A Crisis in Nearly Half the Country
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According to an Otsuka analysis, 48% of U.S. states are on the brink of a caregiving emergency. Not approaching. Not at risk. On the brink.
Twenty-four states have been deemed to have a critical emergency when it comes to caregiver availability. Their infrastructure—nursing homes, long-term care facilities, home care agencies—is buckling under increased demand.
Here's how states rank, what's driving the crisis, and what it means for families.
The 10 Worst States for Caregiver Availability
Based on comprehensive state rankings analyzing pay, workforce size, job growth, and waitlists:
| Rank | State | Key Problem |
|---|---|---|
| 1 | Texas | 1,095 people per 100K waiting for services (5x national average) |
| 2 | Louisiana | Lowest caregiver pay in the nation ($10.60/hr) |
| 3 | Mississippi | Lowest projected job growth (2,200 by 2028) + $11.04/hr wages |
| 4 | Georgia | Critical shortage—fraction of home health aides per 1,000 seniors vs. national average |
| 5 | Utah | Last in nation for annual caregiver wage growth |
| 6 | Pennsylvania | 112,500 shifts go unfilled every month |
| 7 | Maine | Oldest population in U.S. + 11,000 hours unstaffed weekly |
| 8 | Vermont | Only state with negative job growth (down 5% over 10 years) |
| 9 | Alabama | Below-average pay combined with high demand |
| 10 | Arizona | Rapid senior population growth outpacing workforce |
The 5 Best States for Caregiving
Analysis shows these states lead in supporting both professional and family caregivers:
| Rank | State | Why They're Succeeding |
|---|---|---|
| 1 | New York | 30 caregivers per 1,000 residents—best ratio in nation |
| 2 | North Dakota | Strong pay + low waitlists |
| 3 | Hawaii | High wages + comprehensive support programs |
| 4 | Illinois | Above-average pay + workforce investment |
| 5 | Washington | Growing workforce + state LTSS programs |
Where Washington Ranks
Washington presents a mixed picture:
The Good
- WA Cares Fund launching in 2026—first public LTSS program in nation
- Growing workforce compared to many states
- Above-average Medicaid reimbursement rates for some services
The Challenges
- Family caregiver support ranks among the worst in the nation
- $2.3 billion budget deficit putting pressure on services
- Rural areas facing acute shortages
- Seattle-area cost of living making caregiver wages less competitive
By the Numbers in Washington
| Metric | Washington | National Average |
|---|---|---|
| Home health aides per 1,000 seniors | Above average | — |
| Average caregiver hourly wage | $17-19 | $15.50 |
| Projected job growth (2024-2034) | +25% | +22% |
| HCBS waitlist | Moderate | Varies widely |
What's Driving the Crisis
1. Demographics
The math is simple and brutal:
- 10,000 Americans turn 65 every day
- By 2034, seniors will outnumber children for the first time in U.S. history
- 70% of people turning 65 will need long-term care
- The 85+ population—requiring the most intensive care—is the fastest-growing demographic
2. Workforce Economics
According to Johns Hopkins:
- Average caregiver wage: $15.50/hour
- Fast food average: $16.50/hour
- Amazon warehouse: $19+/hour
Why would someone choose difficult caregiving work for less money?
3. Turnover Crisis
The 2025 Activated Insights Benchmarking Report found:
- Industry turnover: 75-80% annually
- Cost per departure: $2,400+
- Average tenure: Less than 1 year
Agencies spend more time recruiting replacements than developing their workforce.
4. Unpaid Caregivers Are Burning Out
- 53 million Americans provide unpaid family care
- Value of their labor: $870 billion annually
- Many are hitting their limits after years of pandemic-era caregiving
When family caregivers can't continue, demand for professional care spikes—but the workforce isn't there.
State-by-State Deep Dive
The Southern Crisis
The South faces the most acute shortages:
Louisiana offers the lowest caregiver pay in America at $10.60/hour. At that rate, a full-time caregiver earns $22,000/year—below the poverty line for a family of three.
