Letter from the Editor #32
An Oldster podcast is coming this fall...Why is it so hard to get home health care aides covered by Medicare and Medicaid?...
Readers,
I’m excited to tell you that plans have just been put into place for an Oldster podcast, to be launched in the fall, sponsored by investor, activist, philanthropist, and veteran broadcast journalist Ruth Ann Harnisch.
I’ll be the host, and my multitalented husband, Brian Macaluso—a podcast junkie and an audio engineer with impressive creds on his resume like WNYC Radio and Electric Lady Studios—will serve as senior producer. He’ll also take over production duties for Oldster’s live events from me. (I’ve got an Oldster anthology to produce! And two daily publications to put out!)
In a very Oldster turn of events, after years of fixing people’s computers (who in the Kingston area remembers his wonderful Tech Smiths, where in the front room I ran an art gallery called The Anvil?) and serving as assorted companies’ I.T. guy (he switched primary fields a few decades ago when the recording industry tanked), Brian is getting to return to his dream area of work—at 64.
This summer Brian will focus on planning and pre-production. We have a pretty good idea of how we’ll format the podcast, but we’re always checking out good examples, and looking for others, so...
Got any favorite podcasts you’d recommend we listen to?
Also, if possible we’d love to land on a major platform like Lemonada, Higher Ground, Slate, Rabbit Grin, or some other one I haven’t yet heard of. If you work at one of those and can help, or if you are a podcasting agent or have one to recommend, please get at me. Thank you!
We hope to take the podcast live in late September or early October. It’ll be a great way for us to celebrate Oldster’s forthcoming fifth birthday.
Speaking of which, I’ve postponed the August 7th Joe’s Pub event for some date as-yet-to-be-determined, likely in the fall or winter. So many of the performers I tapped to take part were going to be on vacation in early August and asked to be included in future events instead. I figure much of the audience might be away then, too, so best to find another time.
Stay tuned for more on a new Joe’s Pub, and the podcast…
Check out the rest of this series here. P.S. Typos happen. Please forgive me if you find any!
“What you are doing with this publication is awesome!” - Abby Alten Schwartz, paid subscriber.
Why is it so hard to get home health care aides covered by Medicare and Medicaid?
First the good news: My mom is doing really well now. She has just about fully recovered from her early May illness. Thanks again to everyone who sent good wishes.
Now the bad news: After my mom was released from the hospital, the Visiting Nurse Association sent someone to take my mom’s vitals and to evaluate her for any additional care she might need. That led to helpful visits by a physical therapist and an occupational therapist.
At the end of the nurse’s first visit, she told us she was recommending that Medicare provide my mother with a home health care aide for three hours a day, five days a week, for two weeks. That sounded helpful, especially given that I’d be going home soon, and would no longer there to help my mom out with cooking, cleaning, shopping, showering, dressing, and other tasks she was unable to fully manage while recovering.
But then the nurse added this devastating line, “You need these services. But I’ll tell you right now that they most likely won’t give them to you.”
She cited a drastic shortage of home health care aides in the system, and cuts to Medicare and Medicaid as factors. “I have an older patient right now with a broken back who can’t get a home health care aide, even though I’ve recommended it a number of times,” she said, “so you most likely won’t get it, either.”
At the end of the nurse’s first visit, she told us she was recommending that Medicare provide my mother with a home health care aide for three hours a day, five days a week, for two weeks. But then she added this devastating line, “You need these services. But I’ll tell you right now that they most likely won’t give them to you.”
This cognitive dissonance is something she said she faces every day. We decided to hire someone on our own for two weeks, someone who’d helped my mom after a surgery several years ago. Fortunately we were able to afford this for a short period of time. But many people cannot.
I did a little research and learned that this issue is something elders have been dealing with for years, and that it’s only getting worse.
“Almost three quarters—74 percent—of New Yorkers needing home health aides were unable to retain a worker in 2021, according to a report by the Consumer Directed Personal Assistance Association of New York State (CDPAANYS),” wrote Gail Robinson in a 2022 article for City Limits. “The shortage forces many older and disabled people to go without the care they need, or remain in hospitals and nursing homes.”
Robinson goes on to identify low wages for home health aides as the primary problem. A more current piece, a March, 2026 article by Grace Segers in The New Republic echoes that.
“Despite the importance of home health care for older and disabled Americans, these workers typically earn lower wages, a trend exacerbating difficulties in hiring for these positions,” Segers writes. “In 2024, the median pay for home health and personal care aides was only $16.78 per hour.”
Another factor she points to is changes to immigration policy:
“Immigration policy will also affect the home care labor force, as immigrants comprise one in three workers in the home care setting. Historical data has shown that previous crackdowns on immigration have led to a reduction in home health care workers.”
In my research I learned about New York State Home Care Crisis Campaign, which is collecting data on this subject: “If you are a NYS resident who has had problems finding home care or a family caregiver who has not been able to hire a home health aide or personal care assistant for a loved one, please share your story.” If you want to share your own story with them, you can find the form for that here.
You’re also invited to tell your story—of difficulty getting home health aides covered for yourself or your loved ones—here.
That’s all for today. Thanks as always for reading, and for all your support. 🙏💝
-Sari
OMG, congratulations and yay for podcast and also...this topic is seriously the story of my caregiving role for the last four years. I have, unfortunately, become something of an expert. In all states this is a brutal situation. In New York State this became even more complicated after Gov Hochul chose a company in Georgia to manage the bureaucracy of Medicaid, which requires that the patient has limited resources. Medicare is also a beast. You can't get a home health aid unless the person has had a hospital stay and is considered to be recovering at home. Lucky families can hire a consultant to advise them...but most families cannot do this and many aides don't want to be paid this way. It is so bad that people who worked hard cannot get support easily when they reach old age. I cannot count the hours I have spent on phone calls trying to wrangle all this.
Good news/ bad news. It’s why President Truman called for a one-handed economic advisor. It was always, on the one hand or the other.
At least we finally know why you married Brian.
Fantastic news about the podcast but please keep the writing flowing.
Great news about your Mom’s recovery. Her outfit and her smile says it all. Love the shoes.
The life and plights of home health aides is another long story. Everyone suffers. Aides, patients and families.
Does Donald give a shit? There’s no ambiguity in that.