PHI

09/23/2026

Nursing home capacity is shrinking across the country, and the direct care workforce is central to why.

As Paula Span of The New York Times reports, drawing on PHI's latest Key Facts 2026 data, nursing home aides earned a median wage of $20.67 an hour last year, and roughly 40% rely on public assistance to make ends meet. Fewer aides work in nursing homes today than a decade ago, even as the oldest baby boomers turn 80.

Federal Medicaid cuts and immigration rollbacks will only add to the strain on nursing homes and home care. Quality direct care jobs are the foundation for quality care, and building that foundation requires sustained investment in wages, training, and career pathways.

Read the article: https://www.nytimes.com/2026/09/19/well/family/nursing-home-beds-baby-boomers.html

See the latest data on the direct care workforce: https://www.phinational.org/resource/direct-care-workers-in-the-united-states-key-facts-2026/

09/22/2026

𝗝𝗼𝗶𝗻 𝗢𝘂𝗿 𝗪𝗲𝗯𝗶𝗻𝗮𝗿: Direct care workers now make up the largest occupation in the United States, nearly 5.8 million strong, and the long-term care sector will need to fill 9.6 million direct care jobs over the next decade. The data also show real progress: wages have risen over the past ten years, and nursing homes are moving away from contract staffing toward stable, permanent teams.

Those gains are now at risk from Medicaid cuts, the rollback of wage and overtime protections, and the repeal of nursing home staffing standards.

On 𝗢𝗰𝘁𝗼𝗯𝗲𝗿 𝟭𝟱 𝗮𝘁 𝟮 𝗣𝗠 𝗘𝗧, PHI experts Kezia Scales, Stephen McCall, and Sarah Angell will present the findings from Direct Care Workers in the U.S.: Key Facts 2026. They'll highlight emerging trends, explain what the new data mean for the field, and discuss the imperative to strengthen this vital workforce in a turbulent policy environment.

Register via Zoom here: https://phinational-org.zoom.us/webinar/register/WN_7-ISuLUjQXSJ8XIHyO4R5w

As the population of older adults increases, so does demand for direct care workers, with over 886,000 new jobs projected from 2025 to 2035—more than any other occupation in the U.S. Recruitment and retention challenges persist, but new workforce data show movement in the right direction. Federal ...

09/18/2026

As of today, the Department of Homeland Security’s new public charge rule is in effect. Immigrants can now be penalized in their immigration cases simply for using programs they are lawfully eligible for, like Medicaid and SNAP.

Immigrants make up at least 29 percent of the direct care workforce, and nearly half of all direct care workers rely on some form of public assistance to meet their basic needs. This rule forces immigrant workers and their families to choose between the food, housing, and health care they are lawfully eligible for and their future in this country.

The result will be more instability for workers, more turnover for providers, and less access to care for older adults and people with disabilities. Combined with recent Medicaid, labor, and immigration policy changes, it deals another blow to a workforce our care systems cannot function without.

Policymakers should reverse course and invest in policies that strengthen, rather than undermine, direct care workers. Read PHI's comments to DHS:

DHS's final public charge rule puts immigrant direct care workers at risk, threatening care for older adults and people with disabilities. Read PHI's statement.

09/15/2026

Today, PHI released our annual Key Facts report and the most authoritative look at the direct care workforce in the country. This year's data shows the workforce has grown to nearly 5.8 million people, the largest occupation in the United States, with the sector needing to fill an estimated 9.6 million direct care jobs over the next decade as the population ages.

Yet workers are still earning a median of just $17.99 an hour, leaving nearly half reliant on public assistance to get by.

"Direct care workers have held our long-term care system together through years of underinvestment," said Jodi M. Sturgeon, PHI's president and CEO. "At a moment when more families than ever rely on care, federal policies are making these already difficult jobs less secure and workers' livelihoods more uncertain. The consequences extend far beyond the workforce, it reaches every person who needs care."

Medicaid cuts, new restrictions on public benefits, and the rollback of wage, overtime, and staffing protections are converging on a workforce that is majority women, majority people of color, and nearly one-third immigrants.

PHI is calling on policymakers to protect Medicaid funding for home and community-based services, preserve wage and overtime protections, and support immigrant workers, while advancing a longer-term vision through its Universal Direct Care Workforce Initiative™ for a system where training counts, credentials travel, and careers can advance.

Read the full report: https://www.phinational.org/resource/direct-care-workers-in-the-united-states-key-facts-2026/

09/09/2026

“When a caregiver disappears, a patient does not simply lose an employee; they lose a trusted, trained person who helps make it possible for them to live safely at home.”

