I spent over a decade focused on provider workforce development, so I tend to look at healthcare challenges through a slightly different lens. While there’s a lot of focus on how hospitals and long-term care facilities get paid when agencies close, I’m more concerned with something that doesn’t get enough attention—how providers themselves are incentivized to serve older adults and vulnerable populations.
Because at the end of the day, payment structures might keep a facility open, but incentives determine who actually shows up to care for the people living there.
The Workforce Crisis in Elder Care
In elder care, workforce shortages aren’t an abstract policy issue—they’re a daily reality. The same nurse aides, social workers, therapists, and nurse practitioners who keep older adults safe are stretched thinner every year. Many of these professionals work in Health Professional Shortage Areas (HPSAs) identified by the Health Resources and Services Administration (HRSA). These are regions that simply don’t have enough qualified providers to meet local needs.
Shortages are especially visible in home- and community-based care, nursing homes, and small assisted living facilities. Many of these organizations close not only because of low reimbursement rates but also because they can’t recruit or retain staff. Without strong incentives, it’s hard to build a stable elder care workforce.
Why Incentives Matter More Than Paychecks
Paying facilities on time keeps the lights on, but incentives keep providers motivated. Federal and state programs have tried for years to fill these workforce gaps. HRSA’s National Health Service Corps (NHSC) and State Loan Repayment Programs (SLRPs) offer loan forgiveness or financial bonuses for clinicians who agree to work in shortage areas. For rural and underserved elder care communities, these programs are often a lifeline.
Federal Programs That Work (and Why They Fall Short)
International medical graduates (IMGs) also play an essential role in elder care. Many physicians who train in the U.S. on J-1 visas can stay in the country if they agree to work for several years in underserved areas. This “waiver” process—often tied to HRSA shortage designations—has quietly sustained access to primary and geriatric care in many communities.
When funding and coordination align, these programs make a real difference. They fill critical roles in skilled nursing facilities, rural hospitals, and community clinics that serve older adults. But these pipelines depend on consistent investment. When budgets fluctuate, recruitment and retention suffer, and older adults lose continuity of care.
How Funding Flows Leave Providers Behind
When agencies close or budgets tighten, public discussion usually centers on financial stability—how to keep the doors open. Less attention goes to whether providers have meaningful reasons to stay once they arrive.
Most state and federal dollars flow through institutions in the form of reimbursements, grants, or emergency relief. Those payments help facilities survive, but they don’t necessarily strengthen the workforce foundation—the people providing the care itself.
If we want to sustain access to quality elder care, we need to rebalance funding. Money should reward recruitment, retention, and training for providers, not just institutional survival.
Investing in People, Not Just Places
Elder care depends on relationships—between patients and caregivers, clinicians and families, providers and communities. Policies that overlook those human connections treat elder care as an institutional issue instead of a workforce one.
We can’t fix access without fixing incentives. The strength of our elder care system starts with the people who choose to work in it. Their choices must be supported, valued, and sustainable.
Let’s start funding the people who care, not just the places where care happens.
