18             Workforce.

19             There is a growing workforce home care

20      shortage crisis, but it existed before the pandemic.

21             It's even greater now, and has spread

22      throughout the state.

23             New York City, which was not touched as much

24      by shortages in prior years, I can say, is now in a

25      full-fledged staffing crisis.







                                                             440
 1             And as we emerge from the pandemic, thousands

 2      of home care workers have left the market, and many

 3      have still not returned.

 4             And I think one piece relative to the issues

 5      with that, is the lack of staff drives an incredible

 6      overtime expense, to make sure continuity of care

 7      exists, patients are cared for, and as we kind of

 8      move things -- move people around.

 9             During the pandemic it was critical because

10      we wanted to ensure the care was there and people

11      were able to remain at home.

12             Now that we're moving out of the pandemic,

13      it's because we don't have workers.

14             Infrastructure.

15             The state's home care infrastructure

16      increasingly is unstable.

17             It's a system designed to keep individuals

18      out of congregate care settings, but it's been

19      neglected and is fraying as a result of decades of

20      Medicaid cuts with simultaneously increasing wage

21      and related costs.

22             It will come as no surprise that it's been

23      exacerbated after the pandemic.

24             This sector of the health-care system

25      received no additional funding support to deal with







                                                             441
 1      any of the pandemic-related issues.

 2             And I will say, we work in multiple states.

 3             Other states did invest.  They provided

 4      access to grant funding.  They increased wages --

 5      rates for increases to wages.

 6             New York didn't do that, so it's an

 7      additional struggle on top of the other challenges.

 8             Without question, home care workers are the

 9      backbone of this health-care sector.  They are the

10      eyes, ears, and hands in the home, and they

11      contribute significantly to controlling health-care

12      costs and improving quality of patients' lives.

13             To that end, we are grateful to you and your

14      colleagues in the legislature for leadership in

15      proposing solutions to address these critical issues

16      and working collaboratively.

17             Our group has been supportive of increasing

18      wages and other important -- other approaches to

19      increase the amount of pay home care workers can

20      take home, through bonuses, recruitment incentives,

21      and fair reimbursement to home care providers.

22             We believe that the best way to accomplish

23      this is by development of regional-based rates

24      similar to the Fair Pay for Home Care bill approach.

25             And I want to emphasize that minimum hourly







                                                             442
 1      regional reimbursement rates, it is about wages, it

 2      is about benefits.

 3             But the cost of delivering an hour of care is

 4      more than just that wage and benefit.

 5             It's payroll taxes, insurance, paid time off,

 6      training time, travel time, overtime, spread of

 7      hours, holiday pay.

 8             It costs us a million dollars-plus a year to

 9      pay time and a half and double time for holiday pay.

10             That's not reimbursed by MLTCs or the

11      Medicaid program, and those are wages that workers

12      deserve.

13             And that's not even managing the regulatory

14      requirements.

15             That funding is critical to our work as well,

16      and it helps target things to our workforce.

17             There are a myriad of other approaches to

18      improving aspects of the home care workforce

19      recruitment and retention challenges: training

20      flexibility, social determinant health support for

21      workers, enhanced training career and ladders, among

22      other things.

23             I'd love to talk about that endlessly because

24      that's what we want to be focusing on.  But it's

25      really about, ultimately, investing in wages and







                                                             443
 1      benefits for this workforce.

 2             Fortunately, there's funding, opportunity at

 3      the federal level, and we look forward to working

 4      with you to help secure that for New York.

 5             SENATOR MAY:  Great.  Thank you.

 6             Matt.

 7             MATTHEW HETTERICH:  Good afternoon, Senators.

 8             Thank you for waiting for all of us today,

 9      and especially for some of us that came up from

10      Long Island; so it's a 4-plus hour ride.

11             So when the meeting cuts off at 5:00, you

12      worry that you made the trip.

13             So I appreciate everybody's time today, and

14      getting to work with you.

15             My name is Matthew Hetterich.  I serve as the

16      administrator of Gurwin Certified Home Health

17      Agency, part of the Gurwin Health Care System based

18      out of Commack, Long Island.

19             In addition to operating both a LHCSA and a

20      CHHA, we serve as a 460-bed nursing and rehab center

21      that provides long-term care, ventilator care,

22      on-site dialysis, medical and social model daycare.

