KFF Health News: Navigating the Challenges of Home Care Solutions
January 08, 2026
KFF Health News: Solving the Home Care Quandary
Imagine you’re ready to leave the hospital, but you feel unprepared to care for yourself at home. Or perhaps you’ve just completed a stint in rehab and are unsure about managing your complex medication regimen, shopping, and cooking. Maybe you recently fell in the shower, prompting your family to urge you to arrange for assistance with bathing and dressing. While there are facilities that provide such help, most older adults prefer to remain in their homes, which presents a significant challenge.
For decades, surveys have consistently shown that older adults prefer to stay in their homes for as long as possible. This desire often stems from struggles with daily activities due to frailty, chronic illnesses, or the loss of a spouse. Consequently, many require home care, whether from family, friends, or paid caregivers. However, the paid home care sector is facing a severe labor shortage, exacerbated by an aging population that is increasing demand.
“It’s a crisis,” states Madeline Sterling, a primary care doctor at Weill Cornell Medicine and director of Cornell University’s Initiative on Home Care Work. “It’s not really working for the people involved,” whether they are patients, family members, or home care workers.
Steven Landers, chief executive of the National Alliance for Care at Home, emphasizes the urgency of the situation: “Do an Indeed.com search in Anytown, USA, for home care aides, and you’ll see so many listings for aides that your eyes will pop out.”
Despite these challenges, some innovative solutions are emerging to improve home care jobs and patient care. Home care is already one of the fastest-growing occupations in the U.S., with 3.2 million home health aides and personal care aides employed in 2024, up from 1.4 million a decade earlier, according to PHI, a research and advocacy group.
However, the nation will need approximately 740,000 additional home care workers over the next decade, as reported by the Bureau of Labor Statistics. Recruiting these workers is challenging due to high consumer costs; the median hourly rate for a home health aide in 2024 was $34, while the median wage for aides was less than $17.
These jobs remain unstable and low-paying. A significant portion of the workforce is female, with about a third being immigrants. Approximately 40% live in low-income households and rely on public assistance. Even when agencies offer health insurance, many workers cannot afford the premiums.
As a result, turnover rates in the industry approach 80% annually, according to a survey by the ICA Group, a nonprofit organization promoting co-ops.
However, there are promising innovations, such as home care cooperatives owned by the workers themselves. The largest, Cooperative Home Care Associates in the Bronx, began in 1985 and now employs around 1,600 home care aides. The ICA Group currently tracks 26 worker-owned home care businesses nationwide.
“These co-ops are getting exceptional results,” says Geoffrey Gusoff, a family medicine doctor and health services researcher at UCLA. “They have half the turnover of traditional agencies, hold onto clients twice as long, and pay $2 more an hour to their owner-employees.”
In a qualitative study published in JAMA Network Open, co-op members expressed that their greatest satisfaction came from having more say in working conditions and patient care. “Workers say they feel more respected,” Gusoff adds.
Another approach gaining traction involves registries that connect home care workers directly with clients, often bypassing agencies that take a significant portion of the fees. One of the largest registries, Carina, serves clients and workers in Oregon and Washington. Established through agreements with the Service Employees International Union, it currently serves 40,000 providers and 25,000 clients.
Carina operates as a free “digital hiring hall,” according to its chief executive, Nidhi Mirani. It primarily serves clients receiving care through Medicaid, with state agencies managing paperwork and background checks. Hourly rates for independent providers on Carina, set by union contracts, are typically lower than agency rates, starting at $20, with benefits like health insurance and paid time off.
Recent studies also indicate that additional training for home care workers can yield significant benefits. Sterling’s team conducted a clinical trial involving home health aides caring for patients with heart failure, the leading cause of hospitalization among Medicare beneficiaries. The study demonstrated that a brief training module enhanced aides’ knowledge and confidence, leading to fewer emergency room visits.
While these small-scale efforts do not directly address the core issue of cost, they represent a step toward improving home care. Medicaid supports home care for low-income older adults, but recent budget cuts threaten this funding. Middle-class families often find themselves in a difficult position, either depleting their resources to qualify for Medicaid or going without necessary care.
As the U.S. has yet to commit to funding long-term care for the middle class, innovative solutions like co-ops and registries may help reduce costs and expand access to home care. With ongoing tests and pilots, there is hope for a more sustainable future in home care.
