The business of caring for older Americans is in a deepening crisis
*Washington Post
December 7, 2025
By Shannon Najmabadi
Workforce Crisis and Economic Pressures
- Soaring Demand vs. Labor Shortage: Home health and personal care openings are projected to increase by 17% between 2024 and 2034. However, the industry struggles to recruit due to low wages (median salary $34,900 or $16.78/hour) and the intense nature of the work.
- Wage Competition: Providers are losing staff to retail and restaurant sectors that offer better compensation. The Home Care Alliance of Massachusetts noted a significant workforce migration when the state introduced a $15 minimum wage.
- Rising Costs: Spending on at-home elder care surged 7% from August to September 2025 alone. Year-over-year, home health costs rose 12%, significantly outpacing the 3% general inflation rate and the 4% rise in nursing home costs.
Impact of Federal Policy and Funding
- Medicare Cuts: The federal government finalized a 1.3% ($220 million) cut to Medicare funding for home health agencies for 2026. This marks the fourth consecutive year of cuts.
- Medicaid Uncertainty: Experts fear that Medicaid changes included in the recently signed domestic policy bill will pressure states to cut home care spending, similar to trends seen between 2010 and 2012.
- Medicare Advantage: Providers note that Medicare Advantage plans often reimburse at rates lower than the actual cost of providing care, contributing to financial instability.
The Role of Immigration
- Reliance on Foreign-Born Labor: Immigrants accounted for roughly 1 in 3 home care workers in 2023. In Massachusetts specifically, Tribute Home Care reports that immigrants make up 90% of their workforce.
- Policy Restrictions: The Trump administration has lowered refugee admissions and moved to end Temporary Protected Status (TPS) and work authorizations for immigrants from countries like Haiti and Venezuela.
- “Chilling Effects”: A 2025 study by researchers at the University of Pittsburgh and UPenn found that increased immigration enforcement (specifically the Secure Communities policy) shrank the home care workforce by 7.5% between 2008 and 2013, reducing access to care for older adults by 5%.
- Provider Impact: Organizations like Goodwin Living and Tribute Home Care report losing vetted, employed caregivers due to changes in legal status, disrupting patient continuity of care.
Provider Closures and Access Issues
- Agency Contraction: Half of U.S. counties lost at least one home health agency between 2020 and 2024.
- Rural Disparities: Closures disproportionately affect rural areas where nurses spend significant time driving between patients. Enhabit Home Health and Hospice closed eight locations this year due to financial pressures and labor shortages.
Impact on Families: The number of family caregivers has jumped 45% in the last decade to 63 million. Due to a lack of home care options, some seniors are forced to move into more expensive assisted-living facilities earlier than necessary.