23      We have an assisted-living facility that's across

24      the street.  We do memory care.

25             We do the entire care continuum.







                                                             444
 1             And soon, after the Independent Building is

 2      finished, we will be one of the few CCRCs on

 3      Long Island, and offering diverse care options for

 4      people out on the eastern portion of Suffolk County.

 5             So I wanted to come and speak today on behalf

 6      of not just the home care agency, but on the whole

 7      care continuum, and seeing what we are experiencing

 8      right now with what is truly a workforce shortage of

 9      not enough nurses, not enough aides, not enough

10      therapists, not enough CNAs.

11             It's been very dire straits, between COVID,

12      between other employment opportunities out there.

13             So, you know, we're looking forward to

14      working with you in the future on what we can do.

15             There's been a lot of discussion today.

16      Obviously, a lot of the core issues have already

17      been addressed.

18             There are a couple of things that I would

19      like to suggest in terms of efficiencies that are

20      relatively cost-neutral.

21             So, for example, home health aides are

22      required to maintain a certain number of in-service

23      hours every year.  They have to do at least

24      12 hours.

25             The agency is responsible for monitoring







                                                             445
 1      those in-service hours.

 2             So if an aide works for Maxim Healthcare, and

 3      then also works for Senator May Home Care, she's

 4      required to take those same in-service hours for

 5      both agencies.

 6             There should be some sort of efficiency

 7      created within the health commerce system, or

 8      somewhere along the way, where those hours can be

 9      recorded on an agency basis, and then prorated,

10      which will also allow for those caregivers to spend

11      more time in the field versus time in the office

12      maintaining those sorts of criteria that are

13      required.

14             In addition to that, there are training

15      programs that are certified by the Department of

16      Health.  There are training programs that are

17      certified by the Department of Education.

18             There should be some look into creating

19      either a universal worker program, or how can we

20      allow these trained caregivers to work across

21      different settings?

22             Whether it's a CNA in the nursing home, a

23      home health aide that's in the home, a resident care

24      assistant that's at the assisted living, a direct

25      support professional; whatever it may be called,







                                                             446
 1      there may be some opportunities in looking at

 2      aligning these caregivers, and the training and

 3      experience they have, in order to be able to serve

 4      as multiple populations; not just for one provider,

 5      like Gurwin, but for multiple providers out there,

 6      and to allow them different opportunities there.

 7             In addition to that, one thing I did want to

 8      mention that has been a positive also, is Gurwin had

 9      created a position called the "resident care

10      assistant," which was an extra set of hands that we

11      utilized in the nursing home in COVID.  This was

12      untrained staff that would be able to at least

13      triage call bells, help with food deliveries, things

14      of that nature; non-clinical hands-on -- or,

15      non-clinical tasks, to allow our other caregivers to

16      provide that care.

17             We'd be hopeful in looking at the staffing

18      ratios that something like that would be allowed to

19      be included in that hourly fix, or that hourly range

20      of care, that's going to be required come January.

21             There's been a lot of horror stories today,

22      but one of the things that I did want to mention is,

23      you know, Gurwin is a CMS-rated five-star facility.

24             We spare no expense when it comes to employee

25      benefits.  We offer wages that are above and beyond







                                                             447
 1      any of our competitors that are out there.

 2             In addition to that, we already meet all of

 3      the staffing requirements that are going to be

 4      required of us.

 5             We are a quality provider that believes in

 6      putting the patient at the center of our care, and

 7      then everything else will fall into place.

 8             When we get calls from for-profit providers

 9      that are inquiring as to what we're doing

10      differently, and how we're operating in this

11      environment, that's somebody that should be included

12      at your table in terms of these discussions and

13      moving forward.

14             So, with that, all I wanted to say is:

15             Before the pandemic, people had already

16      preferred to age and receive care in place in

17      familiar surroundings whenever possible.

18             This has only grown truer in the

19      post-pandemic world, as many people look to bypass

20      facility-based care completely, and new federal

21      programs, such as SNF-at-Home, Hospital-at-Home,

22      continue to showcase the ability of home- and

23      community-based services to deliver higher levels of

24      care in a safe and efficient manner.

25             With the lessons we've learned regarding







                                                             448
 1      infection control and capacity of the overall

 2      health-care system, an investment into home- and

 3      community-based services is money well spent, as it

 4      has been repeatedly demonstrated to be a

 5      cost-effective, patient-care solution at a variety

 6      of levels that's not limited by walls or the number

 7      of beds.

