DiNapoli: NYC Department for the Aging Faces Challenges Meeting Growing Home Care Needs

New York City's Department for the Aging (DFTA) provides home care and case management services to support older New Yorkers in maintaining their independence and remaining engaged in their communities, but is experiencing rising demand for these services. The waitlist for home care continues to expand, while DFTA faces challenges including funding uncertainty, according to a report released today by State Comptroller Thomas P. DiNapoli.

"New York City's older population is growing, and demand for home care and case management is rising rapidly," DiNapoli said. "Current caseloads, expanding waitlists, and the increasing number of older adults show the scale of need. By quantifying it, the city's Department for the Aging can demonstrate how investing in these services helps prevent costly nursing home placements. State and city officials have recognized the department's efforts to address root causes of shortages, including low wages and limited benefits for workers, and clearly documenting this demand can further strengthen support."

DFTA provides a range of services for older adults in New York City including home delivered meals and home care support such as personal care and housekeeping, counseling and a Friendly Visiting program that addresses social isolation and loneliness. For fiscal year (FY) 2026, DFTA's total budget is $618 million, of which 13% is expected to be federally funded.

60+ Population Growing

From FY 2019 to FY 2024, the population age 65 and older and the population age 65 and older with disabilities increased by 17% and 26.2%, respectively. Due to recent federal funding uncertainty, there is a risk that funding for DFTA's critical services could be cut or reduced.

Funding Has Not Kept Pace With Demand for Home Care Services

While DFTA provides an array of services to older New Yorkers, DiNapoli's report focuses on homebound services for which the department provides administration and oversight since all home care services are delivered through contracted community providers. Case management services help older adults with functional impairments gain access to appropriate services, benefits and entitlements needed to age safely at home and maintain their quality of life, including home care.

In FY 2026, planned spending on case management and home care services is expected to be $90.1 million, a 21% increase from $74.6 million in FY 2019. This includes $51.3 million for case management and $38.8 million for home care services. DFTA relies on contract providers to deliver these services.

While total funding for DFTA has grown, home care services have seen the slowest growth of all DFTA's programs since FY 2019. During that time, the number of home care clients and hours served have declined as the waitlist has continued to expand. In FY 2025, there were 3,121 home care clients served, with an additional 356 waitlisted.

Case Complexity Grew

From FY 2019 through FY 2025, the number of DFTA's home care clients dropped by about 20% and has not rebounded to pre-pandemic levels. The hours per client increased 14% in this same period, potentially due to more complex client cases. With fewer clients receiving services, those clients with less severe needs may not be prioritized, and may have less access to services for which they are eligible.

The more complex cases, along with recent cost inflation, have also led to increases in the average cost per client, rising from $8,957 in FY 2019 to approximately $11,700 per year in FY 2025.

Waitlist

The home care waitlist remains a challenge for DFTA, particularly as the older adult population continues to grow. Recently, after action by the City Council, the city now releases this data publicly, but there is little known about those on the waitlist. DiNapoli's report suggests better insight into the composition of the waitlist may help identify individuals who can be diverted from costly nursing homes, which exceeded an annual average cost of $170,000 last year, and highlight the potential for Medicaid cost avoidance made possible by the DFTA home care program.

The growing waitlist occurred at the same time as the agency noted persistent staffing shortages and salary disparities. A June 2025 City Council report showed that the home care waitlist increased 76% since December 2024, reflecting the growing pressure on DFTA's ability to meet home care demand. DFTA also does not advertise its visiting program or conduct outreach to the public, instead requiring its contracted agencies to conduct extensive outreach. DFTA's own staffing limitations may prevent DFTA from reaching some underserved clients, resulting in an expanding waitlist and a significant unmet need for critical services.

The state's Master Plan for Aging recommended providing additional funding to counties to hire more home care workers, helping to reduce waitlists for these services and allocate resources in a more cost- efficient manner before relying on more costly Medicaid-funded programs.

Recommendations

DiNapoli's report recommends that DFTA report every six months on home care staffing levels using data it collects from contracted providers; expand the workforce by partnering with schools to offer students in nursing or other health care-related programs, internships or other opportunities to fulfill clinical requirements or earn academic credits; and implement proposals from the State Master Plan for Aging to improve workforce conditions.

Report
New York City Government Services: Home Care Services

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