More older adults, living longer, with more conditions, needing more help — every day.
Care Enterprise Network
Building a New Care Economy
From care work to care enterprise ownership — scalable pathways through a Care Enterprise Network — starting in California, built for the nation.
Growing
54%
Adults 65+ climb from 57.8 M in 2022 to 88.8 M by 2060 — a 54% increase in the older adult population most likely to need care.
SICKER, LONGER
86%
of adults 65+ have at least one chronic condition; 56% live with two or more. Over a third of adults 85+ have four or more.
Needing Help
70%
of adults who reach 65 will need long-term services and supports before they die.
Workers Wanted
9.7 M
Care sector jobs - such as home health and personal care aides – needed over the next decade
REVOLVING DOOR
60-80%
Annual turnover in these frontline care workers
The Challenge
A Care System at the Breaking Point
The nation is staring down a care workforce crisis and the U.S. care system structurally unable to meet what is coming. A burgeoning aging population, persistent workforce shortages, and strained healthcare economics have converged in ways that undermine access to care, quality of care, and affordability to families.
Coming soon: 1 in 6 new jobs in the entire U.S. economy this decade is a homehealth or personal care aide.
At the core of the challenge for these frontline care roles is workforce economics. Chronically low wages produce chronically high turnover — and that churn is expensive. It raises costs for payors and systems, and it undermines the consistency of care that families and communities depend on. Until the economics of care work change, the access and quality gaps will persist.
While there are many potential solutions, we'll examine one promising systems-level response — the Care Enterprise Network concept under development by Futuro Health.
The Long-Term Care Dilemma: High Cost to Families
Families must wrestle with unaffordable options unless presented with more affordable local alternatives.
Nearly 1 in 5 adults turning 65 will face more than $200,000 in long term care expenses out of pocket.
The cost of inaction doesn’t disappear. It transfers onto families, public programs and emergency systems – and it compound.
Meet Shari and Adriana
The Caregiver
Meet Shari – Futuro Health Scholar
When COVID closed her bank branch, a fire displaced her home and she was caregiving for a terminally-ill parent, Shari entered healthcare through Futuro Health’s debt-free pathway. She became skilled, trusted and deeply committed. What she lacks is the infrastructure to build her own care enterprise. The Care Enterprise Network makes her aspirations possible.
The FAMILY
And Adriana – seeking care for her mother
Adriana’s mother Esperanza has dementia. She needs culturally competent care – someone who speaks her language and knows which telenovelas she loves. The options available are either prohibitively expensive or deeply institutional. Shari is that person. The Care Enterprise Network connects them.
Community-based care enterprises—owned and operated by individuals like Shari—offer an affordable, culturally responsive model of care. With the right supports through the Care Enterprise Network, they can be stabilized, connected, and scaled to serve multiple clients. These providers are uniquely positioned to meet the needs of households who don’t need skilled nursing facilities and how cannot afford Assisted Living programs or in-home care.
Stakeholder Engagement
Convenings to Invite Input and Expertise
An expanding group of leaders is stepping forward to engage in this work. Already, the following organizations have committed to hosting convenings that bring together healthcare systems and payors, state and county leaders, aging subject matter experts, academia, labor, philanthropy, care enterprise owners and others to drive cross-sector dialogue.
Building the Care Economy We Need
A Cross-Sector Roundtable on Meeting the Needs of Older Adults
October 29, 2026 | 8:30-11:00am PST In-Person | ALFSV Members Only
November 18, 2026 | 8:00-9:30am PST | Virtual
December 4, 2026 | 8:30-11:00am PST | In-Person
AN INVITATION
Join Us in Building a More Resilient Care Economy
This work invites partners together across healthcare systems and payors, state and county leaders, aging subject matter experts, academia, labor, philanthropy, care enterprise owners and others to test a practical, viable path forward -- toward a more human-centered care economy.
The Model
The Care Enterprise Network
The Care Enterprise Network brings together small, community-based care enterprise providers--such as residential care facility for the elderly (RCFEs), board-and-care homes, and adult day support programs for example--to better serve the majority of households. The model preserves each care enterprise provider's local, relationship-driven approach while adding a shared services backbone and unlocking access to infrastructure and impact capital typically reserved for larger enterprises.
Workforce & Quality Stewardship
Creation of a career pathway from apprenticeship-to-owner-operator for care enterprises delivered through a care training village approach.
Shared Services Backbone
Shared services - like bulk procurement and back office functions - enable sustainable operations across care enterprises without sacrificing local identity.
Impact Capital Deployment
A blended capital strategy - philanthropy, public sector and private investment - designed so prospective care enterprise owners don't absorb outsized financial risk and to set up foundational infrastructure.