 8             Thank you.

 9             SENATOR MAY:  Thank you.

10             And, last, but definitely not least,

11      Veronica.

12             VERONICA CHARLES:  Thank you so much,

13      Chairwoman May, Chairman Rivera, and Senator Serino,

14      for sticking it out until the end.

15             And I greatly appreciate everyone's

16      thoughtful testimony today, as well as your

17      thoughtful comments and considerations.

18             So I do want to keep my testimony brief.

19             I will be speaking primarily towards

20      private-duty nursing, which is a specific type of

21      nursing services that Maxim provides, that really

22      focuses on pediatric patients, which are sometimes

23      left out of this equation.

24             So my name is Veronica Charles.  I am the

25      director of government affairs at Maxim Healthcare







                                                             449
 1      Services.

 2             We're a national provider of home health-care

 3      services, but we do have seven offices in the

 4      state of New York.  We care for a little over

 5      1700 individuals throughout the state.

 6             That's, again, primarily offering

 7      private-duty nursing services as a LHCSA, a

 8      certified home health agency.  But we also are a

 9      fiscal intermediary in the consumer-directed

10      personal-care program.

11             Maxim has been a longstanding advocate for

12      the New York home care workforce, and we appreciate

13      everything we've discussed today.  And I agree with

14      so much of what my colleagues have had to say.

15             Private-duty nursing is a continuous skilled

16      nursing care provided in the home for medically

17      complex and vulnerable pediatric patients, as well

18      as older adults or individuals that may have had a

19      traumatic brain injury, require a tracheostomy,

20      ventilator care.  But these are really individuals

21      that suffer from a disability, that they require a

22      nurse around the clock to stay alive.

23             So, unfortunately, many New York children,

24      older adults, with these special needs are not

25      receiving enough nursing services in the home, or







                                                             450
 1      able to access these life-saving services, for the

 2      reasons you've heard today, primarily stemming from

 3      low Medicaid reimbursement rates from Medicaid, as

 4      well as the managed-care organizations, which

 5      hinders comprehensive recruitment and retention

 6      strategies.  And that has definitely been true

 7      throughout the COVID-19 public health emergency.

 8             The pandemic has made the delivery of our

 9      specific PDN services more difficult for nurses and

10      costly for agencies, as neither our agencies nor our

11      clinicians have received enough financial support

12      from the State or the federal government associated

13      with COVID that nurses in other industries have

14      received.

15             Offering additional funding to support PDN

16      wages will assist home care providers in improving

17      quality while also containing health-care costs.

18             As we've heard today, it's incredibly costly

19      to keep individuals in the hospital, and it's

20      inappropriate to keep these children in hospitals.

21             The cost of 16 hours of PDN services is

22      approximately one-third the cost of a day in the

23      hospital.

24             So, obviously, we would like to work toward

25      avoidable hospital utilizations, and help save the







                                                             451
 1      state of New York precious Medicaid resources.

 2             And while Medicaid rates in the state are

 3      lower than necessary to maintain this robust

 4      workforce, there's a lack of a PDN rate floor in

 5      New York, which makes it possible for MCOs to pay

 6      less than Medicaid, forcing clinicians and agencies

 7      to cut our costs when we're reimbursed less than

 8      what is guaranteed by Medicaid.

 9             By establishing a PDN rate floor for MCOs,

10      hopefully, the State will be able to provide

11      providers with an opportunity to recruit and retain

12      workforce.

13             And we definitely want the most qualified

14      caregivers for these complex and high-acuity

15      children and older adults.

16             Lastly, it's important to note that LHCSAs

17      have a harder time recruiting and retaining nurses

18      for patients who are over the age of 23, due to the

19      wage cliff created by the Medicaid pediatric rate

20      enhancement for medically-fragile children.

21             We recognize that this was likely

22      unintentional, but what happens is, because of this

23      rate enhancement, when a child turns 23, with a

24      severe disability, the nurse loses roughly

25      30 percent of their pay due to the lack of the







                                                             452
 1      enhancement that was attributed with that case.

