Fast Facts | Originally authored and published by USAging | August 2026
Source and authorship notice: This article was originally authored and published by USAging as a Fast Facts brief. It is reposted by Senior Resources of West Michigan, an Area Agency on Aging, for informational and educational purposes. The original findings, data, research, references and acknowledgement are credited to USAging and the sources cited below. Senior Resources did not author the original report. Download the original report here.
Crisis in the Direct Care Workforce
Our nation relies on in-home direct care workers (DCWs) to support older adults and people with disabilities to live where they want—at home and in the community. The direct care workforce includes people with various job titles and roles, including personal care aides, home health aides, nursing assistants, direct support professionals and more.
They support individuals with daily living activities such as bathing, dressing, eating, meal preparation, housekeeping, transportation and other personal care tasks, and in doing so, allow older adults and people with disabilities to live healthy lives at home for as long as possible.
Despite their indispensable role and the fact that the demand for direct care workers is expected to grow 40 percent by 2038,1, 2 DCWs are among the lowest-paid occupational groups in the U.S.3, 4 In addition to low wages, they contend with heavy workloads, inconsistent schedules, limited training, few career advancement opportunities, and physically and emotionally demanding work environments, resulting in high rates of turnover and vacancies.5, 6, 7
Area Agencies on Aging (AAAs) across the country see these negative impacts firsthand. As community-based organizations that plan, develop, fund and implement local systems of coordinated home and community-based services, AAAs provide a wide range of services—including nutrition, case management, personal care, homemaker services, transportation, health and wellness programs, caregiver support and more.
They provide these services using agency staff and contracted providers, such as the home care agencies that employ direct care workers. Shortages of DCWs challenge AAAs’ ability to meet client needs and deliver services effectively, prompting the development of innovative strategies to shrink the gap.
AAAs are uniquely positioned to provide insights on how the shortage of DCWs affects the ability of older adults to live well at home and in the community. This brief describes AAAs’ perspectives on the impact of staffing shortages on older adults and caregivers, and the strategies AAAs are employing to address this growing crisis.
The persistent shortage of DCWs is a crisis that hinders service delivery, compromises the quality of care and negatively impacts the health and wellbeing of older adults and caregivers.
Methodology
Data in this brief were gathered through the 2025 National Survey of Area Agencies on Aging conducted by USAging in partnership with Scripps Gerontology Center at Miami University and supported by the U.S. Administration for Community Living.8
In this survey, AAAs were asked the following question:
We would like to learn about what impact the direct care worker shortage is having on your AAA’s consumers. For each item below, please indicate how much of a problem, if any, you believe this is in your planning and service area because of workforce shortages. Select from not at all a problem, somewhat of a problem, major problem, or N/A.
The charts reflect the percentage of AAAs responding that each issue was “somewhat of” or a “major” problem in their community as a result of DCW shortages.
Impact of DCW Shortages on In-Home Services for Older Adults
Over three-fourths of AAAs report that DCW shortages are negatively impacting service delivery and quality.
As shown in Figure 1, 89 percent of AAAs report that DCW shortages have resulted in some consumers not receiving the frequency of services they need—for example, two home care visits per week instead of three—with 45 percent of AAAs saying this is a major problem in their area.
Eighty-one percent of AAAs report that some consumers are not receiving needed services at all, and 32 percent said this is a major problem.
Additionally, 77 percent of AAAs indicate that the quality of services received by consumers has declined as a result of DCW shortages, with 17 percent reporting that this is a major problem.
Figure 1: DCW Shortage Impact on Consumer Services (N=404)
| Impact on Consumer Services | Somewhat of a Problem | Major Problem | Total Reporting a Problem |
|---|---|---|---|
| Reduced frequency of services | 44% | 45% | 89% |
| Not receiving needed service(s) at all | 49% | 32% | 81% |
| Quality of services declined | 60% | 17% | 77% |
Source: 2025 National Survey of Area Agencies on Aging.
Direct care workers are vital to addressing long-term care needs and allowing older adults to live in their homes and communities. Therefore, not receiving needed services can have serious consequences for consumers.
AAAs also report on these effects on consumer outcomes as a result of direct care worker shortages, as shown in Figure 2.
Figure 2: DCW Shortage Impact on Consumer Outcomes (N=404)
| Impact on Consumer Outcomes | Somewhat of a Problem | Major Problem | Total Reporting a Problem |
|---|---|---|---|
| Consumers are missing scheduled medical appointments | 65% | 14% | 79% |
| Consumers are experiencing increased hospitalizations | 64% | 16% | 80% |
| Consumers who would be able to remain living at home with supports are entering nursing homes | 64% | 20% | 84% |
| Consumers are unnecessarily experiencing a decline in health status | 61% | 23% | 84% |
| Family and other caregivers are unable to get the support they need | 50% | 45% | 95% |
| Consumers are experiencing social isolation and/or loneliness | 55% | 40% | 95% |
Source: 2025 National Survey of Area Agencies on Aging.
These Impacts Matter, Because:
- Shortages of DCWs can lead to missed medical appointments, declines in health, and increased hospitalizations.
- When family and other caregivers do not have the help they need, their care recipients are more likely to be hospitalized or enter a nursing home, and the caregivers themselves may experience declines in health.9
- Social connection plays a crucial role in maintaining health and overall well-being. Social isolation and loneliness can increase the risk of heart disease by 29 percent, stroke by 32 percent and premature death by 29 percent.10
- Without the in-home care that allows older adults to remain in the community—where the majority of older adults want to live11—the only option for some older adults is to enter a nursing home.
