The Business of Caring for Older Americans is in a Deepening Crisis
Government funding cuts, a caregiver shortage and immigration limits are layering new strains on an industry already hard-pressed to meet demand: Home health and personal care openings are projected to jump 17 percent from 2024 to 2034, according to data from the U.S. Bureau of Labor Statistics, and home health spending is expected to double, to $317 billion, in 2033.
Costs are fast increasing: Spending on at-home elder care shot up 7 percent from August to September, the largest monthly increase on record, according to government data. Nursing home costs rose 4 percent from September 2024 to September 2025, while home health care surged 12 percent, far exceeding the 3 percent overall rise in inflation during that time.
The U.S. elder care industry is caught between competing forces as demand swells: Many families say they would prefer in-home care but can’t afford it. Yet the industry struggles to attract people willing to take on the intimate, labor-intensive work of caregiving, largely because of the low pay. For a home health or personal care aide, the median salary was $34,900 annually or $16.78 an hour. Nurses and other medically trained staff who also attend to seniors at home earn more.
A spokesperson for the Centers for Medicare and Medicaid Services said the administration “recognizes the concerns regarding access to home health care, particularly in rural and underserved areas,” and the potential for rate cuts to affect providers’ stability and patients’ outcomes. But the agency said the cuts “were implemented in a way that fulfills statutory obligations without jeopardizing beneficiary access.”
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This was helpful, but it’s difficult to find a “nursing home” that has staff to take care of an insulin-dependent T1D. What do you suggest?
My response still holds. We don’t have solutions! But we are all concerned/frightened about how we will be cared for if/when we can’t take care of ourselves. We are working on this topic in our advocacy group, if you are interested in helping us “get loud” about this!
This was helpful, but it’s difficult to find a “nursing home” that has staff to take care of an insulin-dependent T1D. What do you suggest? This question was NEVER submitted by me before
David, I think that is the question on the top of our minds … and we do not have solutions, only suggestions. The difficulty is that 1. there is a shortage of caregivers who have expertise in managing T1D diabetes, 2. Each facility is governed by that state’s laws … and some independent homes are unregulated, as I understand it, 3. Some retirement homes will accept T1Ds but often charge much higher fees and require that the T1D be “self-managed”, Some assisted living and nursing homes either don’t take T1Ds or will want to put those patients on MDI and sliding scale, with meals often delivered way before or way after insulin is given. Bottom line: IT’S A MESS and will not be solved in short term, at all! Our “advice” is to investigate the facilities near where you expect to live, take a tour and ask a lot of questions. Please see our “cheat sheets” and tools on our website: https://t1dto100.com/where-will-you-live/planning-for-the-future