As Long Island ages, home care is booming. One alleged unlicensed business highlights dangers to clients and aides.

Friends For Life Homecare bills itself as a mom-and-pop operation that provides friendship to seniors, placing someone in their homes who will tidy up, chat with them and play Scrabble, state records show.

Aides for the Massapequa company say it’s not nearly that idyllic.

They’re asked to work around the clock with clients who are sometimes agitated, they say, hoisting them to and from bed, changing colostomy bags and checking wounds — work requiring strict state oversight and approval that Friends For Life doesn’t have.

The disconnect between the services the company describes and what a Newsday investigation found it offers clients is at the center of a review by the state Department of Health, which alleges the 15-year-old company is operating an unlicensed home health care agency.

This scrutiny of a firm boasting a large reach across Long Island underscores the challenges of regulating a burgeoning home health care industry, and, according to industry and labor advocates, potentially creates a safety risk since the state has no oversight to ensure aides are adequately trained.

After Newsday began inquiring about Friends For Life in late July, the health department in August sued the company  to try to get long-stalled answers about its work. The lawsuit seeks to compel Friends For Life and its owners, Michael Recco and his wife, Amy Recco, to respond to an unanswered subpoena from March that requested business documents, advertisements, client and employee records, contracts and recruitment material.

The health department first suspected the company of operating without a required license in October 2023, but the state inquiry had crawled along until it filed its complaint in Albany County Supreme Court.

Newsday's investigation included speaking with current and former Friends For Life aides, reviewing text messages company officials sent to aides, and reviewing lawsuits against the company filed on behalf of workers and clients.

"It has come to the Department’s attention that you are providing or arranging for home care services and operating a home care agency without the required licensure," a state health official wrote to the Reccos in the October 2023 letter, when it initially sought information about its business, according to an exhibit in the lawsuit.

The letter warned that Friends For Life must "immediately cease" any home care services and notify the state of its plan to transfer clients to a licensed agency. After responding to the state that it was a "companionship" company, Friends For Life has continued operating.

The Department of Health declined to answer Newsday's questions about its investigation, including how many complaints have been filed against Friends For Life and why it took the department more than a year from its first inquiry to issue a subpoena.

"The Department will not comment on pending litigation or matters that are or may be the subject of ongoing review or investigation," Danielle DeSouza, a spokesperson for the Department of Health, said in an emailed statement.

State health officials first wrote to Friends For Life Homecare's owners in 2023 to accuse it of operating an unlicensed home health care agency, and requested more information about their business.

Friends For Life’s responses to the department stated that the company requires no state regulation because it is not a home health care agency, but rather a "non-medical companion agency."

Michael Recco, the president and CEO, twice wrote to the state that his company focused on "light house keeping," "socialization," "companionship," and "read[ing] to client[s]."

Companionship firms do not need licensure by the state health department, and the company says it does not maintain patient records and renders no medical services.

Friends For Life said in separate November 2023 and August 2024 responses to the state that it only had between 15 and 20 clients. It added that its clients are contacted through churches and senior centers, court records show.

The company has offices in Massapequa, Massapequa Park, Babylon and Merrick. On its website, it says it has employed more than 500 caregivers and provided care for "over 10,000 families from Manhattan to Montauk." 

In one response to the state, Friends For Life described itself as offering "non-medical companions" who perform tasks such as "light house keeping" and playing checkers and Scrabble with clients.

A booming industry

Through their lawyers, the Reccos declined to be interviewed for this story. Attorneys representing Friends For Life in the health department lawsuit and a separate suit filed by the U.S. Department of Justice in December 2024 over unpaid wages to aides did not respond to questions about the company.

Those attorneys — Michael Bass, who is defending the state lawsuit, and Jamie Felsen, defending the federal lawsuit — said in an email: "As it is wholly inappropriate to litigate any legal matter in the media, our client refuses to do so. We look forward to a swift and just resolution in the arena where these matters are properly heard, in a court of law." 

New York's home health licensing process requires a $2,000 application fee, a certificate of need and a roughly two-year approval process that ensures a company has enough capital, the owners pass a character and competency review and that health care protocols are up to standard to ensure patient safety. 

