New York City is serving fewer home-care clients even as those who receive care require more hours.
The figures highlight a growing challenge for the city: an aging population is demanding more care while a shortage of caregivers is making that care increasingly difficult and expensive to provide.
A March report from New York State Comptroller Thomas DiNapoli found that the city’s Department for the Aging served 3,121 home-care clients in fiscal 2025, while another 356 people were on the waiting list as of June 2025. The number of clients served had fallen about 20% from fiscal 2019, even as the number of hours of care provided per client increased 14%.
The figures reflect a difficult economic equation. New York City’s population aged 65 and older increased 17% between fiscal 2019 and 2024, while the population of older people with disabilities increased 26.2%. At the same time, staffing shortages and funding constraints have put pressure on the city’s ability to provide home care. Planned fiscal 2026 spending on case management and home-care services is $90.1 million, up 21% from fiscal 2019. Yet the average annual cost per home-care client rose from $8,957 in fiscal 2019 to approximately $11,700 in fiscal 2025.
Alex Moran, CEO of home-care company Roost, says the New York numbers illustrate a problem facing the industry nationally. “New York’s figures show a system serving fewer people while each person needs more hours of care,” Moran said.
“That is the economics of home care across America. Delivery still depends on manual scheduling, heavy administration and high caregiver turnover, so every hour of care costs more to provide, and access ends up rationed through waiting lists.”
Moran argues that addressing the problem will require more than simply recruiting additional caregivers. Technology, he says, needs to reduce the administrative burden surrounding scheduling and compliance, while caregivers need better pay, training and career paths to reduce turnover.
He also argues that Medicaid and other payers should increasingly reward providers for outcomes, including keeping people safely at home and out of hospitals.
The potential financial implications are substantial. The Comptroller notes that nursing-home care can cost more than $170,000 a year on average, making the ability to keep older adults safely at home potentially significant for families as well as public budgets.
Roost is attempting to address part of that challenge through technology, using AI to match caregivers with clients, identify potential risks and streamline operations. The company has begun its U.S. rollout in Cleveland, its first American market, and plans to expand into additional markets across the country.
“Technology must take cost out of coordination, scheduling and compliance so more of every dollar reaches the caregiver and the client,” Moran said.
For New York, however, the immediate problem is already visible: an aging population needs more care, while the system has fewer people available to provide it. The question is whether technology, better workforce economics and changes to the way care is funded can close that gap before waiting lists grow longer.
