America Is Running Out of Caregivers—and Families Are About to Feel It

The direct-care workforce shortage is becoming a family crisis—and a threat to the future of care at home.

What happens when your mother needs help getting dressed, your father cannot prepare his own meals, or your adult child with a disability needs daily support—but no caregiver is available?

For more American families, that question is becoming real.

Most people want to remain in their homes and communities as long as possible. Home and Community-Based Services (HCBS) help older adults and people with disabilities live with greater independence, dignity, and connection. But the system depends on something increasingly difficult to find: enough trained, dependable direct-care professionals.

America is not simply facing a staffing problem. We are approaching a care gap that could affect millions of families.

The People Who Make Care at Home Possible

Direct-care workers assist with essential activities such as bathing, dressing, eating, mobility, medication routines, transportation, household tasks, and community participation. Their work also allows family members to keep working, attend school, raise children, and care for their own health.

According to a July 2026 KFF analysis, approximately 2.3 million direct-care workers provided long-term care to older adults and people under 65 with disabilities in 2024. About 66% worked in home-care settings.

Yet 66% of direct-care workers earned less than $35,000 annually. Among workers in home-care settings, the figure reached 72%.

These professionals perform demanding work, often with irregular schedules, limited benefits, transportation expenses, and significant emotional pressure. When better-paying or more stable jobs are available, many understandably leave the field.

For a provider, an unfilled shift is an operational challenge. For the person waiting at home, it can mean missing a meal, medical appointment, medication support, or community activity.

Why the Shortage Could Get Worse

Demand is increasing as the population ages and more people seek alternatives to institutional care. Meanwhile, several pressures are making recruitment and retention harder.

Low wages and limited advancement

Providers cannot sustainably raise wages without adequate reimbursement. When Medicaid payment rates do not reflect the cost of care, organizations struggle to offer competitive pay, benefits, training, and career opportunities.

Immigration-policy pressure

Immigrants represented approximately 30% of the direct-care workforce in KFF’s analysis. Policies that reduce the available labor pool could place further pressure on a field already struggling to fill positions.

Medicaid uncertainty

Medicaid is the primary payer for long-term care in the United States. Funding changes can affect provider reimbursement, worker compensation, service availability, and people’s ability to remain safely at home.

Personal assistance cannot simply be postponed. Someone who needs help getting out of bed today cannot wait months for the workforce or funding system to stabilize.

The Hidden Impact on Families

When professional care is unavailable, families frequently become the backup system.

A spouse may reduce working hours. An adult child may leave a job. Parents may continue providing intensive support to an adult with a disability well into retirement. The result can be exhaustion, lost income, anxiety, and declining health among family caregivers.

Turnover also creates instability for the person receiving services. An experienced caregiver understands the individual’s routines, communication preferences, health risks, behavioral changes, and goals. Repeatedly losing that trusted professional can make important changes harder to recognize.

Caregivers Need Better Support

Solving this crisis will require more than another recruitment campaign.

Direct-care professionals need compensation that reflects their work, predictable scheduling, effective supervision, strong training, benefits, and career pathways. Providers need reimbursement systems that make those improvements financially possible.

The federal Medicaid Access Final Rule calls for stronger HCBS oversight, including incident-management standards, service-delivery reporting, quality measures, and greater transparency. Those are important goals, but new requirements must be accompanied by workable funding and technology that helps staff instead of adding more paperwork.

Technology Should Support—Not Replace—Caregivers

Technology cannot provide reassurance during a difficult moment or build the human relationship at the center of quality care. It can, however, reduce administrative work and help organizations respond faster.

Well-designed HCBS technology can simplify timekeeping and Electronic Visit Verification, improve communication, organize incident information, and help administrators recognize patterns across service notes. Repeated references to reduced activity, appetite changes, new medication, missed appointments, or unusual behavior could indicate that someone needs closer attention.

Used responsibly—with privacy, security, human review, and HIPAA-conscious safeguards—technology can give caregivers and clinical leaders more time and better information. The goal is not to automate compassion. It is to create more time for it.

What Must Happen Next

• America needs a coordinated response that includes:
• Medicaid reimbursement that supports competitive compensation
• Better benefits, training, scheduling, and career pathways
• Less duplicative paperwork and more useful technology
• Collaboration among providers, families, insurers, and government
• Workforce policies that recognize the country’s growing care needs
• Greater respect for direct-care work as essential, skilled work

Providers and policymakers must also listen to participants, families, direct-care professionals, and frontline supervisors. They know where the system is failing—and which changes would make the greatest difference.

This Is a Family Issue

• The direct-care workforce is easy to overlook until someone you love needs help. Then it becomes personal very quickly.
• Demand for home- and community-based care will continue to grow. The question is whether America will support the workforce needed to meet it.
• Care at home does not happen by accident. It happens because trained, compassionate people show up every day. Supporting them is not only an HCBS priority. It is a national necessity.

Sources

• KFF, Who Are Direct Care Workers and How Might Federal Policy Changes Impact the Workforce?, July 9, 2026.
• Centers for Medicare & Medicaid Services, Home and Community-Based Services Provisions.