The current economy faces unsustainable conditions.

(SeaPRwire) –   Home healthcare workers account for fewer than 3% of all jobs, yet Matthew Nestler, a senior economist at KPMG, sees both reason to pay attention and cause for concern.

“The current system is unsustainable right now,” he told , “and it’s buckling even before we face the massive aging and retirement of the baby boomers—the largest generation ever to go through this process.” 

Even though they make up just a small fraction of the workforce, home healthcare workers have an outsized impact on the rest of the economy, Nestler argued. He explained that if people can’t get the healthcare they need, it will lead to an increase in unpaid elder care, triggering domino effects across the labor market. The person forced into providing unpaid elder care, he noted, “is employed in another part of the economy, so they pass up career opportunities; reduce their work hours; or leave the labor force entirely.”

Think of this as the home healthcare sector’s canary in the coal mine. 

Healthcare—including home healthcare and elder care—has thrived despite a cooling labor market. The sector alone added 693,000 jobs in 2025, while the U.S. economy saw a total increase of just 116,000 jobs. That means without healthcare, the economy would have lost about 577,000 jobs. The sector’s resilience is largely due to the baby boomers: the oldest are now 80, and the youngest are nearing retirement age. This generation represents nearly 73 million people in the U.S. and now requires more care as they age. According to Centers for Medicare & Medicaid Services data, personal healthcare spending for older adults topped $1.2 trillion in 2020, averaging around $22,000 per person. 

Fewer hours, more problems

Citing Bureau of Labor Statistics data, Nestler wrote in a LinkedIn post this week that while home healthcare services added 7,000 jobs in March, this is still well below 2024’s average of 12,900 added jobs per month—far less than the growth needed to keep up with high demand. Moreover, weekly hours for healthcare services employees have dropped from a peak of about 30 in March 2023 to 28 today, marking the lowest point in nearly two decades. This decline is steepest for production and nonsupervisory employees in the sector.

KPMG found that 10% to 20% of workers across every industry provide unpaid elder care. Many of these individuals are Gen Xers and millennials, who hold leadership and management positions in their jobs. While companies are recognizing the importance of unpaid care and offering some benefits, the burden of unpaid care will increase unless the labor supply is replenished, Nestler said. 

He noted that falling hours and meager payroll additions for home healthcare workers are signs that external pressures are straining this critical sector.

“Demand for home healthcare services continues to rise as the population ages and more seniors prefer to age in place at home,” he wrote on LinkedIn. “Yet hours are declining while payrolls grow modestly and prices rise.”

Burnout and immigration woes

Home healthcare jobs, which rely on public funding with low reimbursement rates and have historically had a large labor supply, typically pay low wages—less than $35,000 annually. 

These low wages have led to underemployment, forcing home aides and elder care workers to sometimes take on one or two additional jobs. Others leave the sector entirely due to abysmal pay combined with the emotional and physical toll of the work, Nestler said.

While a post-pandemic surge of immigrants willing to take low-wage jobs helped expand the workforce, Nestler warned that the Trump administration’s immigration crackdown has slowed that growth. A survey of 691 healthcare workers across 30 states by Physicians for Human Rights and the Migrant Clinicians Network found that 26% of clinicians said immigration enforcement has directly impacted patient care, particularly preventive care, chronic pain management, and mental health treatment.

“These are really difficult jobs,” Nestler said. “They’re emotionally challenging; they can also be physically demanding in some ways. It reflects our society’s values that some of the most necessary jobs—caring for the oldest among us—are the lowest paid.”