The Looming Crisis in Home Health Care

Deep cuts to medicaid may force states to decrease spending for the hiring of workers critical to the care of disabled and elderly Americans.

The health care industry has offered a rare bright spot for a struggling labor market, growing at dramatic rates even as employment flags in other sectors. It’s not only hospitals and medical facilities that are hiring more: Demand for home health care workers has spiked over the past decade, and as the American population ages, the need for these professionals will only increase. But cuts to Medicaid and shifts in immigration policy could threaten the future of these vital working-class positions.

The workers in this sector include home health aides, who assist elderly and disabled individuals with care such as checking vital signs and helping administer medications, as well as with activities of daily living, like bathing, eating, and going to the bathroom. There are also personal care aides, who provide assistance with the activities of daily living, and with tasks such as running errands, preparing meals and cleaning. In short, they are crucial to the quality of life for any individual who is otherwise unable to meet their own daily needs.

Despite the importance of home health care for older and disabled Americans, these workers typically earn lower wages, a trend exacerbating difficulties in hiring for these positions. In 2024, the median pay for home health and personal care aides was only $16.78 per hour. While the labor is both physically and emotionally taxing, there is a perception that the occupation is lower-skilled than other health professions because it may require less training.

“The workforce has just historically been under-recognized and under-appreciated,” said Madeline Sterling, associate professor of medicine at Weill Cornell Medicine and the director of the Initiative on Home Care Work at Cornell University.

Home aides are a part of the “direct care” labor force, which includes workers who operate in both home and nursing facility settings. Eighty-seven percent of direct care workers are women, 65 percent are considered low-wage, and 28 percent are black, according to data by the health news and research organization KFF. With 41 percent of workers aged 50 or older, the industry is also disproportionately older, in part because a proportion are family members who are being reimbursed for their care of loved ones.

Nursing assistants, home health........

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