 2             In order to protect these patients from

 3      losing their lifelong nurses in many circumstances,

 4      and in an effort to help support this ongoing

 5      workforce shortage, we do ask that the legislature

 6      consider extending that enhancement rate for

 7      medically-fragile children over the age of 23.

 8             And, lastly, as we look to things that are a

 9      little bit different than our skilled workforce,

10      like our unskilled workforce -- which I don't like

11      that term for our personal care assistants -- we

12      really ask that we look to looking at these rates as

13      well, that will help personal-care assistants across

14      the state, specifically in the consumer-directed

15      program.

16             The CDPAP program has increased access to

17      care for approximately 75,000 New Yorkers,

18      statewide.  And the importance of this program was

19      obviously further emphasized during the pandemic.

20             Given the work that Maxim and other FIs

21      have put into running a highly successful operation

22      within CDPAP, I would be remiss if I did not voice

23      our concern regarding the ongoing RFO process that

24      many of my colleagues have brought up, that have

25      threatened to drastically reduce access to FIs,







                                                             453
 1      and take away job opportunities from these numerous

 2      personal-care workers.

 3             In order to increase the unskilled workforce

 4      in home- and community-based services, we ask the

 5      legislature work to preserve this program by

 6      allowing good-faith FIs to continue to operate in

 7      this program, with specific attention to FIs that

 8      practice areas of excellence and promote easier

 9      access to job opportunities.

10             Thank you-all so much for your time, we

11      greatly appreciate it.

12             And we look forward to working with you in

13      the future.

14             SENATOR MAY:  Thank you.

15             Any last comments or questions?

16             SENATOR RIVERA:  Last comment I'll say, the

17      gentleman who came from Long Island, you know, it

18      being the time that it is, there's a couple of great

19      restaurants in the neighborhood; if you just want to

20      stay the night, and take off tomorrow morning very

21      early.

22             Just as a suggestion, because it's going to

23      be a long drive.

24             But in all seriousness, thank you to everyone

25      for being here, particularly all of the -- there's







                                                             454
 1      obviously some very key, I think it was -- what was

 2      it? -- the one -- oh, yeah, we need to make sure we

 3      fund it more adequately.

 4             That we provide a more stable revenue source,

 5      that we provide a more -- just -- that we provide

 6      better conditions for these folks, who perform an

 7      incredibly important job, and which is only going to

 8      become even more necessary in the years to come.

 9             And that we have an opportunity -- as

10      I believe there was a lady just said it very

11      recently, there was an opportunity, because of the

12      crisis that we are in, we are in a crisis, we

13      shouldn't waste it.  I think it was what she said.

14             I believe, you know, I always said, that we

15      have an obligation at times like this, to actually

16      really invest, to really think in the long term, and

17      not just think, you know, as we said before, penny

18      wise, pound foolish.

19             But, really, a couple of great places I'll

20      suggest.

21             MATTHEW HETTERICH:  Are we going to dinner?

22             SENATOR RIVERA:  I'm going someplace.

23             I'm just saying you should, too.

24             SENATOR SERINO:  I just want to say thank you

25      to everybody.







                                                             455
 1             You know, everybody that has come before us

 2      today really cares about what they do.

 3             We are headed towards a crisis and it has to

 4      be addressed.

 5             You know, like I've said many times over

 6      through the years, our seniors and our vulnerable

 7      populations have kind of been like an after-thought,

 8      and [indiscernible].

 9             And it's something that we really have to

10      work on now.

11             So I really appreciate everybody's testimony

12      today.

13             Thank you.

14             SENATOR MAY:  And let me conclude with the

15      same.

16             It's gratitude to you, and to everybody who

17      has been here.

18             We talked about this crisis, but that means

19      even more, that those of you who are still doing

20      this work are doing it out of love and commitment

21      and passion.

22             And it is that much more important that you

23      keep doing what you're doing, and that we find ways

24      to support you in it.

25             So thank you to everybody who has tuned in







                                                             456
 1      here, who has been here in person.

 2             Thank you to the staff, who have been

 3      amazing, and keeping this running; all of you.

 4             And I'm just grateful to all of you, and to

 5      my colleagues, for sticking with it, but also the

 6      ones who have been here in the course of the day.

 7             So, thanks again.

 8             The hearing is officially over now.

 9             Thanks.

10                (Whereupon, the public hearing held by the

11        joint committees concluded, and adjourned.)

12                            --oOo--

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