Healthcare policy debates often focus on budgets, reimbursements, and eligibility requirements. While those conversations are important, they can overlook the people who ultimately determine whether care reaches older adults at all: caregivers.
A new report from KFF has renewed attention on how proposed Medicaid changes could affect the nation’s direct care workforce. At a time when America’s aging population is driving unprecedented demand for home-based services, workforce stability is becoming just as critical as healthcare funding itself.
For families, this distinction matters. Access to care depends on more than having insurance coverage or qualifying for benefits. It also depends on whether qualified caregivers are available when they are needed.
“Families should pay attention because Medicaid policy doesn’t just determine whether services are covered. It also affects whether there’s someone available to provide them,” says Jim Prussak, CEO of Applause Home Care. “Even if a person qualifies for home and community based services, those benefits have limited value if there are not enough caregivers to deliver the care.”
As more older adults choose to remain in their own homes, the demand for skilled caregivers continues to grow. Yet providers across the country are already facing significant challenges recruiting and retaining the workforce needed to support that shift.
The consequences extend well beyond staffing numbers.
According to Prussak, workforce stability directly shapes the experience older adults have at home.
“Workforce shortages can mean longer wait times to receive services, difficulty finding consistent caregivers, more frequent staff turnover that disrupts continuity of care, and greater reliance on unpaid family caregivers who may need to reduce work hours or leave the workforce to fill gaps,” he explains.
Consistency is particularly important in home care because strong relationships often become part of the care itself. Older adults benefit when caregivers understand their routines, preferences, personalities, and evolving needs. Frequent turnover interrupts that familiarity, forcing both clients and families to continually adapt to new caregivers.
The workforce challenges themselves are complex.
Competition for qualified workers has intensified as caregiving skills are increasingly valued across multiple healthcare settings. At the same time, inconsistent schedules, canceled shifts, and fluctuating hours can make it difficult for caregivers to maintain stable incomes. The emotional and physical demands of caring for older adults also contribute to burnout, making retention an ongoing challenge for providers.
If those workforce shortages continue, families are likely to notice the effects quickly.
“If workforce shortages continue to grow, then there may be longer wait times for services, reduced available hours, and less continuity of care through more frequent caregiver turnover,” says Prussak.
These challenges have prompted many agencies to rethink how they support their employees.
Rather than relying solely on aggressive hiring, providers are increasingly investing in workforce stability through competitive compensation, flexible scheduling, ongoing education, and operational improvements that reduce administrative burdens. Technology has also become an important tool, helping agencies streamline scheduling, improve communication, and allow caregivers to spend more time focused on clients rather than paperwork.
Prussak believes those investments ultimately benefit everyone involved.
“Investing in caregivers is fundamental in the Care Partnering Model,” he says. “When agencies invest in their caregivers through competitive compensation, ongoing training, career development, and supportive leadership, the benefits extend well beyond the workforce. They directly improve the care experience for clients.”
This philosophy reflects Applause Home Care’s care partnering approach, which emphasizes working with clients rather than simply performing tasks for them. That model depends heavily on caregivers who feel supported, engaged, and equipped to build meaningful relationships with the individuals they serve.
“Caregivers who feel supported are often better positioned to focus on individualized care rather than simply completing tasks,” Prussak says. “This aligns with a partnership approach that emphasizes dignity, independence, and quality of life.”
Looking ahead, the conversation surrounding long-term care will likely become even broader than reimbursement policies or healthcare spending alone.
America’s aging population continues to grow, increasing demand for in-home and community-based services every year. Meeting that demand will require coordinated efforts from policymakers, providers, and families alike.
Prussak believes all three groups have a role to play.
For policymakers, strengthening the direct care workforce means viewing caregiving as a long-term investment through competitive reimbursement, workforce development, and career advancement opportunities. Providers must continue building resilient organizations that prioritize recruitment, retention, professional development, and innovative care models. Families, meanwhile, should recognize that planning for long-term care includes understanding workforce availability alongside financial and legal preparation.
“One of the most important things policymakers, providers, and families should recognize is that the future of healthcare depends not only on medical innovation, but also on having a strong, sustainable direct care workforce,” Prussak says.
As discussions around Medicaid and long-term care continue, one reality remains clear: expanding access to home-based care requires more than funding programs. It requires investing in the people who make that care possible every day.