Testimony of the Hartford Institute for Geriatric Nursing (HIGN) before The New York City Council Committee on Aging and The New York City Council Committee on Mental Health, Disabilities and Addiction | April 8, 2019

Good Morning Chairperson Ayala, Chairperson Chin and all Council Members present. My name is Dr. Tara A. Cortes and I am Executive Director for The Hartford Institute for Geriatric Nursing (HIGN), the geriatric arm of the New York University (NYU) Rory Meyers College of Nursing. Thank you for the opportunity to testify today andshare myexpertise on the topic of home health aide services.

From 2015 to 2050, the U.S. population over age 65 will double, and the population over age 85 will triple. New York City demographics will be largely consistent with these national figures. Direct care givers—nursing assistants, home health aides, personal care attendants—will be essential to keeping people living in place at home or living comfortably in assisted-living or long-term care. The number of direct care givers must increase to meet this demand in cities across the country, and New York City should beno exception.

Turnover rates in the geriatric nursing field are high due to job dissatisfaction and burnout. To combat this trend, it is imperative that we provide better training, certification,and career advancement opportunities to prospective direct care givers. To meet all levels of care that willbe needed over the next decades, the geriatric nursing community must develop the skills of direct care givers across the continuum—from personal attendants to advanced care givers. These efforts will help to ensure better outcomes, improved patient experiences and cost-effective care.

Support for workforce development is essential. The Hartford Institute is working with the Archcare Workforce Improvement Organization, funded by New York State Department of Health, to provide home health aides with the knowledge they need to feel confident in their jobs. For example, many aides leave their jobs because they cannot deal with aggressive behaviors which are often part of the disease stages in peoplewith dementia. We teach home health aides to understand the behaviors and provide approaches to managing them. Continued support for this kind of workforce development is criticaland further partnership and support from New York City’s leaders is important in addressing the turnover rates for home health aides.

At HIGN we are keenly aware of the significant contributions the immigrant community makes to the home health aide services field. 1 of 4 direct caregivers in New York City is an immigrant. This community is a vital component of our workforce, and provides culturally and linguistically sensitive care to a multicultural aging population. Definitions of “skill” and “merit” in visa applications shouldbe expanded to include all members of the health care team, specifically direct care givers—HIGN would support any effortsto achievethese expansions.

In addition to these policy changes, encouraging further involvement of the New York City immigrant community in geriatric care will be critical given our ever-diversifying and aging city population. We would be interested in partnering with the city to support ongoing training in cultural competence, including bias concerns, to enhance communication and care amongst teams providing healthcare to older adults.

Since its start in 1996, the singular mission of the HIGN has been to shape the quality of health care of older adults. Today’s health care landscape offers exciting and unique opportunities for HIGN to leverage health care reform to positively affect the quality of care of the aging population. We are here today to welcome the opportunity to partner with the City Council and lend our expertise in this field.

Thank you for the opportunity to testify, and we would be happy to answer any additional questions the Committees may have. (Please contact Konstantine Tettonis, NYU Government Affairs, kt1249@nyu.edu)