Personal Care Aides: Assessing Self-Care Needs and Worker Shortages in Rural Areas


Susan A. Chapman, Lillie Greiman, Timothy Bates, Laura M. Wagner, Ari Lissau, Kirsi Toivanen-Atilla, and Rayna Sage

Oct 2022

Previous research has documented shortages of personal care aides who provide Medicaid home and community-based services, but there are few detailed geographic data to determine the areas of greatest need and assess the availability of personal care aides nationwide. Using 2013–17 data from the American Community Survey and the Office of Management and Budget, the authors analyzed potential need for personal care aide services among adults and the supply of aides across the US. Areas with the highest percentages of adults with self-care disability were mainly in the South, and the gap between the potential need for personal care aide services and the aide supply was greatest in southern states. Within states, there were fewer personal care aides per 1,000 adults with self-care disability in the more rural and most rural areas than in the least rural areas. Wage and benefit increases, improved training and career opportunities, increased flexibility in state Medicaid policies on paid family caregiving, incentives and compensation for travel, and increased data collection and government tracking of workforce data could help boost the supply of personal care aides in rural America.

This article was featured in a special Health Affairs issue on Disability and Health in October 2022.

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