On the surface, the potential for deeper investment in the care economy is clear. The President-elect won the 2024 election with significant working-class support, from voters for whom the economy was an overriding concern. The 2024 Republican Party Platform vowed both to protect at-home care for older adults and to address the shortage of direct care workers.
Yet two major policy priorities of the incoming administration threaten to undermine these goals, at the expense of one of the most crucial engines of our nation’s economic future: the direct care workforce. Direct care work represents our nation's largest occupation, with the most anticipated growth and powerful potential to strengthen the economy. As Americans age—our population of older adults is projected to increase to 88.8 million by 2060—it will only be possible to meet demand through significant investment in the quality of these jobs.
Family caregivers, advocates, consumers, direct care workers and all Americans should have significant concern about two declared Administration priorities:
- Anticipated cuts to Medicaid. Medicaid covers more than 72 million of the most vulnerable Americans, including ensuring long-term services and supports for more than 5.6 million people living at home and in community-based institutional settings. PHI has long called for protecting and strengthening the Medicaid program—as a vehicle to improve the quality of direct care jobs, expand coverage, and ensure consistent, high-quality care. Cuts to this program will bring significant disruption to care in the United States, and have profoundly negative impacts for older adults, people with disabilities, and direct care workers.
- A public pledge to “carry out the largest deportation operation in American history.” This short-sighted and inhumane policy will significantly impact immigrants to the United States, who account for more than one in four (28%) of all direct care workers. A 2023 study found local increases in immigration leading to higher quality, more person-centered care by multiple measures. Recent research demonstrates that immigrant workers tend to remain in direct care positions longer than U.S.-born workers, providing vital stability in long-term care.
Conversely, studies have shown that states with harsher restrictions on immigrant workers directly correlate with reduced staffing levels in care settings.
‘Our aging population will require more care, not less. Our economy needs more workers, not fewer.’
It’s worth noting that these statistics do not directly factor in the so-called “gray market,” which refers to home care workers hired directly by individuals or households using private funds. PHI’s estimates of the size and anticipated growth of the direct care workforce do not include this gray market, which is difficult to measure. A focus on deporting undocumented individuals and families will have a particular impact in this area and further pressurize the overall demand for care.
As voters expressed, our nation’s economy faces significant challenges. Fixing them is a vital and important goal. That shouldn’t happen at the expense of our nation’s most vulnerable.
Every day, more than 5 million direct care workers in our country provide essential care and support for millions of older adults and people with disabilities. They deserve quality training, fair compensation, quality supervision and support, respect and recognition, and real opportunity.
The mathematics of care in the United States are unforgiving. Our aging population will require more care, not less. Our economy needs more workers, not fewer. And our long-term care system needs strengthening, not dismantling. The direct care workforce represents not just essential care providers but a vital economic force—one that could power significant economic growth if properly supported.
The question for policymakers on both sides of the aisle shouldn’t be about whether our nation can afford to invest in care—but rather, about whether we can afford not to. These workers, and the millions they support, deserve care and support from us in turn. They deserve our resolve.
Jodi M. Sturgeon is president & CEO, at PHI in New York.
Photo credit: Shutterstock/Monkey Business Images
