Why it may get even harder to find caregivers for America’s aging – The Washington Post
Jonas Atta-Kyereme, left, is a caregiver for David Reese, 85, a retired pediatrician who lives at Goodwin House Alexandria, one of Goodwin Living’s senior living facilities in Virginia. (Maxine Wallace / The Washington Post)
The business of caring for older Americans is in a deepening crisis
Government funding cuts, caregiver shortages and immigration limits are adding new strains to an industry that’s already hard-pressed to meet demand.
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By Shannon Najmabadi
Shannon is reporting on aging in America. Are you caring for an aging family member? Planning or paying for long-term care? Have an tip or noticed a trend? Please contact shannon.najmabadi@washpost.com.
Jonas Atta-Kyereme helps 85-year-old David Reese dress in the morning and prepare for bed at night. He makes sure the retired pediatrician takes his medicine, and calms him when he gets anxious looking for his wife,Jane, who died last year.
It’s a typical shift for Atta-Kyereme, a caregiver who began working in Reese’s home after the older man sustained a traumatic brain injury during a fall last year.
“He needed 24-7 care,” said Reese’s brother-in-law George Sullivan. “He didn’t even recognize his own home that he’d lived in for 50 years.”
Home health workers and caregivers like Atta-Kyereme, who immigrated from Ghana two years ago, fill a critical role in the health care ecosystem as America ages and demand for caregivers soars.But government funding cuts, a caregiver shortage and immigration limits are layering new strains on an industry already hard-pressed to meet demand: Home health and personal care openings are projected to jump 17 percent from 2024 to 2034, according to data from the U.S. Bureau of Labor Statistics, and home health spending is expected to nearly double,to $317 billion, in 2033.
Atta-Kyereme and his wife were both teachers in Ghana before immigrating to the U.S., enrolling in certified nursing assistant programs and becoming home health aides, he said. (Maxine Wallace / The Washington Post)
Costs are fast increasing: Spending on at-home elder care shot up 7 percent from August to September, the largest monthly increase on record, according to government data. Nursing home costs rose 4 percent from September 2024 to September 2025, while home health care surged 12 percent, far exceeding the 3 percent overall rise in inflation during that time.
The U.S. elder care industry is caught between competing forces as demand swells: Many families say they would prefer in-home care but can’t afford it. Yet the industry struggles to attract people willing to take on the intimate, labor-intensive work of caregiving, largely because of the low pay. For a home health or personal care aide, the median salary was $34,900 annually or $16.78 an hour. Nurses and other medically trained staff who also attend to seniors at home earn more.
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.”
The tension is rapidly coming to the fore as changes in immigration policy threaten to squeeze the workforce. While foreign-born workers make up 19 percent of the U.S. labor force, they accounted for about 1 in 3 home care workers in 2023, according to a KFF analysis.
After the U.S. ramped up immigration enforcement under its Secure Communities policy, the home care workforce shrank 7.5 percent between 2008 and 2013, according to a 2025 study by professors at the University of Pittsburgh and the University of Pennsylvania. The data also showed that older adults in need of assistance were 5 percent less likely to get home care.
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