Reimagining Long-Term Care: A Conversation with McKnight's Home Care

The challenges facing the long-term care system, which includes older adults, people with disabilities, direct care workers and family caregivers, are worsening, according to Robert Espinoza, founder and CEO of the new The CareWorks Project.

Our country’s long-term care system is at a crossroads.

The number of older adults is growing rapidly. People are living longer than ever. Millions of family caregivers are struggling to balance work, caregiving, and their own well-being. Direct care workers continue to face low wages and limited opportunities for advancement. And the costs of care are placing increasing strain on families, providers, and government alike.

These challenges are deeply interconnected. Yet too often, we address them in isolation.

That was the focus of a recent conversation I had with Liza Berger, Editor of McKnight's Home Care, on the McKnight's Newsmakers podcast.

Why The CareWorks Project?

During our discussion, we explored why I launched The CareWorks Project and the broader vision that guides our work. At its core, The CareWorks Project exists to help leaders across sectors rethink how long-term care is financed, delivered, staffed, and experienced.

The conversation touched on several themes that will continue to shape our work in the years ahead. Here are four of them:

First, we discussed the growing pressures facing everyone touched by long-term care—from older adults and people with disabilities to family caregivers, workers, businesses, and communities. These challenges are not temporary. They are being driven by demographic, economic, and social forces that will only intensify in the decades ahead.

Second, we explored the direct care workforce crisis and why workforce challenges cannot be separated from broader system design. While wages and benefits remain critical, lasting solutions also require investments in training, career pathways, supportive services, and a stronger public understanding of the value of care work.

Third, we discussed the urgent need for long-term care financing reform. Too many families are forced to navigate a fragmented system that is difficult to understand, difficult to access, and often financially devastating. Building a stronger future will require bold thinking about how we finance care and support people across the lifespan. Marc Cohen's extraordinary 2025 report on long-term care financing options, gleaned from decades of policy experimentation, demonstrates what's possible.

Finally, we reflected on a larger question that sits at the heart of this work: What kind of society do we want to be?

Do we continue to treat care as a private burden borne by individuals and families? Or do we begin to recognize care as a public good—one that strengthens communities, supports economic opportunity, and allows people to live with dignity?

These are the questions that inspire The CareWorks Project every day.

I'm grateful to Liza Berger and the team at McKnight's Home Care for the opportunity to discuss these issues and share the vision behind our work.

To listen to the full conversation, click here.