As elder care only grows, more oversight needed

Each of us has a story to tell, of the intensely personal and complex journey in caring for an aging parent, grandparent, spouse or close friend. The stress, worries, debates over every step are consuming. Some live with it every day, with an enormous physical and emotional toll. Others, especially those who must guide it from a distance, must trust professional caregivers to take on an arduous job. Behind it all is a deep desire to make the right choices, to do right by those who always cared for us.

We can't do it alone.

As Long Island's population ages, those struggles will multiply. The region needs a comprehensive approach to providing resources, oversight and solutions for those who need care and those who give it.

The Island is home to more than 500,000 people age 65 or older — a number that grew 24% just in the last decade, and that's nearly 18% of Long Island's overall population, according to the Center for an Urban Future. Care is costly, especially for the more than 32,000 who live at or below the poverty line. Long Island is graying faster than the rest of the state outside of New York City.

Meanwhile, younger generations are working more and longer and having children later, leaving them often sandwiched between parents and children who both need their care, even while they grapple with rising costs of housing, health care and food.

With those trends come an exploding need for staff, facilities, agencies and options, both for those who wish to age in place at home and those who require an assisted living or nursing home facility. The concerns, from staffing to cost to meaningful oversight, mount. As care industries expand, it's increasingly difficult for regulators, inspectors and others to keep up. 

That opens the door for bad actors, potential fraud, financial pitfalls and inadequate care, which could leave vulnerable seniors and their families at risk.

Take the Newsday news division's investigation into Friends for Life Homecare, a Massapequa firm that claims to do "companionship" care, which includes "game-playing" and "chit-chatting."

The state Health Department has suspected the company was doing home health care work without a license for more than two years. It was only after Newsday inquired that the department filed a lawsuit in Albany County Supreme Court to get Friends for Life to answer a subpoena for records and information.

Meanwhile, Friends for Life continued to operate. Multiple aides said they did home health care work, including administering medication, bathing patients, dressing wounds and changing a colostomy bag.

Were seniors at risk? We don't know. But a company like Friends for Life would not have thrived outside of the system's standards if there wasn't a market for such care.

Companion companies aren't licensed by the Health Department, while home health care agencies are. Officials must assess the broader state of oversight and accountability for all forms of elder care, to determine where licensing, inspection and regulation need improvement. To start: The Health Department itself requires additional resources to better inspect and surveil.

Also important: State officials must provide the public with expansive information so family members and friends can make wise decisions in assessing their options, including companies, agencies, facilities and individuals. A clearinghouse of dashboards, databases and details that highlight complaints, investigations, staffing shortages and other issues could help.

Staffing is key. Shortages existed before COVID-19; now staffing levels are even lower at nursing homes, inpatient rehab centers and hospice care locations. According to Bureau of Labor Statistics data, such skilled nursing facilities employed around 18,300 nurses across Long Island in the first quarter of 2020. Now, that number is an estimated 16,303.

What that means: As the number of seniors in need increases, the number of nurses in key skilled facilities is falling.

Minimum per-resident staffing hours were enacted into law in 2022, requiring at least 3.5 hours of nursing care per resident per day, 1.1 hours of which must be provided by a registered nurse or licensed practical nurse. But there's no public database to display who's complying and who's not and such information isn't readily available. Health Department officials told the Newsday editorial board that's because no "final determinations" have been made, even on nursing homes first issued non-compliance notices in 2022. That's unacceptable.

Beyond that, officials must address the root problems, by incentivizing nursing care employment, adding employee protections and improving the industry so more people will want to work there.

We also must strive for the ultimate goal: allowing as many seniors as possible to age in place, in their homes. That returns the spotlight to them and their families — the heart of the matter. Beyond agencies and individual caregivers, there are ways, through programs like Medicaid's Consumer Directed Personal Assistance Program, to allow family and friends to care for ill and disabled seniors. The state must recognize and fix any obstacles, while finding new tools to allow seniors to remain at home, with the care and quality of life they deserve.

There's no minimizing this issue; it's a massive undertaking and it's not simple. Gov. Kathy Hochul must lead a comprehensive effort. Determine what works, what doesn't — and what more the state can do. If New York seizes this opportunity to lead, Long Island's hundreds of thousands of seniors who either need help now or will one day soon can benefit.