‘The current system right now is unsustainable’: top economist sees a crucial crack in the economy

Home healthcare workers make up less than 3% of the total jobs, but KPMG senior economist Matthew Nestler sees reason to pay attention—and reason to be concerned.

“The current system right now is unsustainable,” he told Fortune, “and [it’s] buckling before we’re hit with this massive aging and retiring of the baby boomers—the largest generation ever to age and retire.” 

Despite making up just a fraction of the workforce, home healthcare workers have a disproportionate impact on the rest of the economy, Nestler argued, saying that if people are unable to get the health care that they need, that will result in an increase in unpaid elder care, causing domino effects all through the labor market. The person pushed into unpaid elder care, he reasoned, “is employed in another part of the economy, then passes up career opportunities; they reduce work hours; they leave the labor force.”

Call it the home healthcare canary in the coal mine. 

Healthcare, including home healthcare and elder care, has boomed despite a cooling labor market. The sector alone added 693,000 jobs in 2025, despite the U.S. economy seeing a total increase of 116,000 jobs. That........

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