Typically, customers must pay out of pocket for licensed home care, although some services may be covered by private insurance. Most plans don't cover non-medical companionship services, requiring clients to pay for it with their own funds.

Despite the stringent state requirements, the home health aide sector has boomed in New York in recent years, driven by the aging population and state and federal policies that incentivize people to receive care at home rather than at more expensive institutions. Home health and personal care aides accounted for the top job category in New York last year, according to the most recent estimates by the Bureau of Labor Statistics, with an estimated 623,000 aides working in home health and personal care as of May 2024, a 40% increase from five years prior.

There are nearly 500 licensed home care agencies serving Long Island, according to the health department.

This rapid growth also lends itself to potential for fraud in the industry, according to Bill Hammond, a senior health policy fellow at the Empire Center, a think tank based in Albany.

He said the state’s controls on the home health aide industry are "obviously not adequate to the job.

"The department itself has kind of raised an alarm about how fast it’s growing. It has raised an alarm about the possibility of fraud and it gets a complaint like this [Friends For Life] and doesn't get around to following up on it for years," Hammond said in an interview, suggesting a systematic review of the industry.

State health officials declined to answer questions about their regulation of the industry.

A pattern of home health work

Interviews with four current and former Friends For Life aides and the review of lawsuits filed on behalf of former clients cast doubt on company statements that it does not provide home health or medical services. The aides themselves say they have the required certifications and training to perform home health aide duties, but were unaware that Friends For Life didn't have state approval to oversee that kind of work. 

At least one of them was identified by the company in payroll records as a "non-medical companion."

The four women, who did not want to be named for fear of losing their jobs and facing retaliation, said they routinely helped transfer clients from beds and chairs, helped clients go to the bathroom, bathed them and helped administer medication, activities within the scope of a home health aide.

"We had to do bed transfers, chair transfers," a 62-year-old former Friends For Life worker, who said she has been a registered home health aide for roughly 16 years, told Newsday. "We do everything."

Another aide, who has worked "on and off" at Friends for Life for years, said her work runs the gamut.

"Lifting, bathing," the 61-year-old said. "That’s grooming. You show up, clean and you have to do all of that. "

Some of the women also described work that went beyond even what a certified home health aide is allowed to do, including medical-level duties such as dressing certain kinds of wounds, or doing physical therapy.

The 62-year-old aide said she cried the first time she was asked to change a client’s colostomy bag, something a companionship company isn't allowed to do. 

"We’re not supposed to do a job like that," she said in a phone interview. The aide recalled calling Friends For Life and was told that she would not get additional placements with clients if she couldn’t handle the colostomy bag change.

When told by Newsday that Friends For Life says it’s not a home health care agency, but rather a companionship company, the aide called them "a bunch of liars."

'Crosses the line'

Al Cardillo, the president and CEO of the Home Care Association of New York State, a nonprofit trade group representing home health care agencies, said: "It’s greatly concerning if there’s an organization that’s actually operating in a manner that’s intended to be licensed and formally regulated.

"The No. 1 goal of licensure or certification is the protection of the public and the abidance of a uniform standard of care," Cardillo said in an interview.

He added that there’s a firm line between companionship and the work of a home health aide. The state spells out the scope of those tasks that are and aren’t permissible by home health aides.

"When you start to provide what would be anything hands on for an individual — you know, you’re helping them bathe, you’re helping them wash, get in and out of bed, assisting on and off the toilet, anything of that nature it crosses the line," Cardillo said.

Norma Recco, Michael Recco's mother, ran her own home health care agency in the 1970s and helped cofound an industry trade group now known as the New York State Association of Health Care Providers.

Kevin Thomas, the group's current president, said the allegations lodged by the state against Friends For Life "is the kind of situation that we dread."

"There needs to be more inspections; there needs to be more enforcement," said Thomas, a former Democratic state senator from Levittown, in an interview.

Lawsuits over care

Screenshots of text messages sent from a Friends For Life employee to a 59-year-old aide who worked for the company for three years describe assignments such as bathing, transfers and medication reminders.

One client, a 72-year-old woman with Parkinson's disease, was described as a fall risk and the aide was encouraged to do physical therapy exercises with her.

