Home-Based Care Employment Exceeding Pre-Pandemic Levels

Though labor shortages persist, glimmers of hope are on the horizon.

Employment in the home-based care sector rose above pre-pandemic levels in 2023, according to the Medicare Payment Advisory Commission (MedPAC). The U.S. Department of Commerce defines this sector to include hospices, home health agencies, private duty, pediatric agencies and other providers of care in the home.

Total employment in this sector was 5% higher in July 2023 than in February 2020, MedPAC reported. However, these aggregated data don’t necessarily indicate what is happening in individual markets.


“These data may not reflect labor conditions in local geographic areas,” MedPAC said in its March 2023 report to Congress. “Despite the rebound in employment since the pandemic, there have been concerns from home health care stakeholders that staffing remains a challenge.”

MedPAC cited the National Association for Home Care & Hospice (NAHC) as a source for this information. A 2023 report from the Hospital & Healthcare Compensation Service (HCS) and NAHC also indicated that turnover had fallen last year.

Nevertheless, workforce pressures and associated costs are overwhelmingly the industry’s most damaging headwind, including the associated wage hikes, enhanced benefits and bonus programs. The shortages also have reduced clinical capacity, which has contributed to drops in patient census and length of stay for many providers.


Some companies have closed facilities or shut down altogether as a result of the labor shortage.

The workforce issue is longstanding. It existed before the pandemic, though it worsened during the outbreak. While the MedPAC data shows some incremental improvement, providers are by no means out of the woods.

“It has been really hard for hospices in different markets to find good, qualified staff who want to work in this space, so doing well with recruitment is one of the biggest challenges,” Altonia Garrett, COO of Blue Ridge Hospice, previously told Hospice News. “That’s going to be more of an issue to meet increases in demand in the next several years, particularly with clinical staff.”

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