The Workforce Problem Isn't Coming - It's Already Here

by Jamie Daugherty, Executive Director

Workforce challenges in home-based care are often talked about as a future issue.

But for those of you running agencies, this isn’t theoretical. It’s operational.

It shows up in delayed starts of care.
It shows up in referral decisions you don’t want to make.
It shows up in how often your leadership team is stepping in to fill gaps.

The reality is simple: we are not preparing for a workforce shortage—we are already operating within one.

Demand Is Growing Faster Than Capacity
The demand side of this equation is well understood.

We have an aging population, increasing acuity in the home, and a healthcare system that is continuing to shift care out of institutional settings. Hospitals, health systems, and payers are all looking to home-based care as part of the solution.

But capacity is not keeping pace.

Across home health, hospice, and in-home care, agencies are competing for the same limited workforce. At the same time, the expectations placed on that workforce continue to increase—clinically, administratively, and operationally.

This imbalance is not temporary.

This Is a Structural Issue
It’s easy to frame workforce as a recruitment problem. And recruitment is certainly part of it.

But what we are experiencing is broader than that.

• Retention pressures are real
  Burnout, workload, and competing opportunities are driving turnover across all service lines.
• Training pipelines are limited
  Whether it’s nurses, aides, or caregivers, the pipeline into home-based care is not keeping up with demand.
• Regulatory and reimbursement pressures add complexity
  Requirements continue to increase, while reimbursement does not always reflect the true cost of delivering care.
• Geography matters
  In many parts of Oregon, particularly rural communities, workforce limitations are even more pronounced.

For agency leaders, this creates a constant balancing act between access, staffing, and sustainability.

What This Means for Agency Operations
Workforce constraints are shaping decisions in ways that would have been unthinkable even a few years ago. 

Agencies are:

• Being more selective in the patients they can admit
• Adjusting service areas based on staffing availability
• Rethinking productivity expectations and team structure
• Investing more time in retention than recruitment

None of these are ideal. But they are necessary in the current environment.

Where We Go From Here
There isn’t a single solution to the workforce challenges we’re facing.

But there are a few areas where alignment matters: 

• Retention has to be a priority
  Keeping the staff you have is just as important—if not more—than bringing in new staff.
• Workforce expectations need to align with reality
  At both the policy and organizational level, we need to ensure expectations match what is operationally feasible.
• Collaboration across providers matters
  This is not a problem any one agency can solve alone.

A Place to Have the Right Conversations
This is exactly why convening as a provider community matters.

At the upcoming OAHC Annual Conference on April 16–17 in Salem, workforce will be a central theme—not just in formal sessions, but in the conversations happening between peers.

Sessions like “The Power of Retention: How to Keep Your Best People” and broader discussions on workforce, leadership, and operations are designed to address what agencies are dealing with right now—not in theory, but in practice.

Just as important, it creates space to connect with others facing the same challenges, share strategies, and align around what needs to happen next.

Moving Forward
Workforce challenges are not new to this field. But the scale and persistence of what we’re seeing today is different.

For agency leaders, this is no longer about short-term fixes. It’s about adapting operations, supporting teams, and advocating for policies that reflect the reality on the ground.

Because access to care at home ultimately depends on one thing:

Having the people to deliver it.

OAHC will continue working to ensure that workforce realities are clearly understood and represented in the policies shaping home-based care.