Another assignment for an 87-year-old with dementia noted that she needed help with showers and dressing herself, the text messages show.

Lawsuit complaints filed against Friends For Life, on behalf of former clients allegedly injured while under an aide's care, are written with the assumption that it is a home health care company. They make no mention of the licensure allegations against the company.

The daughter of a woman sued the company in July, alleging her mother was injured during a transfer from a chair to her bed, fracturing her femur while in the care of a Friends For Life aide "employed as a nurses’ aide and/or home health aide."

Another suit filed in June 2024 by the estate of a former Friends For Life client states that the company "held itself out to the general public and plaintiff in particular as a capable and competent provider of home care services" and that an injury sustained while in the care of Friends For Life allegedly resulted in her wrongful death, days later.

Efforts to reach the plaintiffs in the cases, which are ongoing, were unsuccessful.

Another lawsuit filed in September 2021 by a former Friends For Life aide alleges that she was paid subminimum wages and did not receive overtime pay. It also says that the company "owns and operates a home health care service, placing home health and personal care aides at the homes of patients in the New York City metropolitan area."

The aide received a $70,000 settlement two years later. She declined to be interviewed for this story.

Contractors or employees?

Friends For Life is also facing a separate lawsuit from the U.S. Department of Labor for allegedly misclassifying aides as independent contractors to avoid paying overtime and record-keeping requirements.

The Department of Labor, under then-President Joe Biden, sued Friends For Life in December 2024, claiming that the company improperly classified workers as independent contractors, a designation that allows workers to set their own pay rates and hours without the supervision and control of an employer. The lawsuit — which asks for unpaid overtime wages and damages — lists more than 200 known Friends For Life aides who could be owed compensation for unpaid overtime, along with additional employees who hadn’t been identified yet.

In September, Friends For Life and the Department of Labor said they reached the framework for a settlement, but discussions over the specifics had stalled due to the government shutdown. The Department of Labor did not respond to requests for comment.

The aides Newsday spoke with said they had to sign paperwork claiming they were contractors for the company, despite not being able to set their hours of work or rate of pay. They say they’re now saddled with paying thousands of dollars in taxes because they were not automatically deducted from their paychecks.

An employment verification letter from Friends For Life's payroll department to one of the aides, viewed by Newsday, states she is an independent contractor and, despite her personal certification to perform home health care duties, "works as a non-medical companion. Her schedule and salary vary upon case and availability."

In New York, home health care companies are legally only required to pay for 13 hours of work on a 24-hour shift as long as aides have eight hours of rest, including five hours of uninterrupted sleep, and three hourlong meal breaks. In New York City, Long Island and Westchester, the minimum wage for a home health aide is $19.10 an hour, which is slated to increase to $19.65 in January.

The aides detailed how they were paid a fixed rate ranging from $120 to $170 a day for 24-hour shifts spanning from a few days to upward of three weeks, and didn't receive overtime pay during visits where they did not get the required five hours of uninterrupted sleep or breaks.

Friends For Life denies that the aides were misclassified as independent contractors, according to court records.

'Desperate for a job'

A 63-year-old aide who worked with Friends For Life this past spring said she was "desperate for a job" so she took on a client who had recently broken her hip and needed help getting around her home. The client told her she was paying $380 a day for the services, but the aide said she only received $160 a day for working around the clock for two weeks, putting her final pay at $2,240 for the two-week stay.

Under state requirements, if the aide had been earning the minimum wage of $19.10 an hour for 13 hours of work for two weeks, she would have been entitled to $3,476 hours of pay. 

Friends For Life, the woman said, worked her for "24-hour shifts. Night and day."

"I do everything for her, up and down," the woman said of the client, describing sleeping in a lounge chair and crying because she couldn’t get any rest.

Rona Shapiro, the executive vice president of 1199SEIU, the union that represents thousands of home health care workers, said the "alleged wage theft and misclassification hurts caregivers — and it also hurts the vulnerable New Yorkers who depend on them to continue living independently in their own homes." 

Cardillo, the trade group CEO, urges people looking for a home health care company to call the facility and ask if they’re licensed by the state, or certified by the state and federal government to operate in the area.

The State Department of Health also has a website where prospective clients can view legally approved home health care companies.