Addressing the in-home care workforce gap in your city

A local workforce response succeeds when it improves the job as well as the reliability of care.

1. What does a local workforce gap look like in daily life?

The gap is not simply the difference between a posted job and an applicant. It appears when a person cannot obtain help with bathing, meals, mobility, or medication routines at the hours that make a home workable. It appears when a worker loses income because a client cancels, then drives across town for a short shift, or when a family repeatedly explains a routine to a new person. A city should map these experiences by neighborhood, language, time of day, and type of service, not rely only on regional averages. The U.S. Bureau of Labor Statistics projects substantial demand for home health and personal care aides as the population ages (BLS, 2024). Demand alone does not explain shortages. Pay, benefits, job quality, transportation, training capacity, and the structure of public reimbursement all shape whether people can remain in this work.

2. Why must pay and job quality be part of the solution?

Recruitment campaigns cannot fix a job that does not provide a predictable living. Direct-care workers often manage physically demanding tasks, emotional strain, fragmented schedules, and limited advancement while caring for people with complex needs. Competitive compensation matters, but so do paid orientation, paid travel time where appropriate, sick leave, benefits, respectful supervision, and a reliable way to raise a safety concern. These investments can reduce turnover and preserve relationships that make care safer. PHI's workforce research documents the relationship between job quality and the stability of long-term services and supports (PHI, 2024). Local leaders should listen directly to workers, including those who left, rather than assuming a single incentive will solve every barrier. A retention plan should describe how it changes the actual workday and how the city or provider will measure whether workers experience that change.

3. How can training improve care without creating another barrier?

Training should prepare workers for the work they are asked to do, pay them for their time, and recognize skills that can lead to better roles. Practical instruction may include safe transfers, infection prevention, communication with people living with dementia, documenting changes, boundaries, and how to obtain help. It should be available in languages workers use and scheduled around real caregiving and transportation needs. Training alone is not a substitute for adequate staffing: a well-trained worker still cannot safely cover impossible workloads. The National Institute for Occupational Safety and Health emphasizes that worker safety requires organizational controls as well as individual instruction (NIOSH, 2024). Partnerships with community colleges, workforce boards, labor organizations, and home-care employers can create paid pathways, but they should monitor completion, placement, wages, and retention, not celebrate enrollment alone. Mentoring by experienced workers can make early shifts safer and less isolating.

4. Which local data make planning more honest?

Collect data that show both service demand and the workforce conditions behind it. Useful indicators include requests that went unfilled, hours missed, canceled visits, travel distance between assignments, turnover, vacancy duration, injury reports, and the neighborhoods where people wait longest. Disaggregate carefully to identify inequities while protecting privacy in small areas. Pair numbers with structured listening sessions for older residents, unpaid caregivers, direct-care workers, and providers. Ask what happens after a visit is missed, not just whether an agency filled the slot. The Administration for Community Living supports state and local networks that connect older adults and caregivers with services, making those networks important partners in interpreting access gaps (ACL, 2024). Publish a concise dashboard only if it explains definitions and limits. Data should guide investment, not become a scorecard that hides the people behind a percentage.

5. What can cities do with partners they already have?

Cities do not usually employ every home-care worker, but they can convene the people who shape local conditions. Workforce boards can fund training and transportation supports. Transit agencies can identify routes that make early or late shifts possible. Community colleges can align credentials with real employer needs. Public health, aging, disability, and housing offices can share non-identifying information about access barriers. Providers and worker organizations can test scheduling, mentoring, and career ladders. The strongest collaboration has a modest initial purpose, a written role for each partner, and a public review date. Avoid asking workers or families to attend repeated meetings without compensation or visible follow-through. The U.S. Department of Labor's good-jobs framework highlights fair pay, worker voice, flexibility, and safety as connected job-quality elements (U.S. Department of Labor, 2023). Partnerships should use that lens to improve conditions, not merely market openings.

6. How should technology support, rather than intensify, the workforce?

Scheduling software, mobile documentation, telehealth, and communication tools can reduce duplicated calls and help teams see changes quickly. They can also create constant surveillance, unpaid after-hours work, inaccessible interfaces, or unrealistic productivity targets. Before procurement, ask workers to test the workflow during a paid shift. Measure whether the tool shortens documentation, improves continuity, or simply transfers clerical work to the person providing hands-on care. Build in training, technical support, privacy protections, and a process for correcting inaccurate records. Technology should never be used to justify sending a worker alone into a task that requires two people or clinical assessment. NIST's guidance on trustworthy technology underscores the importance of validity, reliability, accountability, and transparency in systems that affect people (NIST, 2023). A local technology policy can require human review for consequential decisions about assignments, performance, or access to work.

7. How can leaders tell whether the response is working?

Set measures that reflect both worker stability and the experience of people receiving care. Track retention at 90 days and one year, average hours, wage progression, paid training completion, travel burden, missed visits, continuity of caregiver, and participant-reported reliability. Review unintended effects: a bonus that attracts applicants but leaves schedules chaotic, or a digital system that works only for employees with newer phones. Compare outcomes across neighborhoods and groups to avoid widening disparities. Share results in plain language and adjust investments when the evidence points elsewhere. A workforce strategy should also acknowledge what local government cannot solve alone, such as state reimbursement rates, while making concrete commitments within its authority. The National Academies' work on long-term care describes workforce adequacy as fundamental to a high-quality system, not an optional add-on (National Academies of Sciences, Engineering, and Medicine, 2022). Durable progress is visible in a more sustainable job and a more dependable home-care relationship.

Bottom line

Addressing a workforce gap means making care work sustainable: listen locally, improve job quality, remove practical barriers, and hold every partnership accountable for reliable care at home.

8. What should residents and decision-makers ask for next?

A public workforce plan should make a few commitments that residents can follow: a baseline of unfilled care needs, a worker-informed job-quality agenda, an accountable lead agency, and dates for reporting progress. Older adults and caregivers can describe the practical impact of missed or changing visits without assigning blame to individual workers. Workers can identify barriers that do not appear in payroll data, such as unpaid waiting time, unsafe assignments, or schedules that cannot accommodate transit. Providers can show where reimbursement or credentialing rules make continuity difficult. City leaders should combine those accounts with transparent data and pursue state and federal partners where local authority is limited. The point is not to promise instant staffing. It is to build a local care economy in which skilled people can enter, remain, and advance in work that older residents depend on every day.

9. How can a plan remain accountable?

Review the plan in public at regular intervals and publish the choices made when results are disappointing. A workforce gap is often discussed in abstract terms, but budget decisions, contracting standards, transit schedules, and training access are concrete choices. Name the tradeoffs, invite workers and care recipients to comment, and revise the plan when evidence shows a barrier was underestimated. Accountability also means avoiding claims that a city has solved an issue simply because it announced a program. Progress is sustained only when jobs are sufficiently stable and households can count on care arriving safely.

Residents deserve regular, plain-language updates on whether visits are more reliable and jobs have become more sustainable. That record allows leaders to correct course before another household loses essential support.