If you’ve researched long-term care for yourself or a loved one, you’ve probably noticed that finding qualified caregivers isn’t getting any easier. Whether you’re looking for in-home care, assisted living, or nursing home services, providers across the country continue to report staffing shortages that can affect availability, wait times, quality, and costs.
At the same time, America’s population is aging rapidly. Adults age 65 and older now make up a larger share of the population than ever before, and that number will continue to grow over the coming decades. Simply put: More Americans will need long-term care services while the supply of workers available to provide that care is struggling to keep pace.
Recent changes in U.S. immigration policy have added another layer of complexity to this challenge. While immigration policy is often viewed through a political lens, its effects on the long-term care workforce are also an economic issue. Because immigrants make up a significant portion of America’s caregiving workforce, policies that reduce the available labor pool could further tighten an already strained market, potentially increasing costs for families and making care increasingly harder to find.
The growing gap between care demand and caregiver supply
Home health aides, personal care aides, certified nursing assistants, and other direct care professionals provide essential support that helps millions of older adults remain safe and maintain their quality of life.
Unfortunately, when it comes to paid caregivers, supply has not kept up with demand. Direct care work is physically and emotionally demanding, wages have historically been modest, and turnover remains high. Research from PHI, a national organization focused on the direct care workforce, has consistently found that recruiting and retaining caregivers remains one of the senior living and care industry’s biggest challenges.
Even so, the U.S. Bureau of Labor Statistics projects that home health and personal care aides will be among the nation’s fastest-growing occupations through the next decade, driven largely by the aging Baby Boomer population. Millions of new job openings are expected, not only because more workers will be needed but also because many current caregivers are themselves approaching retirement.
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The impact of immigration on long-term care
Immigrants play a much larger role in long-term care than many people realize.
Research from KFF has found that approximately 30% of direct care workers are immigrants, particularly home health aides, nursing assistants, and personal care aides. Many long-term care providers rely on these employees to fill positions that have proven difficult to staff through the domestic labor force alone. What’s more, KFF notes that at least 20% of immigrant direct care workers are from one of the 75 countries that have recently put on an immigrant visa pause.
Reporting by CNBC similarly notes that these changes affecting work authorization and immigration could further reduce the available caregiver workforce at a time when providers are already struggling to hire enough staff. Financial planners and aging experts interviewed by CNBC warn that if fewer workers are available, agencies and senior care providers may have to increase wages to attract employees, and these added costs are often passed along to consumers.
Importantly, this worker shortage isn’t simply theoretical or even financial. A 2026 study from Harvard Medical School, MIT, and the University of Rochester researchers found that increased immigration has historically improved staffing levels in nursing homes and was also associated with better care quality for residents.
>> Related: The Crossroads of Immigration Reform and Long-Term Care
Why fewer caregivers can mean higher costs
Basic economics helps explain why workforce shortages often lead to rising prices. When demand for a service increases while the available workforce remains limited, employers typically must compete more aggressively for employees. That often means offering higher wages, signing bonuses, improved benefits, or other incentives.
Those higher labor costs don’t simply disappear. Because staffing is one of the largest operating expenses for home care agencies, assisted living communities, and nursing homes, providers frequently need to increase prices for residents in order to remain financially viable.
Indeed, families may already be seeing these increases. According to CareScout, the national median cost for non-medical in-home care reached about $36 per hour in 2026, while annual median costs were approximately $76,632 for assisted living and $133,462for a private nursing home room. Costs can vary considerably by region, but they have generally trended upward each year and will likely continue that trend as caregiving supply and demand diverge.
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Repercussions for older adults and their loved ones
No one can predict exactly how future workforce trends or immigration policies will affect long-term care costs. Many factors (including wage growth, state Medicaid funding, training initiatives, technology, and demographic changes) will influence the future workforce.
Yet, most senior living and care experts agree: Demand for caregiving services is expected to remain strong for many years. If workforce shortages persist, families could potentially face:
- Higher hourly rates for in-home caregivers
- Longer wait times for home care services
- Greater competition for assisted living or nursing home availability
- Increased pressure on unpaid family caregivers
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Planning ahead can create more options
Of course, none of these outcomes is guaranteed, but they do reinforce the importance of planning in advance for potential future care needs, before care becomes an immediate necessity. Older adults and their loved ones can take practical steps to improve their future choices by proactively discussing questions such as:
- What type of care would you prefer if your health changes?
- Would aging at home remain realistic if paid caregivers become harder to hire?
- How would assisted living, a nursing home, or even a proactive move to a continuing care retirement community (CCRC) fit into your financial plan?
- What resources are available to help pay for future care?
Starting these conversations early gives families more flexibility and more time to compare care options before senior living and care decisions become urgent.
>> Related: Pre-Crisis vs. Post-Crisis Planning: Confronting Life’s Unknowns
Looking beyond the headlines
Immigration policy is only one piece of a much larger long-term care puzzle. The United States is experiencing a historic demographic shift as millions of older adults enter the years when they are most likely to need assistance with activities of daily living (ADLs). At the same time, employers across the care continuum continue working (and often struggling) to recruit and retain enough qualified caregivers to meet growing demand.
Whether future workforce shortages are addressed through expanded training programs, technological innovations, immigration policy, higher wages, or a combination of approaches, one reality remains unchanged: Proactive long-term care planning is becoming increasingly important.
For older adults and their loved ones, understanding how workforce trends influence both the availability and cost of care can lead to better-informed decisions. Planning ahead won’t eliminate uncertainty, but it can provide more choices, greater financial preparedness, and a better chance of finding the right care if and when it’s needed.
