The New York City shared aide program (cluster care): a model for the future

In order to combat rapidly escalating home health care costs, New York City and State have inaugurated a "shared aide" program in which home attendant "teams," as opposed to individual aides, serve large groups of elderly clients who live in close proximity (e.g., at senior housing sites), thus reducing the aide-to-client ratio. Using New York City as a model, this paper examines the premises underlying the shared aide concept--the program's objectives, methodology, advantages/disadvantages to home care workers and clients, and, most importantly, its potential, if implemented nationwide, for cost containment and a corresponding substantial reduction in the Medicaid budget.