A new report from The Washington Post paints a stark picture of the nation’s home care system as it enters a period of extreme strain. The story follows caregivers like Atta-Kyereme — an immigrant from Ghana who now provides 24/7 support to an older adult recovering from a traumatic brain injury — to illustrate how essential this workforce has become as the U.S. ages. Demand for home health and personal care workers is projected to grow 17 percent by 2034, yet agencies are struggling to keep pace amid record cost increases and chronically low wages.

The Post highlights the critical role immigrants play in sustaining home care, noting they make up about one-third of the national workforce. With new federal immigration restrictions and the potential loss of legal protections for workers from Haiti, Venezuela, and other countries, providers warn the labor pool is tightening at the worst possible time.

Home health workers like him fill one of the most critical roles in the care continuum. Yet according to the Post, they are doing so amid unprecedented pressure. Demand is rising sharply: home health and personal care job openings are projected to climb 17 percent between 2024 and 2034, and national home health spending is expected to nearly double by 2033. At the same time, costs have surged at record levels.

Families feel the strain every day. Spending on at-home elder care jumped 7 percent from August to September alone — the steepest one-month increase ever recorded. While many older adults want to remain at home, fewer can afford the services that make that possible.

And for workers, wages remain stubbornly low. Last year the median salary for home health and personal care aides was $34,900 — just $16.78 an hour. That economic tension is reshaping the labor pool. As The Washington Post reported:
“Even retail and restaurant jobs can offer better compensation,” said Jake Krilovich, chief executive of the Home Care Alliance of Massachusetts. When his state passed a $15 minimum wage, ‘we saw a lot of the workforce migrate as a result of that.’”

Taken together, the Post notes, the country is entering a precarious moment where rising demand meets a shrinking workforce — leaving older adults at risk, families overwhelmed, and providers unsure how long they can keep their doors open.

The consequences are cascading across communities. Agencies are closing, especially in rural areas. Families are waiting longer for help or turning to more expensive assisted-living facilities. Some older adults, unable to secure reliable support, simply go without care. Providers describe the situation as “a slow-moving car crash,” one that threatens both patient outcomes and the broader aging-services infrastructure.

For caregivers like Atta-Kyereme, the work is deeply personal — a continuation of cultural traditions rooted in respect for older adults. For the system around him, however, sustaining that work will require policy decisions that recognize caregiving not as low-wage labor, but as essential health care.

https://www.washingtonpost.com/business/2025/12/04/elder-care-home-health-shortage/