By Maureen Glynn
Many of us have cared for, are caring for, or will care for aging parents and loved ones. Supporting them can be rewarding and meaningful, but it often brings real challenges and the difficult task of finding good, affordable care.
For decades, the Commonwealth has been a national leader in supporting older adults who wish to age at home. Through MassHealth Long-Term Services and Supports (LTSS), the consumer-directed Personal Care Attendant (PCA) Program, and the Frail Elder Waiver, Massachusetts has invested in community-based care rather than institutional placement.
That strategy reflects both fiscal prudence and personal dignity. Home- and community-based services are generally less costly than nursing facility care and allow older adults to remain connected to family and community.
But as the baby boomer generation ages, the conversation is shifting. The question is no longer simply how programs are structured. The question is whether there will be enough caregivers to sustain them.
Across Massachusetts, home care providers continue to report difficulty recruiting and retaining direct care workers. These jobs — essential to keeping older adults safe and independent — are physically demanding and emotionally complex. At the same time, the Commonwealth’s high cost of living intensifies labor market competition.
Demographic trends make the challenge clear. The number of residents over 75 — and particularly over 85 — is steadily increasing. Demand for in-home services under LTSS programs will likely grow alongside it. If workforce supply does not expand at a similar pace, strain may emerge in the form of longer wait times, heavier reliance on unpaid family caregivers, or increased use of higher-cost institutional settings.
To its credit, Massachusetts has not ignored these realities. In addition to prioritizing home- and community-based services in MassHealth policy and stabilizing providers with federal pandemic relief funds, the state has launched and advanced several workforce-focused efforts to strengthen and professionalize home care.
Establishing Licensure and Standards for Home Care Agencies
The Massachusetts Legislature has advanced legislation to create a formal licensure framework for non-medical home care agencies. This proposal would establish baseline operational standards, including requirements for worker training, background checks, insurance coverage, and safe working conditions. It would also create advisory structures to help address workforce concerns and quality oversight.
As demand for home care accelerates, standardization may help ensure consistency, safety, and professionalism across providers — reinforcing public confidence while improving recruitment and retention.
Expanding Workforce Development Initiatives
The Massachusetts Executive Office of Health and Human Services has implemented workforce initiatives to recruit, train, and retain health and human services workers, including those in home care. These efforts include career pathway development, sector-based training partnerships, and strategies to address shortages across the broader health care system.
While not limited to home care aides, these programs help build the pipeline of qualified caregivers and create more sustainable professional pathways within the sector.
Supporting the PCA Workforce
The Personal Care Attendant Workforce Council plays a central role in supporting access to a stable, qualified PCA workforce. By negotiating wages and benefits for PCAs and promoting training and workforce supports, the Council helps sustain one of the largest components of the Commonwealth’s home-based care system.
Because the PCA program is foundational to aging in place, workforce conditions within this model have system-wide implications for access and stability.
Investing in Broader Workforce and Caregiver Supports
The Commonwealth has directed significant funding toward workforce development programs that train workers for health care and related industries. These investments, while not exclusively targeted to home care, contribute to the broader caregiving labor pool.
At the same time, advocacy organizations continue to promote policies that strengthen the overall caregiving ecosystem — including tax proposals, workplace protections, respite support, and recognition of family caregivers. Informal caregivers remain an indispensable complement to professional home care services.
Massachusetts has built a strong framework for aging in place. Its investments in MassHealth LTSS, consumer-directed care, and community-based services have positioned the state as a leader.
Looking ahead, workforce sustainability may need to move even closer to the center of aging policy discussions. Thoughtful consideration of reimbursement structures, training pipelines, career ladders, and retention supports could help align workforce capacity with projected demographic demand.
Direct care workers are, in many ways, the foundation of the Commonwealth’s aging strategy. Their stability affects not only individual families, but also hospital capacity, long-term care expenditures, and overall economic participation.
Massachusetts has often led the way in healthcare innovation. Ensuring a resilient home care workforce may represent the next chapter in that leadership — supporting older adults, strengthening families, and preserving the promise of aging in place.