Illustration: Natalie Peeples/Axios
Some of the earliest and lasting effects from President-elect Trump's promised immigration crackdowns would be in home health and long-term care, both of which rely on a substantial number of immigrants and undocumented workers.
Why it matters: Reducing an already thin labor market could have serious ramifications for aging adults or those with disabilities — and potentially put more stress on family caregivers.
What they're saying: "Immigration policy is long-term care policy," said David Grabowski, a Harvard Medical School professor who's chronicled how foreign-born workers filled key nursing home roles early in the pandemic.
- He found nursing homes in regions with a higher share of foreign-born nursing assistants provided more direct care and better quality.
- "If you were to tighten up immigration or begin deporting individuals, it's going to lower the available workforce, and this is only going to add to an already challenging labor situation," he said.
- With the fast-growing senior baby boomer population, many of the gaps have been filled by immigrants.
- The American Immigration Council estimates more than a third of home health aids in the U.S. are immigrants. In states like California, New York and New Jersey, it's estimated at least 40% of the caregiving workforce is foreign-born.
- Trump transition spokesperson Karoline Leavitt said in a statement that the deportation of criminals, drug dealers and human traffickers would lower costs for families and strengthen the workforce.
- Experts say the effects of tighter immigration policies would be felt beyond communal settings, and especially in home care, where workers, predominantly women, earn around $16 an hour, according to government data.
- Undocumented workers made up an estimated 6.9% of home health aides and 4.4% of personal care aides, according to the American Immigration Council.
- It's hard to quantify the size of that market, but studies have found families in rural markets are five times more likely to reach for care on the gray market where supply through companies may be limited, Howell said.
- Aggressive immigration enforcement could cause home care workers who might have otherwise legally entered the U.S. to move to countries with friendlier polices. Canada, for instance, announced a permanent residence program earlier this year specifically aimed at incentivizing foreign-born caregivers.
- Many caregivers who are documented immigrants may live in mixed-status households, and deportation — or the threat of deportation — may destabilize those households and force them to go work in other sectors.
- The concern is "this could put our industry under increased strain, that foreign-born workers might just decide the sector is not for them broadly. And clearly, we have so much data that says that they are the lifeblood," Howell said.
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