Opinion: Aging in Place Shouldn’t Cost Everything You’ve Worked For

“Thousands of middle-income older adults are caught in between—too poor to pay privately [for home care], too ‘wealthy’ to qualify for help. Now, New York has a chance to fix part of that gap.”

Every day at Encore Community Services in Midtown Manhattan, I meet older New Yorkers who worked their whole lives and now face an impossible choice. They can drain their savings to pay for home care, or try to live without the help they need to stay safe at home.

Medicaid, the public insurance program for people with very low incomes, will pay for long-term home care. But Medicare, which nearly all older adults rely on after 65, will not. In New York, thousands of middle-income older adults are caught in between—too poor to pay privately, too “wealthy” to qualify for help.

Now, New York has a chance to fix part of that gap. New York State Senate Bill S7077, which passed the Legislature this year and awaits Gov. Kathy Hochul’s signature, would remove the client fees for the state’s Expanded In-Home Services for the Elderly Program, or EISEP.

The program provides home care for people who don’t qualify for Medicaid. If signed, the bill would make those services free for thousands of older adults who currently pay out of pocket. This would only cover 20 hours of home care per week. But for many of my clients, that difference would decide whether they can stay home or not. 

Last month, I visited an elderly former nursing home worker for an assessment. She lives alone and suffers from several chronic illnesses that make it nearly impossible to manage basic daily tasks like cleaning, laundry, or shopping. Some days, the pain is so severe she can’t get out of bed.

She earns just above the Medicaid income limit, so she doesn’t qualify for assistance, and the cost of private home care is far beyond reach. When we calculated her fee for New York’s EISEP home-care program, it came to more than $1,200 a month—a full third of her income. Her response was immediate: “I can’t afford that.” 

Other clients try what’s called a Medicaid Spend Down. It requires them to pay down their “extra” income each month just to qualify for services—a constant financial drain. Some turn to Pooled Income Trusts, legal arrangements that let them deposit excess income to meet Medicaid rules while using the money for certain expenses. But these trusts are complicated, often require a lawyer, and make it harder for people to access their own funds. With no truly affordable option, too many older adults keep struggling to care for themselves in pain and isolation.

Ending monthly EISEP fees won’t solve everything, but it will finally give these New Yorkers a little breathing room. It says clearly that home care isn’t a luxury; it’s basic support for living with dignity. When people can afford consistent help, they avoid falls, stay healthier, and often delay or prevent nursing-home placement by keeping them in their community. That saves families stress—and it saves taxpayers money.

Recent reporting in The New York Times showed how Medicaid can even come after a person’s home after they die to recover care costs—a policy that’s stripped tens of thousands of families of modest inheritances. It’s another way the current system punishes aging and perpetuates inequality, especially for families who have little wealth to begin with.

But the deeper problem is national. Medicare, the program that covers nearly every older American in need of this support, still excludes long-term home care. Unless someone has just left the hospital and needs short-term skilled nursing, Medicare won’t pay for an aide to help with bathing, cooking, or taking medication. Those are the very supports that keep people stable and independent in their own homes.

Because of that gap, families scramble to fill the void. Adult children cut work hours or quit jobs to care for aging parents. Hospitals see more preventable readmissions. Nursing homes fill with people who could have remained at home if a few hours of weekly help were covered. The policy is outdated, and it’s costing us all more in the long run.

We’ve modernized Medicare before—adding prescription coverage, preventive screenings, even telehealth during the pandemic. Expanding it to include home care is the next logical step. It would cost money, yes, but we already spend billions cleaning up the consequences of not doing so. A modest home-care benefit would be both compassionate and cost-effective.

At Encore, I see the difference every day when care works. A client regains strength after a fall. A widow cooks her own meal again. A man stays in the apartment he’s called home for 40 years. These small victories are what dignity looks like.

Gov. Hochul should sign S7077 and make New York a model for the nation. Then, Congress should follow that lead and bring Medicare into the modern age. Aging in place shouldn’t depend on your income or your ZIP code. It should be a right we guarantee to every older adult. 

Matthew Welch is a financial caseworker at Encore Community Services, a non-profit organization in New York City that provides services for older adults. His work empowers older adults to live financially independent and healthy lives.