---

type: claim
domain: health
description: "Universal workforce shortages and facility closures indicate systemic care capacity failure not regional variation"
confidence: proven
source: "AARP 2025 Caregiving Report"
created: 2026-03-11
supports:
  - "family caregiving functions as poverty transmission mechanism forcing debt savings depletion and food insecurity on working age population"
reweave_edges:
  - "family caregiving functions as poverty transmission mechanism forcing debt savings depletion and food insecurity on working age population|supports|2026-03-28"
---

# Caregiver workforce crisis shows all 50 states experiencing shortages with 43 states reporting facility closures signaling care infrastructure collapse

The paid caregiving workforce crisis has reached universal geographic scope and is now causing structural capacity loss. All 50 US states report home care worker shortages, 92% of nursing homes report significant or severe workforce shortages, and approximately 70% of assisted living facilities face similar constraints. Most critically, 43 states report that Home and Community-Based Services (HCBS) providers have closed entirely due to inability to staff operations.

This is not a regional labor market phenomenon or a temporary post-pandemic disruption — it represents systemic failure of the care labor market at the wage levels the current system can support. Paid caregivers earn a median of $15.43/hour, a wage that cannot compete with alternative employment in an economy where many entry-level positions now start above $15/hour.

The facility closures in 43 states indicate the crisis has moved beyond "shortage" into "collapse" — providers are exiting the market entirely rather than operating understaffed. This creates a cascading effect where remaining facilities face even greater demand pressure, accelerating the shift of care burden onto unpaid family caregivers.

## Evidence

- **All 50 states** experiencing home care worker shortages (AARP 2025)
- **92%** of nursing home respondents report significant/severe workforce shortages
- **~70%** of assisted living facilities report significant/severe shortages  
- **43 states** report HCBS providers have **closed** due to worker shortages
- Median wage for paid caregivers: **$15.43/hour**

## Challenges

None identified. This is a descriptive claim about measured workforce conditions across all 50 states.


### Additional Evidence (confirm)
*Source: [[2025-07-24-aarp-caregiving-crisis-63-million]] | Added: 2026-03-15*

AARP 2025 data confirms: 92% of nursing homes report significant/severe shortages, ~70% of assisted living facilities report similar shortages, all 50 states face home care worker shortages, and 43 states have seen HCBS provider closures due to worker shortages. Median paid caregiver wage is only $15.43/hour, yet facilities still cannot attract workers.


### Additional Evidence (extend)
*Source: [[2026-03-20-fierce-healthcare-obbba-domino-effect]] | Added: 2026-03-20*

ARPA home care funding expires end of 2026, creating a funding cliff for the home care workforce. 40% of home care workers live in low-income households and 1/3 rely on Medicaid themselves. The ARPA expiry compounds the existing workforce crisis by removing federal funding support at the same time that OBBBA work requirements threaten workers' own Medicaid coverage. This is a supply-side shock layered on top of the existing shortage.

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Relevant Notes:
- [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
- [[modernization dismantles family and community structures replacing them with market and state relationships that increase individual freedom but erode psychosocial foundations of wellbeing]]

Topics:
- [[domains/health/_map]]
