Who will care for aging Baby Boomers?

Families searching for beds for aged or sick loved ones soon may find that there isn’t a skilled nursing facility available, if there aren't enough nurses and other workers to fill the growing labor shortage.

Experts say that the skilled-care industry is facing a perfect storm. First, the U.S. population is aging and living longer, according to the U.S. Census Bureau. This aging demographic is increasing the number of aged individuals who need a high level of care. Second, the Covid pandemic escalated the level of burnout among direct-care workers. Finally and most recently, tighter immigration policies are exacerbating existing shortages of these workers, as 28% of direct-care workers at skilled-care facilities are foreign-born, compared to 19% of the U.S. workforce overall.

As a result of this perfect storm, there may not be enough room available at skilled nursing facilities for the people who need them, forcing patients to instead go into assisted living homes, which are meant to offer a less intensive level of care, said Jeffrey Covington, director of healthcare research and data analytics for BOK Financial®.

He explained that there are four tiers of care:

• Skilled nursing is the highest, for the patients requiring the most care. These facilities provide 24/7 medical care and rehabilitation services for individuals recovering from surgery, illness or injury.
• Assisted living for those who need help with daily activities such as bathing, dressing, and medication reminders, but do not require intensive medical care.
• Independent living for active older adults who can live on their own but want the convenience of community living.
• Home health, which delivers medical or therapeutic services—such as nursing care, physical therapy, occupational therapy and assistance with medications—in a person’s home.

As the number of available beds in the higher tiers fill up, patients are directed down to the next level of care, even if they need a higher level of care, Covington said. For instance, relatives may have to care for loved ones with the help of home-health professionals. Home health is what will fill the gap in care available to serve the increase in patients, Covington noted.

Some facilities have had to curtail admissions
Moreover, even when there are technically open beds, skilled nursing facilities can’t admit new residents if there aren’t enough workers to care for them. Doing so would “jeopardize patient care and or increase the possibility of government intervention. Therefore, facilities have no choice but to limit admissions.” Covington said.

For some facilities, this conundrum of open beds but not enough staff to admit new patients is already the reality. One-quarter of senior living and care organizations operating single-site facilities has limited admissions over the past year because of staffing issues, according to a June 2025 Ziegler CFO Hotline survey. For organizations with multiple facilities, that figure is 18%.

When there are not enough skilled-care beds available for the people who need them, everyone suffers. Aged and sick individuals may receive a lower level of care than they need. Their relatives may have to care for them even if they are ill-equipped to do so. Meanwhile, the facilities themselves take a direct hit to revenue because they’re paid on a per-patient, per-day basis, Covington said.

A closer look at the worker shortage
Across the board, skilled-care facilities in rural areas are facing the biggest lack of available workers, the Ziegler survey found. However, single-site and multiple-site organizations in metropolitan and semi-metropolitan areas are not immune to the problem, either. Overall, the Ziegler report found that “multi-site rural organizations face the most critical shortages, especially with regards to CNAs and LPNs. Sub-metropolitan multi-sites struggle most with RN recruitment and single-site organizations generally report lower vacancy rates overall.”

Nurses, in particular, are in high demand, the survey found. When asked which professions are the most difficult to recruit and retain, Certified Nursing Assistants (CNAs) was the most common response, followed by Registered Nurses (RNs) and then Licensed Practical Nurses (LPNs). “The total stock of nurses has not been growing fast enough to meet the demand,” Covington said.

This lack of nurses and other direct-care professionals is not new, but it has worsened and, without intervention, will only get worse, experts said. One contributing factor is burnout, which reached its height during Covid.

“Healthcare took a big hit during the pandemic and is still feeling the effects,” said Jessica Johnson, senior director of senior housing and care at BOK Financial. Due to the heavily regulated nature of skilled nursing and the higher mortality rate than at less-acute-care facilities, the stakes are high, which may increase direct-care workers’ stress. “It's hard to attract and retain talent to an industry under that much scrutiny and pressure,” she noted.

Another factor that’s affecting the U.S. workforce across the board is the high number of Baby Boomers retiring. Over the next six years across all industries, employers may have to replace between 10.8 million and 14.8 million employees who are “Peak Boomers”—that is, people who will reach the peak retirement age of 65 between now and 2030.

Finally, a more recent factor is the tighter stance on U.S. immigration, Covington said. Of the organizations surveyed by Ziegler, 15% said they are trying to recruit international/foreign workers but are facing visa or legal hurdles. One organization quoted in the Ziegler report said that they already “have been in a holding pattern for waiting for foreign trained nurses for over a year and a half. We began the process two-and-a-half years ago.” Another organization said they have a contingency plan to hire additional per diem staff to account for the expected impact, although they expect it to be slight.

Meanwhile, home-health care—the tier that Covington anticipates will be key in absorbing the large increase in patients—may experience one of the largest hits from tighter immigration policies. That’s as nearly one in three home caregivers are foreign born.

Policy changes, help of AI may be the path forward
Like other industries that rely on immigrant workers, the skilled-care industry may benefit from what experts call a cogent immigration policy. This policy would be somewhere in between the two extremes of having open borders, which could impact the economy and pose national and local security risks, and aggressive deportations, which also could have negative effects on the economy, said Steve Wyett, BOK Financial chief investment strategist.

“If the U.S. gets overly aggressive with deportations, then it will shrink the labor force,” he explained. “If we shrink the labor force, that probably means more competition for the remaining workers. If competition goes up, that might mean wages go higher. If wages move higher, that's going to be a problem from an inflation standpoint.”

This trend of greater competition leading to higher wages is already being seen in the skilled-care industry, especially when organizations have to rely on more expensive per diem workers, such as traveling nurses, to fill staffing gaps. Of the organizations surveyed, 96% said their staffing costs increased over the past 12 months, including 36% that said these costs have increased significantly, the Ziegler report shows.

Altogether, the compounding challenges that the long-term industry faces—workforce shortages, rising costs and the pressures from the aging U.S. population—may require the help of AI and technological solutions to extend the capabilities of staff while maintaining quality of care, Covington believes.