Home care workers at five private-equity-owned New York agencies described low pay, unpaid work, unstable hours and difficulty reaching managers when clients needed help, according to a new Cornell University study. The interviews included workers in the Buffalo-Rochester region, tying the findings to a part of the state that serves Finger Lakes families.
The Worker Institute report, released through Cornell's ILR School, examines workers' experiences at agencies in New York City and western New York. Its authors say private equity ownership often perpetuated existing problems in home care and, in some cases, added technology that made it harder for workers to communicate with staff or match clients with appropriate help. The study is based on interviews, not a statewide measurement of every agency or a direct test of patient outcomes.
What workers told researchers
Researchers conducted 40 interviews: 25 with home care workers and 15 with other people familiar with the industry, including union representatives, researchers, government officials and a private equity consultant. Ten of the workers were based in the Buffalo-Rochester region and 15 in the New York City area. They worked at five private-equity-owned agencies; the report does not identify their names or give a separate Rochester-area breakdown.
Workers in the study reported earning $17.50 to $22 an hour, typically $18 to $19, during a study period the report identifies as April 2025 through March 2026. Many described few or uncertain benefits and shifts that varied with client demand. Most said they struggled to secure more than 20 or 25 hours a week at an agency. Short shifts and unpaid travel between clients made it difficult for some to piece together a stable income.
Some said they stayed beyond scheduled hours to help clients but were not paid for that time. Others described payroll errors, missing promised supplements or having to buy their own supplies. In one account, a worker said she paid for a wheelchair-accessible cab to get a client home after a laundry trip ran over the scheduled shift; the agency did not reimburse her. These are workers' accounts presented by the researchers, not findings that a court or labor agency ruled against all five employers.
The report also describes workers arriving at clients' homes without accurate information about medical needs or language. Some said they could not reach supervisors promptly when a client's condition changed or a task required qualifications they did not have. Workers also described management failing to respond adequately to complaints about harassment or unsafe conditions in clients' homes.
“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 report co-author Zoë West, a worker rights and equity associate at the Worker Institute, in a Cornell Chronicle summary.
Automation and the limits of the evidence
Workers at three agencies reported more technology and less direct contact with agency staff after private equity acquisitions. Scheduling apps could match shifts by availability and location without adequately accounting for a client's care needs or an aide's skills, the researchers found. Workers said phone contact with schedulers and payroll staff became harder, while problems with electronic visit-verification apps sometimes affected logged hours and pay.
At three agencies, workers said in-person training was replaced with online modules after acquisition. The change reduced opportunities to practice and ask questions together and, for isolated workers, another point of contact with the agency. The report says technology need not be harmful on its own: an app could aid scheduling if managers still consider worker skills, client needs and preferences and remain reachable.
The researchers also heard from some workers whose agencies had a legitimate labor union. Those workers reported stronger benefits, including paid time off, health coverage and retirement contributions, than many workers at the other agencies. The study did not establish that private equity ownership alone caused every poor condition it documented; low wages, uncertain hours and weak oversight were already common across the home care industry.
The sample was recruited partly through targeted social media advertising and worker organizations, rather than random selection. Only about one-third of the workers had experience at their agency both before and after its acquisition, limiting direct before-and-after comparisons. The interviews illuminate specific experiences at five agencies but cannot show how frequently those experiences occur across New York or how care recipients fare overall.
The report focuses on the agency model of Medicaid home care, in which an agency assigns an aide to a client. That differs from the consumer-directed program, in which care recipients choose and train their caregivers. An earlier Cornell report found private-equity-backed agencies received at least 7.6% of Medicaid home care revenue reported by providers in 2022, an undercount because some agency data were missing. The authors said private equity's role expanded substantially in 2025 when a private-equity-owned company became the single statewide fiscal intermediary for the separate consumer-directed program, which accounted for more than half of personal care services that year. That administrative role should not be confused with ownership of half of all provider agencies.
What the report recommends
The Cornell team calls for a living wage backed by adequate Medicaid reimbursement, guaranteed or more predictable hours, benefits, stronger enforcement of labor rules and protections for organizing. It also recommends regular in-person training, better safety screening for new client assignments, more responsive supervision and greater transparency about how public money moves through home care.
The authors want the state to support nonprofit and worker-owned agencies and curb financial practices that take money out of Medicaid-funded care. They also recommend reconsidering the role of managed care organizations, saying some plans' payment rates and limits on authorized care hours can put pressure on both providers and workers. Those are the researchers' policy proposals, not changes New York has enacted.
The project was supported by the Robert Wood Johnson Foundation. The report's co-authors are Anne Marie Brady, Zoë West, Sanjay Pinto, Robyn Rowe and Michael Lenmark. As New York's population ages, the authors argue that the quality of workers' jobs and their ability to get help on a client's behalf are part of the same question: whether publicly financed home care can reliably meet residents' needs.
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