Mississippi combines rock-bottom wages ($11.04/hr) with the lowest projected job growth. By 2028, the state expects only 2,200 home health aide positions—for an aging population of 600,000+ seniors.
Georgia has a "critical" rating with a severe shortage of home health aides relative to its senior population.
The Waitlist Crisis
Some states have massive backlogs of people waiting for home care:
Texas leads with 1,095 people per 100,000 on waitlists—more than 5x the national average. That translates to tens of thousands of Texans waiting for Medicaid-funded home care.
Pennsylvania has a different but equally dire problem: 112,500 shifts go unfilled every month. The services are approved; there's just no one to provide them.
The Wage Stagnation States
Utah exemplifies a frustrating paradox: median household income nearly $16,000 above the national average, but caregiver pay is $16,872 annually—and growing slower than anywhere else in the country.
When caregiving doesn't keep pace with other wages, workers leave for better opportunities.
The Demographic Crunch
Maine has America's oldest population—21.8% of residents are 65+. The state reports nearly 11,000 hours of personal care going unstaffed every week.
Vermont is the only state that saw caregiver positions decrease over a 10-year period (down 5%). Combined with an aging population, this creates an accelerating shortage.
What This Means for Families
If You're in a Crisis State
- Start searching early: Don't wait until you need care tomorrow
- Consider multiple agencies: Spread your options
- Explore family caregiver programs: Some states pay family members to provide care
- Look into veteran benefits: VA Aid & Attendance can fund private care
- Join waitlists immediately: Even if you don't need services yet
If You're Relocating
Families considering moves for retirement or to be near aging parents should factor in:
- Medicaid HCBS availability and waitlists
- Professional caregiver workforce density
- State support for family caregivers
- Cost of private-pay home care
States like New York, Hawaii, and Washington offer better infrastructure—but also higher costs.
If You're a Family Caregiver
- Know your state's support programs (many people don't)
- Connect with Area Agency on Aging for resources
- Consider respite care to prevent burnout
- Explore whether you can be paid for caregiving
What's Being Done
Federal Level
- CMS 80/20 Rule: Requires 80% of Medicaid HCBS payments go to workers (full breakdown)
- H.R. 1 provisions: May reshape Medicaid funding (analysis)
- HCBS spending protections: Advocacy ongoing to protect services
State Innovations
Some states are trying creative solutions:
- Washington: WA Cares Fund provides public long-term care insurance
- California: IHSS pays family caregivers up to $20/hour
- New York: Highest caregiver-to-population ratio through workforce investment
- North Dakota: Competitive wages despite lower cost of living
Industry Responses
Agencies are adapting through:
- Technology to reduce administrative burden
- Flexible scheduling to attract workers
- Higher wages (where rates allow)
- Better onboarding to reduce early turnover
Looking Ahead
By 2034, the U.S. will need 6.1 million additional home care workers according to federal projections.
Current trajectory won't get us there.
The states succeeding share common traits:
- Higher Medicaid reimbursement rates
- Investment in workforce development
- Support programs for family caregivers
- Long-term strategic planning
The states failing tend to have:
- Below-average wages
- No state-level LTSS programs
- Rapid demographic aging without workforce growth
- Political resistance to Medicaid expansion
What You Can Do
For Your Family
- Research your state's programs now—don't wait for a crisis
- Consider long-term care insurance or state programs like WA Cares
- Plan for a future where professional care may be scarce
For Your Community
- Support caregiver wage legislation
- Advocate for Medicaid funding
- Value caregiving work in how you talk about it
For Policy
- Contact legislators about workforce funding
- Support immigration pathways for care workers
- Push for training program expansion
The caregiver shortage isn't inevitable. It's a policy choice—and states that choose to invest are proving it can be solved.
Looking for home care in Washington State? Search our provider directory to find agencies in your area.