Four years ago, the City Council considered legislation to limit how many hours a home care aide could work and ban shifts longer than 12 hours. Supporters made a compelling case. But people with disabilities, home care workers, and state legislators warned that because home care is funded through Medicaid, the bill would restrict access to care and cost workers their jobs. The Council did not pass it.
Now, the proposal is back — moving forward with little meaningful input from the people most affected: older adults and people with disabilities. The Council is expected to vote on the bill on April 8.
The legislation would ban “live-in shifts,” or 24-hour shifts. In theory, workers receive eight hours of sleep and three one-hour breaks and are paid for 13 hours. Eliminating these shifts may sound like progress — and they can be exploitative — but the reality is more complicated.
The bill contains a fundamental flaw that could leave people without care and workers without jobs.
For more than a decade I relied on 24-hour live-in home care. I had two aides covering the week. After breaking my neck at 15, I was left with very limited mobility. Many nights I needed help repositioning or using the bathroom. These workers made the difference between living at home and being placed in a nursing facility.
Even knowing the system wasn’t fair, I accepted it — because the alternative was institutionalization. I would make the same choice again.
Today, I receive care through 12-hour split shifts and advocate for better wages and protections for workers. I support paying aides for every hour they work. But this bill will not achieve that goal.
Home care in New York City is governed by Medicaid, and managed care plans decide how many hours a person receives. A city law cannot force those plans to authorize more care. Instead, plans may authorize care that cannot be delivered under the new rules and keep the difference.
Home care agencies, meanwhile, cannot assign unauthorized hours or bill for unapproved services without risking Medicaid fraud.
The result: people who rely on live-in care could lose workers — and those workers could lose their jobs.
What is intended as a workers’ rights law could become a windfall for managed care companies—and a disaster for older adults, people with disabilities, and the home care workforce.
We’ve seen these structural problems before. They stopped this bill in the past. But this time, the voices of those most affected are being sidelined.
At a Feb.18 hearing, no one from the disability community was directly invited to testify. Since then, outreach to Council members has too often been met with silence.
In our community, we say: “Nothing about us without us.” Yet this process feels like the opposite.
The 24-hour shift system has roots in inequity, when both disabled people and the workers who cared for them — often Black women — were undervalued. That legacy continues today.
But we cannot fix one injustice by creating another. We cannot pit workers against the people they care for.
Real reform requires collaboration among consumers, workers, advocates, unions, and lawmakers — and it must happen at the state level, where Medicaid policy is set.
We all deserve a system that provides high-quality care, respects workers, and allows people with disabilities to live with dignity in their communities. This bill, as written, does not get us there.
Hernandez is the advocacy and policy associate at the New York Association on Independent Living (NYAIL).