The Rural Health Workforce No One Is Funding
Family caregivers are the largest care workforce in the country. In rural counties, they are often the only one on the ground, and the one least likely to get support.
Family caregivers can no longer be viewed as a supplement to the health system. These unpaid caregivers are a workforce on their own. In 2024, the 59 million Americans caring for an adult provided 49.5 billion hours of care worth more than $1 trillion, the equivalent of nearly 24 million full-time workers, or about 17% of the country’s full-time workforce. In rural counties, where clinicians are scarce and growing scarcer, that workforce is often the only consistent source of care a person has. It is also the one Rural Health Transformation funding keeps overlooking.
Every state now has Rural Health Transformation Program money to spend, and much of the conversation centers on a familiar problem. There are not enough clinicians in rural America. That is true, and it is only half the picture. The other half is a workforce that already shows up in every rural county, manages complex care daily, and costs the system nothing in wages. These are the same people who can help improve health outcomes by providing informal care. State plans that treat the clinician shortage as the entire problem will miss the fastest return available to them.
Rural America is short on clinicians, and will be for years
The shortage is not a forecast. It is the present condition. In 2023, 92% of rural counties were designated primary care health professional shortage areas, compared with 83% of non-rural counties, together affecting more than 40 million people. Forty-five percent of rural counties had five or fewer primary care physicians, and roughly 200 had none at all. On average, there is one physician for every 2,881 rural residents. The Commonwealth Fund projects that rural areas will have only about two-thirds of the primary care physicians they need for at least the next decade.
This is the gap the Rural Health Transformation Program was built to close, and a meaningful share of the funding will go toward alternate initiatives such as, recruitment residency slots, loan repayment, training pipelines. Those investments are sound. They also take years to produce a practicing clinician, and they do nothing for the family managing an aging parent’s heart failure this winter. The caregiver burden is real, and when burnout pushes these family members out of the informal caregiving role, the entire rural health ecosystem suffers.
The workforce already on the ground
While states build pipelines, someone is already doing the work. One in five family caregivers lives in a rural area. They manage medications, monitor symptoms, perform wound care and injections, and drive the long distances rural care demands. More than half of family caregivers now provide high-intensity care to their care receivers, the hands-on medical support that used to happen inside a facility. In a county with one physician for every few thousand residents, the caregiver is not working around the edges of the health system. They hold the part of it that reaches the patient on the days no appointment does.
Why states fund around family caregivers instead of for them
If caregivers carry this much, why are they so rarely a line in the budget? Some of it is visibility. Their work happens at home, personal care tasks are off the clinical record, so it does not register in workforce planning. Some of it is an assumption. A qualitative study from the Veterans Health Administration found that rural clinicians often believe support services are already reaching families through social workers, while the caregivers themselves report not knowing those services exist. The workforce is essential and invisible at the same time, and invisible workforces do not get funded.
The blind spot has a price. Rural caregivers more often struggle to find affordable services, with 34% reporting difficulty. When that support is missing, the fallout tends to arrive at the emergency department, which is the costliest place a thin rural system can absorb it. Their own health declines when their caregiving responsibilities become too much.
Supporting the workforce you already have pays off faster
Recruiting a rural physician is a decade-long investment. Equipping the caregivers already in the home returns value within a single budget cycle. The evidence is specific:
- Integrating family caregivers into hospital discharge planning reduces readmissions by about 25%.
- On Trualta’s platform, caregiver activity runs 40% higher in rural communities than in urban ones. Where formal care is thin, families must go deep to learn the skills necessary to survive between appointments.
- Across partner programs, caregiver support has contributed to more than $100 million in quantified health outcome savings, including a 20% reduction in unexpected hospital visits and a 15-month delay in long-term care placement.
A different way to read the workforce problem
For the state teams writing Year 1 RHTP plans, it’s time to start thinking about family caregiving and the shortages these unpaid caregivers fill differently. Caregiver enablement is workforce development aimed at the workforce that already exists, and it shows results in months rather than the decade a recruitment pipeline requires. Funding clinicians and funding caregivers are not competing choices. They are two halves of the same rural area workforce strategy, and only one of those halves is already staffed.
For how caregiver support maps to RHTP’s approved uses and stays clear of duplicating existing programs, see our companion post on RHTP funding fit.
Trualta already serves as a rural backbone for caregiver support.
If your state is shaping its Year 1 RHTP plan, we can show you what it looks like to invest in public health, and in the workforce you already have.
Visit our Rural Health Transformation Resources
Frequently Asked Questions: Rural Health and Family Caregivers
Functionally, yes. AARP values their unpaid labor at more than $1 trillion a year, equivalent to about 17% of the U.S. full-time workforce. They provide the majority of long-term care in the country, and in rural America they often supply the most consistent care a patient receives.
About one in five of the nation’s family caregivers lives in a rural community. With 63 million caregivers in the U.S. as of 2025, that represents millions of people delivering care where clinicians and direct care workers are in shortest supply.
Longer distances to care, fewer local services and caregiver resource centers, and a higher likelihood of struggling to find affordable support, with 34% reporting difficulty. Many also provide high-intensity medical care with little training or backup.
Yes. Caregiver integration in discharge planning cuts readmissions by roughly 25%, and partner programs have linked caregiver support to reduced emergency visits and delayed long-term care placement, both major cost drivers for rural systems.
Sources
- AARP and National Alliance for Caregiving. (July 2025). Caregiving in the US 2025. Washington, DC: AARP. https://doi.org/10.26419/ppi.00373.001
- Houser, A., Caldera, S., Flinn, B., & Choula, R. (March 2026). Valuing the Invaluable 2026: Family Caregivers’ Contribution Reaches $1 Trillion. Washington, DC: AARP Public Policy Institute. https://doi.org/10.26419/ppi.00402.001
- The Commonwealth Fund. (November 2025). The State of Rural Primary Care in the United States. New York, NY: The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2025/nov/state-rural-primary-care-united-states
- Rodakowski, J., Rocco, P. B., Ortiz, M., Folb, B., Schulz, R., Morton, S. C., Leathers, S. C., Hu, L., & James, A. E. (2017). Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis. Journal of the American Geriatrics Society, 65(8), 1748–1755. https://doi.org/10.1111/jgs.14873
- Ngo, V., Chamberlin, E., Marfeo, E., Shirk, S., Hicken, B., Cruise, C., Venegas, M., & Moo, L. (2025). Family Caregiver and Clinician Perceptions of Resource Access in Rural Areas. Innovation in Aging. https://doi.org/10.1093/geroni/igaf122.321
- Trualta. (February 2026). Trualta Surpasses $100M in Healthcare Savings. Internal report / press release.
