Home Care Clinicians are Asking for More Support, and They’re Right. But We’re Still Missing the Bigger Fix.

By Liz Friedman, Co-Founder and CEO of GPS Group Peer Support

The home care clinicians at Mass General Brigham who are pushing for a first union contract are asking for what any of us would recognize as reasonable: manageable caseloads, fair compensation, and clearer expectations. Their demands deserve swift attention and action. But if we treat this moment solely as a labor dispute, we will miss the deeper issue it reveals, along with the opportunity to fix it.

Home-based care is no longer peripheral to our health system. It is foundational. This workforce supports millions of patients each year, including older adults, people living with chronic illness, and individuals recovering from acute medical events who need skilled care at home. As the population ages and medical complexity increases, demand for home health clinicians is projected to grow significantly over the next decade, driven both by demographic shifts and a clear preference for receiving care outside institutional settings. In addition, home care services are generally less expensive than hospital care or nursing home care, so supporting this workforce is a significant financial investment as well.

And yet, the systems supporting this workforce have not kept pace with the reality of the work.

In my role as CEO of GPS Group Peer Support, I have partnered with organizations like New England Life Care and have seen firsthand what this work actually entails. Home care clinicians are not moving through controlled environments with immediate backup. They are traveling alone from home to home, managing complex treatments in unpredictable conditions, and making high-stakes decisions without the infrastructure that hospital-based clinicians might take for granted.

They enter spaces that are not designed for care, where equipment may be limited, environments may at times be unsafe, and family dynamics can add layers of complexity. These providers build relationships over time with patients who are often vulnerable, in decline, or nearing the end of life. They witness suffering up close, navigate fear and resistance, and carry the weight of these experiences with them as they move on to the next patient.

This is not just clinical work. It is sustained emotional labor.

Research reflects what these clinicians already know. A 2022 study published in Home Healthcare Now found that more than 60 percent of home health nurses experience moderate to high levels of burnout, driven by workload intensity, emotional strain, and professional isolation. These are not marginal challenges; they are structural features of the job as it is currently designed.

That is why the current demands around workload and compensation matter so much. Without changes, the system is unsustainable. But even if every demand on the table were met tomorrow, we would still be leaving a critical gap unaddressed, and the system could still remain unsustainable.

The dominant model of support in healthcare assumes that if we fix staffing ratios and adjust compensation, the rest will follow. That assumption breaks down in home-based care, where clinicians are, by design, working in isolation and absorbing a level of emotional and relational complexity that is difficult to quantify and even harder to sustain over time.

What is missing is not just more resources. It is a better structure for how those resources support the human experience of doing this work. Peer support is one of the most effective, and underutilized, ways to provide that structure.

In peer support models, clinicians and care workers are given dedicated space to process the emotional realities of their work with others who understand it from the inside. These are not informal check-ins or optional add-ons; they are structured, facilitated environments that reduce isolation, strengthen resilience, and create continuity in how clinicians make meaning of what they experience day to day.

We have seen this in our own work. When home care clinicians are given consistent opportunities to connect with peers, reflect on challenging cases, and share the emotional load of their work, the impact is immediate and tangible. They feel less alone, are better able to stay present with patients, and they are more likely to remain in the workforce.

The reality is that home care clinicians are being asked to deliver highly relational, emotionally demanding care within systems that are still largely built for throughput and efficiency. That mismatch is what drives burnout. And it is why contracts, while necessary, are not sufficient.

If we want to build a sustainable home care workforce, we need to design for the full scope of the work, including the human experience of delivering them. The clinicians organizing right now are doing more than advocating for themselves. They are surfacing a truth the system has been slow to acknowledge. Healthcare that is delivered in people’s homes requires a different kind of support, one that recognizes isolation, emotional labor, and relationship-building as central to the work.

Home healthcare providers are fighting for basic workplace requests. But they deserve even more. Because if we continue to treat burnout as an individual problem, or even just a staffing problem, we will continue to lose the very people our system increasingly depends on. But if we take this moment seriously and redesign support around the realities of home-based care, we have an opportunity to build something stronger, more humane, and more aligned with what patients and clinicians alike actually need.