By Paula Span
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
January 08, 2026
KFF Health News: Solving the Home Care Quandary
Imagine you’re ready to leave the hospital, but you feel unprepared to care for yourself at home. Or perhaps you’ve just completed a stint in rehab and are unsure about managing your complex medication regimen, shopping, and cooking. Maybe you recently fell in the shower, prompting your family to urge you to arrange for assistance with bathing and dressing. While there are facilities that provide such help, most older adults prefer to remain in their homes, which presents a significant challenge.
For decades, surveys have consistently shown that older adults prefer to stay in their homes for as long as possible. This desire often stems from struggles with daily activities due to frailty, chronic illnesses, or the loss of a spouse. Consequently, many require home care, whether from family, friends, or paid caregivers. However, the paid home care sector is facing a severe labor shortage, exacerbated by an aging population that is increasing demand.
“It’s a crisis,” states Madeline Sterling, a primary care doctor at Weill Cornell Medicine and director of Cornell University’s Initiative on Home Care Work. “It’s not really working for the people involved,” whether they are patients, family members, or home care workers.
Steven Landers, chief executive of the National Alliance for Care at Home, emphasizes the urgency of the situation: “Do an Indeed.com search in Anytown, USA, for home care aides, and you’ll see so many listings for aides that your eyes will pop out.”
Despite these challenges, some innovative solutions are emerging to improve home care jobs and patient care. Home care is already one of the fastest-growing occupations in the U.S., with 3.2 million home health aides and personal care aides employed in 2024, up from 1.4 million a decade earlier, according to PHI, a research and advocacy group.
However, the nation will need approximately 740,000 additional home care workers over the next decade, as reported by the Bureau of Labor Statistics. Recruiting these workers is challenging due to high consumer costs; the median hourly rate for a home health aide in 2024 was $34, while the median wage for aides was less than $17.
These jobs remain unstable and low-paying. A significant portion of the workforce is female, with about a third being immigrants. Approximately 40% live in low-income households and rely on public assistance. Even when agencies offer health insurance, many workers cannot afford the premiums.
As a result, turnover rates in the industry approach 80% annually, according to a survey by the ICA Group, a nonprofit organization promoting co-ops.
However, there are promising innovations, such as home care cooperatives owned by the workers themselves. The largest, Cooperative Home Care Associates in the Bronx, began in 1985 and now employs around 1,600 home care aides. The ICA Group currently tracks 26 worker-owned home care businesses nationwide.
“These co-ops are getting exceptional results,” says Geoffrey Gusoff, a family medicine doctor and health services researcher at UCLA. “They have half the turnover of traditional agencies, hold onto clients twice as long, and pay $2 more an hour to their owner-employees.”
In a qualitative study published in JAMA Network Open, co-op members expressed that their greatest satisfaction came from having more say in working conditions and patient care. “Workers say they feel more respected,” Gusoff adds.
Another approach gaining traction involves registries that connect home care workers directly with clients, often bypassing agencies that take a significant portion of the fees. One of the largest registries, Carina, serves clients and workers in Oregon and Washington. Established through agreements with the Service Employees International Union, it currently serves 40,000 providers and 25,000 clients.
Carina operates as a free “digital hiring hall,” according to its chief executive, Nidhi Mirani. It primarily serves clients receiving care through Medicaid, with state agencies managing paperwork and background checks. Hourly rates for independent providers on Carina, set by union contracts, are typically lower than agency rates, starting at $20, with benefits like health insurance and paid time off.
Recent studies also indicate that additional training for home care workers can yield significant benefits. Sterling’s team conducted a clinical trial involving home health aides caring for patients with heart failure, the leading cause of hospitalization among Medicare beneficiaries. The study demonstrated that a brief training module enhanced aides’ knowledge and confidence, leading to fewer emergency room visits.
While these small-scale efforts do not directly address the core issue of cost, they represent a step toward improving home care. Medicaid supports home care for low-income older adults, but recent budget cuts threaten this funding. Middle-class families often find themselves in a difficult position, either depleting their resources to qualify for Medicaid or going without necessary care.
As the U.S. has yet to commit to funding long-term care for the middle class, innovative solutions like co-ops and registries may help reduce costs and expand access to home care. With ongoing tests and pilots, there is hope for a more sustainable future in home care.
By Paula Span
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
