Commuting Crisis Disrupts Home Care in Big Apple

More than 100,000 personal attendants and home health aides work in New York City, and they’re facing major obstacles in reaching clients.

The Big Apple’s public transportation system has fallen into decay, with the subway experiencing breakdowns and significant delays, and as a result many workers on their way to see in-home care clients find themselves stuck, according to a recently released report.

While New Yorkers of all stripes are affected by the subway crisis, home care aides are hit especially hard, according to the report and a related New York Times article. The median wage for a home health aide was $11.35 per hour, or $23,600 annually, as of May 2016, according to the Bureau of Labor Statistics. With that salary level, many home health aides rely on public transportation to get to and from work, and can’t rely on alternatives such as taking taxis or ride-sharing services like Uber and Lyft.


The situation is placing at least one home care company in a difficult position, forcing it to manage logistical challenges and bear some transportation-related costs.

Transit trouble

New York City’s subway system carried 5.7 million riders during an average weekday in 2016, and the system has not kept up with the rising number of residents and visitors utilizing it over the years. The delays and disruptions on the subway in New York City have impacted the health care industry the most, according to a report from the Center for an Urban Future.


For in-home care workers, traveling to a patient or client’s home now can take hours. There are approximately 130,000 personal attendants and home health aides in New York City, according to the Paraprofessional Healthcare Institute (PHI). Across the private sector, health care workers face the longest commute times—51.2 minutes on average, the Center for an Urban Future found.

The issue is likely to get worse over time, the Center projects, as the senior population in New York City is expected to outpace the national trend, driving up demand for home health care workers. Over the next two decades, the number of city residents 65 and older is expected to grow 35%, with 96% of them choosing to age in place at home, according to the report.

However, these workers have challenges unique to them that are only compounded by transportation woes.

“They visit patients in their homes—sometimes traveling to two or more clients in a single day,” the report found. “That means the average five-day workweek for a home health aide could involve up to 20 different trips to and from their patients’ homes. Given the cost of owning and maintaining a car—not to mention the challenge of finding convenient parking—all of the home health aides we surveyed for this report rely on public transportation to get them to work.”

Furthermore, this group of workers most frequently doesn’t live in areas that have easy access to public transportation. Many of these workers have to take several transfers and spend hours commuting per day. At the same time, the low wages have meant that a home health aide “must devote a far bigger chunk of her paycheck to her commute than do other health workers,” the report found.

“And if the buses and trains don’t gether to work on time, she’s looking at giving up even more of her earnings to pay for taxis or private cars,” the report authors wrote.

Costs to companies

Some providers are helping caregivers pay for rides to get to clients on time, but that option also takes a financial burden on a company.

For example, Alliance Homecare, a private duty home care provider based in New York City, spent $3,400 in reimbursements to home health aides who resorted to taxis or private ride services to get to work in 2016, according to the report, and 2017 was expected to come with an even higher cost. The provider also attempts to pay caregivers a higher wage, but it doesn’t always provide the ability for workers to live in areas with ready access to public transportation.

“We start our caregivers at $15 an hour and take care of them as well as we can, but that still doesn’t enable them to live in the neighborhoods of the clients they service,” Alliance Homecare CEO Gregory Solometo told Home Health Care News. “We do our best to place them on cases in or near the areas they live but that isn’t always possible. Our clients rely on our ability to be reliable and punctual. We stress to our team the importance of communication when running late. It’s the responsibility of agencies to think about the location of client and caregiver when setting up a new schedule.”

Written by Amy Baxter

Companies featured in this article: