This commentary is by Rustam Sengupta, the founder and CEO of Tuktu, a community-powered care platform. He lives in Burlington and supports his father, who has dementia.
Last month I met Margaret. That’s not her real name, but her situation is real. She came to a small community gathering I host around Vermont to facilitate conversations about care and what it means to support each other here.
She is 78 and lives alone in a farmhouse outside Montpelier, a home she has been in for more than 40 years. She does not need a nurse. She needs a neighbor. Someone to drive her to the grocery store, help with housekeeping and maybe share a meal on a Thursday. Her daughter is in Boston. Her son is in Seattle. Margaret is managing for now. But only barely.
There are thousands of Vermonters in Margaret’s situation. And the number grows every year.
Vermont is the third-oldest state in the country by median age. Deaths have outpaced births here every year since 2015. The state ranks last nationally for the percentage of residents aged 25 to 44. By 2030, one in three Vermonters will be over 60.
Here is the number that should stop us cold: Vermont has an estimated 118,000 adult family caregivers who together deliver 85 million hours of unpaid care every year, valued at over $2 billion. Not reimbursed. Not supported. Just quietly absorbed by working Vermonters who are already stretched thin. That is one in four Vermont adults right now.
This is not a problem coming down the road. It is already here, and most of our public conversation is not keeping up with it.
Federal Medicaid cuts projected at $911 billion over 10 years will land hard in Vermont. Medicaid is the primary payer for long-term home care in America, the funding that covers rides, aides and daily check-ins that keep older Vermonters at home instead of in facilities. Vermont already has only 11 adult day programs for older adults in the entire state, and multiple care homes have closed in recent years. Gov. Phil Scott described Vermont’s fiscal situation in January 2026 as a pincer closing: federal funding shrinking while healthcare costs keep climbing and the tax base gets smaller.
The average Vermonter over 65 earns less than $61,000 a year, and the average Social Security benefit for a retired Vermont worker is $1,872 a month. Professional in-home care, when families can find it at all, costs $40 an hour. The math is already broken for a lot of families.
Vermont was awarded $195 million in 2026 from the federal Rural Health Transformation Fund, one of the highest per-capita grants in the nation, with roughly $1 billion expected over five years. Green Mountain Care Board Chair Owen Foster was clear about what this moment demands: “This is not about bailing out our system. It’s about redesigning it.”
Redesigning means being honest about what actually keeps people out of hospitals. Social determinants of health, such as transportation, food and connection, account for 80%-90% of modifiable contributors to health outcomes. Research across more than 1,400 hospitals found that hospitals investing in community-directed support had measurably lower readmission rates. Helping Margaret get to her grocery store twice a week is not just kindness. It is healthcare, and it costs a fraction of a preventable emergency room visit.
A portion of Vermont’s Rural Health Transformation funding should go directly to building community-powered, nonmedical care networks: local, vetted helpers providing rides, wellness check-ins, companionship and support after a hospital stay. The fund’s own stated goals describe exactly this: “evidence-based interventions to improve prevention and chronic disease management” and “consumer-facing, technology-driven solutions for community health.” This is a measurable cost reducer for the hospital system, not a soft extra.
Vermont already has strong foundations. AgeWell Vermont delivers meals, rides and connection to thousands of older Vermonters. The Age Strong VT plan, from the Department of Health, calls for a coordinated system of services that lets people age where they want to age, at home, in their communities. These programs need more support, not less.
What we also need is a community-powered layer that can scale: local networks such as Tuktu, where a retired teacher, a college student or a stay-at-home parent can offer a few hours of help and earn something for it, while keeping money circulating in Vermont rather than flowing out. When care stays local, so does the economic benefit.
I say this as the founder of a technology platform working in exactly this space, so I want to be upfront about my perspective: Good technology in care does not replace the human part. It removes the friction. It handles vetting, scheduling and matching so the relationship between two people can stay fully human. Used well, technology makes community care affordable for seniors on fixed incomes and accessible for families juggling work and distance. It does not have to be a threat to Vermont values. It can be an extension of them.
Vermont has a long track record of doing something hard first and doing it right. The care crisis bearing down on every state in America is already here in Vermont, earlier and sharper than almost anywhere else.
That is painful. It is also an opportunity. If Vermont builds a real model of community-powered care, combining strong public programs with accessible local networks and sensible use of technology, funded in part by the Rural Health Transformation Fund, it will not just help Margaret and the thousands of Vermonters like her. It will build something the rest of the country will look to in the years ahead.
The water is warming. We should not wait for it to boil.