Immigrants make up a large portion of the home health caregiver workforce, and with the current state of citizenship protocols, they also serve as a major solution to staffing shortages.

09/08/2026

When legal immigration pathways and statuses are restricted, care access, continuity, and quality are undermined. PHI contributed to a recent BBC News feature that highlights the devastating impact of terminating Temporary Protected Status (TPS) for Haitian caregivers.

Immigrants represent more than one in four direct care workers across the United States. Alongside U.S.-born direct care workers, they provide critical daily support to millions of older adults, people with disabilities, and families across America.

TPS is a vital, legal immigration status. Its termination for Haiti and other countries is part of a concerning policy shift to radically restrict immigration by eliminating legal statuses for many individuals already residing in the U.S.

This policy shift harms the direct care workforce and the vital services direct care workers provide. As PHI’s Vice President of Policy and Research, Kezia Scales, notes in the article: "We simply do not have enough people in our domestic market, when you exclude immigrants, to fill those jobs."

Punitive immigration policies and practices push paid caregivers out of the workforce, erode the pipeline of new workers into this field, and compromise access to care for all those who rely on it.

Congress and the states must act to protect immigrants, who are a cornerstone of the direct care workforce and our long-term care system.

Read the full BBC News feature: https://www.bbc.com/news/articles/cg491zp13qqo

Read our policy brief on supporting immigrant caregivers: https://www.phinational.org/resource/phi-midterm-policy-brief-series-support-immigrants/

09/07/2026

This , we honor the 5.4 million direct care workers who provide essential daily support to older adults and people with disabilities across the country. They are the nation's largest workforce, overwhelmingly women, people of color, and immigrants, and quality care depends on the quality of their jobs.

Yet we mark this occasion at a moment of mounting pressure, as the basic labor protections they rely on are being eroded. Federal proposals would strip minimum wage and overtime protections from home care workers and weaken safeguards against misclassification, while the first-ever nursing home staffing standards have been repealed before they could take effect. These rollbacks do not stand alone. Alongside cuts to Medicaid and shifting immigration policy, they are destabilizing the workforce our long-term care system depends on, precisely when demand for care is surging.

These conditions are not inevitable. They are the result of policy choices, and better choices are within reach. Congress and individual states can act by restoring direct care workers' wage and overtime protections, reinstating nursing home staffing standards, and investing in a national direct care workforce strategy.

Labor rights are the foundation of quality care. Read our recent policy brief, Defend Labor Rights: https://www.phinational.org/resource/phi-midterm-policy-brief-series-defend-labor-rights/

09/02/2026

Earlier this year, PHI’s Jake McDonald (Senior Policy Advocacy Specialist) and Jenna Kellerman (Senior Director of Workforce Development) joined California Association for Health Services at Home's At the Table podcast to break down the critical challenges facing the home-based care workforce today. From structural hurdles to the daily realities of providers and workers, they discuss why long-term care for older adults and people with disabilities relies on immediate, systemic investments in job quality.

The good news? We already have the solutions within reach. By implementing PHI's Five Pillars of Direct Care Job Quality and building clear, universal career pathways, we can stabilize this essential workforce.

Read the top takeaways from their conversation or listen to the full episode: https://www.phinational.org/at-the-table-the-workforce-is-the-quality-care/

09/01/2026

Federal policy rollbacks are actively stripping essential workplace protections from our nation’s 5.4 million direct care workers.

As highlighted in McKnight's Senior Living, our midterm policy brief, “Defend Labor Rights,” details the severe consequences of recent actions by the Department of Labor and CMS. By threatening minimum wage and overtime protections, easing independent contractor misclassification, and repealing crucial nursing home staffing standards, these policies devalue the workforce that supports older adults and people with disabilities.

Read the full coverage of our brief and our recommendations for stabilizing the care workforce:

Federal policy changes are stripping away basic workplace protections for the nation’s 5.4 million direct care workers, and it’s imperative that Congress and the states act to reverse the damage, according to the third and final brief in a midterm policy series from PHI.

08/31/2026

The end of Temporary Protected Status (TPS) for Haitian immigrants is already pulling experienced caregivers out of the field. As Howard Gleckman reports in Forbes, tens of thousands of Haitian direct care workers, many with years on the job, are losing the legal work permits their positions depend on. The result is fewer people to care for older adults and those with disabilities at a moment when staffing shortages are already mounting.

Trump’s decision to revoke Temporary Protective Status for immigrants will damage long-term care in the US. One facility had to fire 19 Haitian staffers.