Private equity ownership results in poor working conditions in NYS home care

Private equity firms in New York state promise their investments in home care agencies will improve the industry.

But in reality, they perpetuate poor working conditions for workers by continuing the exploitation that is prevalent across the industry, from low wages and wage theft to managerial negligence and unsustainable work hours, according to a new study from the Worker Institute at the ILR School.

The findings have significant implications for New York, as private equity firms gained control of half of the state's home care in 2025, according to a related Worker Institute report released in June, the co-authors said.

"They're taking advantage of an industry where the workforce, predominantly women of color, is devalued, poor working conditions are the norm and regulation and oversight are weak," said Zoë West, worker rights and equity associate at the Worker Institute and co-author of the study.

The report, "Private Equity's Impact on Home Care Workers and Patients in New York State," examines the working conditions of home care workers at five agencies in New York owned by private equity firms and the implications of the private equity's management practices on workers' job quality, well-being and ability to provide quality care.

In addition to continued worker exploitation, the report finds that private equity owners, who buy up small agencies and consolidate them into larger chains, increase the use of technology and automation in ways that depersonalize communication between workers and clients. This exacerbates existing problems of managerial neglect, including a lack of communication, coordination and responsiveness to workers when they have serious problems serving clients in their homes.

Finally, the research found that other financial actors - including venture capital firms and managed care organizations - drive down labor standards and extract profits in New York's Medicaid home-care system.

"The provision of home care is an essential public service for aging individuals and people with disabilities, and it is predominantly paid for with publicly financed taxpayer dollars," said Anne Marie Brady, senior extension associate, worker rights and equity, in the Worker Institute and co-author of the report. "The fact that, over time, federal and state policies have been designed in such a way as to allow private 'financialized' actors, like private equity firms, to provide this essential public service for financial gain through profit-seeking shareholders is an irresponsible use of precious public dollars."

The report lays out a series of recommendations to address the problems, including:

• Enact and fully fund a living wage for home care workers;
• Convene a state task force to establish sustainable benefits and working hours for home care workers;
• Protect workers' rights to organize and unionize;
• Strengthen support and safety for home care workers;
• Require agencies to provide in-person training at regular intervals:
• Enforce existing laws and regulations, while demanding transparency and accountability;
• Foster the development of mission-driven and nonprofit home care agencies;
• Curb the extraction of public dollars for private profits; and
• Make home care funding more equitable.

The report is part of a broader research project, supported by a grant from the Robert Wood Johnson Foundation, exploring privatization and structural racism in home care.

The first report in the series, Private Equity Pathways into Home Care: The Case of New York State, published in June, found that:

• Private equity firms spent nearly $70 billion on home care acquisitions in New York since 2020, driven by high demand for home-based care, increased access to debt and opportunities to acquire market power through consolidation;
• New York private equity-backed home care agencies received $2.32 billion in Medicaid revenue in 2022; this will rise sharply in 2026 after private equity gained control of half of the state's home care in 2025; and
• Private equity ownership drives instability through frequent ownership changes and leadership churn, with private equity home care agencies in New York changing ownership every five years on average.

"Financial actors shouldn't be reaping private profits from public dollars," West said. "Home care should be treated like the essential, professional work that it is. That requires lifting standards, directing enough public funding to make those standards real and enforced, and protecting home-care workers' right to voice and representation at work.

"Lifting standards and strengthening oversight in this way also helps to curb the ability of financial actors, such as private equity investors, to profit at the expense of workers."

Julie Greco is the communications director for the School of Industrial and Labor Relations.