America’s home healthcare sector is cracking under the weight of an aging population. Baby boomers—nearly 73 million strong—are hitting their peak care years. The oldest now 80. Demand surges. But workers? They’re vanishing.
Weekly hours for home health aides have plunged to 28, the lowest in almost two decades, down from 30 in early 2023. Job growth slowed to 7,000 in March 2026, half the prior year’s pace. Without healthcare’s 693,000 jobs added in 2025, the U.S. economy would have shed 577,000 positions, per Fortune analysis of Bureau of Labor Statistics data. Health care props up the job market, as The New York Times reports. Yet the sector masks deeper rot.
Matthew Nestler, KPMG senior economist, warns of the fallout. “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.” Demand climbs as seniors opt to age in place. Personal healthcare spending for older adults topped $1.2 trillion in 2020—$22,000 per person. Hours fall. Payrolls creep up modestly. Prices spike.
Low pay drives the exodus. Aides earn under $35,000 yearly, median $16.82 an hour. Nursing assistants hit $19.84, still below the $49,500 national median. Poverty wages for poverty-level families. “These are really difficult jobs,” Nestler said. “They’re emotionally difficult; they can also be physically difficult in some ways. It reflects our society’s values that some of the most necessary jobs—taking care of the oldest among us—are the lowest paid.”
Turnover’s Brutal Toll
Nearly 80% annual turnover in home care. New hires bolt at 70% within 100 days. PHI projects 6.1 million openings by 2034—681,000 new jobs, plus millions from quits and retirements. Home health aides form the largest U.S. occupation, fastest-growing through 2034, per BLS via KPMG. Agencies turn away clients. Families wait weeks.
Priya Chidambaram, KFF senior policy manager, sees no relief. “All these things are combining to create this inevitability that there will not be enough of a workforce to meet the demands of an aging population,” she told NBC News. By 2035, over 20% of Americans will be 65-plus. One in five needing care. Boomers serve not just elders but younger disabled people too. “It’s going to impact us for the next 30 years.”
And unpaid care? It burdens 10% to 20% of workers across industries. Gen X leaders cut hours, skip promotions, quit. KPMG tallies 38.2 million unpaid eldercare providers in 2023-2024; 24 million employed. Healthcare loses 4.4 million to this shadow force. Dominoes fall. Labor markets seize.
Immigrants fill gaps—one-third of home health workers, per KFF and KPMG. Post-pandemic surge helped. Now Trump-era crackdowns bite. A survey of 691 workers across 30 states by Physicians for Human Rights and Migrant Clinicians Network found 26% reporting enforcement hits patient care—preventive services, chronic pain, mental health hardest. Foreign-born pay into Social Security and Medicare as net contributors. Curbs hasten dependency ratios, strain budgets.
But policy squeezes harder. Medicaid cuts loom—$1 trillion proposed. Reimbursements stay low, chaining wages. States vary: Connecticut eyes doubled 65-plus by 2060, outpacing workers 15%. Rep. Jane Garibay calls it a “crunch.” “We’re lacking nurses. We’re lacking every population. But it’s not only just bad policy, it’s dangerous,” per CT Public.
Raj Namboothiry of Manpower notes the strain. Medical postings linger longest. “Health care has constantly shown gains when the rest of the sectors are on pause,” he said in The New York Times. “This has become America’s most reliable job engine.” Reliable? Yes. Sustainable? No.
Ripple Effects Threaten Broader Economy
Home care doubled since 2014, yet shortages persist. BLS eyes 740,000 more aides needed this decade. Rural areas starve—ratios of aides to disabled plummet. Sandwich generation mid-career pros juggle kids and parents. Prime-age mothers’ participation dips, especially sans college degrees.
Prices double inflation since late 2023. Agencies innovate—tech pipelines, bonuses, flexible shifts. But core fixes lag. Raise reimbursements. Ease immigration for care visas. Train domestically. Value the work.
Nestler predicts cascades. Without paid care, unpaid surges. Employed caregivers pass opportunities, slash hours, exit. “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.” Boom turns bust. Watch closely. The canary wheezes.
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