Although advocates promote caregiving services to families in need, the formal care system is directly dependent upon the availability of workers willing to provide this type of care. If there is a worker shortage, are clients with cognitive impairment more adversely affected than other clients? This article reports the findings from a study conducted in one state during a worker shortage. A worker bias was found against servicing Alzheimer clients in their homes that was not evident in day care facilities or nursing homes with Alzheimer units. Policy is sues are raised and recommendations made concerning workerʼs wages and benefits, work life, job design, and the structure of the long term care industry.