As the Government Reopens, Pressing Direct Care Workforce Challenges Loom

This week, Congress resolved the stalemate over the longest government shutdown in U.S. history. Even as funding temporarily returns to most government agencies and services resume, work on the FY26 federal budget remains unfinished. As a result of the extended budget process, critical attention and resources are being drawn away from issues with significant long-term consequences – including challenges that will have a damaging impact on our nation’s paid caregiving workforce.

Direct care workers provide vital daily care and support to older Americans and people with disabilities across the spectrum of long-term care settings. The home care aides, personal care aides, and nurse assistants who comprise this workforce together number over 5.4 million and comprise the fastest-growing occupation by volume in the country. Increasing longevity and the growing U.S. population of older adults will continue to drive demand for these workers. Yet systemic job quality challenges, including low wages, insufficient training, and limited advancement opportunities, severely limit the impact of  recruitment and retention efforts and cause high rates of turnover.

Federal leadership is urgently needed to address recent policy actions that further threaten this workforce. PHI calls on Congress to take the following actions:

• Restore Medicaid: The budget reconciliation bill passed by Congress this past summer, known as OBBBA, included dramatic cuts to Medicaid and fundamentally altered the program. Medicaid is the primary payer of long-term services and supports and these cuts pose a dire threat to our nation’s care infrastructure. Action is needed to restore funding to Medicaid and encourage new long-term care financing approaches to meet future needs.
• Protect immigrant direct care workers: Immigrants comprise 28 percent of the U.S. direct care workforce. Efforts to restrict immigration, withdraw work authorizations, and conduct immigration raids and deportations have a devastating impact on these workers, their families, employers, and those who depend on care. Action is needed to ensure the safety and security of immigrant direct care workers and their families.
• Fund SNAP (Supplemental Nutritional Assistance Program): Although SNAP benefits (small subsidies to help people afford groceries) are resuming following the government shutdown, OBBBA will result in significant federal government funding reductions while shifting administrative and cost burdens to the states. Public benefits, including SNAP, are often a lifeline for direct care workers, nearly a third of whom live in or near poverty, and a significant percentage of the older adults and people with disabilities they support. The disruption of and potential cuts to these benefits damage the economic stability of workers, families, and communities across the country. Action is needed to ensure the viability of this program.
• Sustain Labor Protections for Home Care Workers: The Administration’s recent actions to remove basic labor protections, including  minimum wage and overtime, from home care workers devalues workers and threatens workforce stability. Action is needed to uphold the Home Care Final Rule and ensure these workers have the same protections as nearly every other category of U.S. worker.

For more information on these and other actions needed to cultivate a strong direct care workforce, please see PHI’s recent policy brief, The Path Forward: Preserving, Strengthening, and Reimagining Care in the United States.