- Potentially avoidable health care and nursing home utilization result in increased costs for consumers and taxpayers. Annual nursing home costs exceed $100,000, while part-time in-home care costs just a fraction of that.12
- Overall, shortages of DCWs threaten the ability of older adults to live with optimal health, well-being and independence in the community.
Strategies to Address the DCW Shortage
AAAs are adopting a range of strategic initiatives to combat the workforce crisis in their communities to the extent possible.
The most common of these include providing consumer-directed care, in which family, friends or neighbors receive payment to provide care (41 percent), increasing wages to attract and retain direct care workers (36 percent), and offering flexible work schedules (23 percent).
While these strategies may help meet the need, the systemic issues that cause DCW shortages remain, and require action at the state and federal levels to see meaningful change.
Engaging Future Direct Care Professionals
Direction Home Akron Canton Area Agency on Aging & Disabilities (DHAD), located in Ohio’s Region 10b, has a Provider Engagement Coach who works with individuals interested in a career in home care.
The Coach helps people learn how to get trained and pursue certification as independent or Consumer Directed Providers. Coaches assist individuals in qualifying as direct care workers in Ohio’s PASSPORT Medicaid waiver program and provide opportunities to gain additional credentials, helping them advance their careers.13
DHAD partners with over 100 agencies that hire these caregiving professionals for open positions and collaborates with the Ohio Department on Aging for training and development opportunities.
This has resulted in improved recruitment of DCWs: the number of unstaffed direct care positions across Region 10b decreased significantly, from 223 vacancies out of 7,440 positions in 2024 to just seven open positions in 2025.
Promoting Flexibility to Find Care
Atlanta Regional Commission in Georgia has addressed the DCW shortage by giving caregivers and clients more flexibility—whether through vouchers, so they can shop around if one home care agency faces workforce shortages and they want to find another, or through consumer direction, which allows clients to hire a family member to provide care or hire staff from an agency of their choosing.
Atlanta Regional Commission also encourages their county-based agencies to contract with more than one provider agency, so they have similar flexibility when delivering in-home services.
Conclusion
The shortage of DCWs impacts the ability of older adults to remain in their homes, reducing independence and increasing reliance on institutional care. The DCW shortage negatively impacts not only the quality of in-home services but also the physical, emotional and financial health and well-being of older adults, caregivers and their families.
AAAs work to ensure that older adults, caregivers and people with disabilities receive the care and essential services they need. AAAs are responding to the DCW shortage by implementing innovative strategies to deliver critical services and care to their consumers.
AAAs are addressing this shortage where they can, but most factors driving the workforce shortage are beyond the control of a single agency and require a systemic approach to finding solutions.
August 2026
References
- Health Resources and Services Administration. Long-Term Services and Support: Demand Projections, 2023-2038.
https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/ltss-projections-factsheet.pdf - Joyce Famakinwa. Home Care’s Industry-Wide Turnover Rate Reaches Nearly 80%.
https://homehealthcarenews.com/2024/07/home-cares-industry-wide-turnover-rate-reaches-nearly-80/# - Olga Khavjou, Guadalupe Suarez, Denise Tyler. Wages of Direct Care Workers Lower Than Other Entry-Level Jobs in Most States.
https://aspe.hhs.gov/sites/default/files/documents/7a611d901c615e5611ea095b1dcf8d08/wages-dcw-lower-ib.pdf - Center for American Progress. Direct Care Worker Pay and Benefits Are Low Despite High Demand for Services.
https://www.americanprogress.org/article/direct-care-worker-pay-and-benefits-are-low-despite-high-demand-for-services - Center for American Progress. Direct Care Worker Pay and Benefits Are Low Despite High Demand for Services.
https://www.americanprogress.org/article/direct-care-worker-pay-and-benefits-are-low-despite-high-demand-for-services - PHI. State Index Tool.
https://www.phinational.org/state-index-tool/ - U.S. Department of Labor. Report to the House and Senate Appropriations Committees on the Direct Care Workforce.
https://www.adagreatlakes.org/Publications/Newsletter/ETA_report_Appropriations_Committees_on_Direct_Care_Workforce.pdf - USAging. AAAs Respond to Complex Community Needs: Trends and New Directions From the National Survey of Area Agencies on Aging.
https://www.usaging.org/aaasurvey - Megan E. Shepherd-Banigan, Zhen Li, Pujan R. Patel. Caregiver Emotional Wellbeing is Related to Nursing Home Admissions Among Veterans. Journal of the American Geriatrics Society, 2025; 73 (11): 3396-3405.
https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70087 - U.S. Office of the Surgeon General. Our Epidemic of Loneliness and Isolation.
https://www.hhs.gov/surgeongeneral/reports-and-publications/connection/index.html - Joanne Binette and Fanni Farago. 2024 Home & Community Preferences Among Adults 18 and Older. AARP Research, December 2024.
https://doi.org/10.26419/res.00831.001 - AARP. Long-Term Care Scorecard Report.
https://ltsschoices.aarp.org/scorecard-report/2023 - Direction Home Akron Canton. Have You Ever Thought About Becoming a Caregiver?
https://www.dhad.org/blog-news/have-you-ever-thought-about-becoming-caregiver
Acknowledgement
This brief was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award with $496,608 (or 75 percent) funded by ACL/HHS and $166,646 (or 25 percent) funded by non-government source(s).
The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS or the U.S. Government.
Original author and publisher: USAging
Original publication date: August 2026
Reposted by: Senior Resources of West Michigan, Area Agency on Aging
Purpose of repost: Educational and informational use. All original research, findings and source attribution remain credited to USAging and the references listed above.
