The United States is barreling toward a home healthcare crisis. Over the next decade, the country will need to fill 9.3 million job openings in the direct care sector. That includes home health aides, nursing assistants, and personal care aides — the people who help our elderly parents and grandparents get dressed, eat, bathe, and stay safe at home.
America is aging fast
The reason is simple: the U.S. population is getting older, and fast. By 2060, the number of people aged 85 and over is expected to triple, hitting 19 million. At the same time, the number of working-age adults is staying mostly flat. That means fewer people will be around to provide care, just as more Americans need it.
Yet while demand is skyrocketing, the supply of workers is already strained. Turnover in the home care field is sky-high — nearly 80% a year — and wages remain painfully low. In 2022, the median hourly wage for home care workers was just $14.50, according to Direct Care Workers in the United States: Key Facts. Annual earnings averaged around $20,600.
And across all direct care occupations, the numbers aren’t much better. The median wage for direct care workers in 2023 was just $16.72 per hour. As a result, 37% of the workforce lives in or near poverty, and nearly half, 49%, rely on public assistance programs to get by.
“This is poverty work,” said Arnulfo De La Cruz, president of SEIU Local 2015, which represents over 500,000 long-term care workers in California. “It’s done primarily by women at rates that are a tiny bit above minimum wage.”
Immigrants are holding up the system
Immigrants make up a huge portion of the direct care workforce. About a third of home care workers are immigrants, and many are employed through Medicaid-funded consumer-direction programs or hired privately in the so-called “gray market.”
But recent immigration policies under the Trump administration are putting those jobs at risk. Work permits are being revoked, humanitarian parole programs have been cut, and Temporary Protected Status (TPS) is being rolled back for hundreds of thousands of workers from Venezuela, Haiti, Cuba, and Nicaragua.
“Without them, people will have trouble finding care and will be forced to go without care,” said Jennie Murray, president of the National Immigration Forum.
De La Cruz added, “If there is no one to provide care, people will get sicker. They will have to turn to emergency rooms and hospitals.”
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Hard work, low pay, and little support
Home care jobs are physically and emotionally demanding. Workers often juggle part-time schedules, unpaid caregiving for their own families, and still don’t earn enough to make ends meet. About 43% of home care workers are part-time, and nearly 40% live in low-income households. A third are housing cost-burdened, spending more than 30% of their income on rent or mortgage.
Even with pandemic-era funding, wage increases have stalled. In fact, adjusted for inflation, home care wages fell from 2021 to 2022.
Who will fill the gap?
With fewer immigrants able to work legally in the U.S., families are being pushed into tough decisions. Some turn to the gray market, hiring off-the-books workers with no regulation or protections. Others are forced to reduce their own work hours or quit jobs to care for aging relatives.
At the same time, demand keeps rising. Between 2021 and 2031, home care is expected to add more new jobs than any other occupation in the country. And that’s not even counting the need to replace workers who leave the field altogether.
“Targeting immigration and Medicaid is the perfect storm for attacking care,” De La Cruz said. “We will not be able to meet the needs of the elderly. People will go without care.”
What needs to happen
Industry leaders are calling for immigration reform and better pay. Some are pushing for a “Home Care Visa” to help bring in qualified caregivers. Others want higher Medicaid reimbursement rates tied to wage improvements.
Right now, though, the gap is widening. And without action, a generation of aging Americans could find themselves without the basic help they need to live at home.
The numbers are clear. The need is urgent. And the workers we rely on most are being pushed out.