Supporting the home care workforce across the Southern United States: impetus, exploration, and policy strategies

Southern states face severe home care labor shortages due to low wages, poor working conditions, and limited career advancement opportunities, which are exacerbated by the region's historical labor policies and economic inequalities. This study analyzed workforce size in relation to the population of older adults likely to require paid home care services, subsequently contextualizing those results using a thematic analysis of state American Rescue Plan Act section 9817 spending plans to identify trends in proposed initiatives designed to strengthen the workforce across the region. Our findings highlight significant disparities in workforce availability, with more diverse areas with higher concentrations of Hispanic, immigrant, and low-income populations exhibiting higher workforce capacity compared with less diverse regions. We also found consensus across states on the inadequacy of direct care worker wages, demonstrated by the large number of proposed reimbursement rate increases included in the state spending plans.