Immigration and the Direct Care Workforce

In a recent New York Times article that drew on PHI’s research, a long-term care provider from Dallas, Texas, reported that 80 percent of the direct care workers he hires are immigrants: “We don’t go out looking for people who are immigrants,” he told the Times. “We go out hiring people who answer the call — and they are all immigrants.”

Like the U.S. economy overall, our nation’s long-term care system is powered by immigrants. More than one in four direct care workers are immigrants—with a much higher proportion in some regions. These workers provide vital services and supports to millions of Americans.

Yet, the Trump Administration is on a course that would decimate the U.S. immigration system. The Administration seeks to radically restrict immigration, and the President has promised to conduct “the largest domestic deportation operation in American history,” targeting not just migrants without work authorization but also those covered by programs such as Temporary Protected Status (among others). The Administration is also pursuing efforts to denaturalize current citizens.

Policies that displace immigrants from our country or otherwise prevent them from doing their jobs will have an outsized impact on long-term care, devastating workers, their families, and millions of Americans who depend on long-term care.

Immigrants are a Critical, Growing Part of the Direct Care Workforce

Immigrants play an essential role in ensuring that older adults and people with disabilities receive quality care. In recent years, immigrants have comprised a growing segment of the direct care workforce, increasing from 21 percent in 2011 to 28 percent in 2022. Even more immigrants will be needed to help fill nearly a  million new direct care jobs within the next decade—as, based on demographic shifts, the number of U.S.- born workers entering the workforce declines.

Research demonstrates the value of immigrant direct care workers for the U.S. long-term care system and for individuals’ health and quality of life:

• Increased immigration has been shown to lead to higher staffing levels in nursing homes, alleviating workforce shortages and improving care quality and health outcomes for nursing home residents.
• Conversely, punitive immigration restrictions and rhetoric create a chilling effect—even for the vast majority of immigrant direct care workers who have valid work authorization—that reduces staffing levels in nursing homes, and may exaggerate the overall shortage of direct care workers (including in home care and other settings).
• Immigrant workers remain in direct care positions longer than U.S.-born workers, providing important workforce stability and continuity of care.

Harsh Immigration Policies Will Challenge Care… and the U.S. Economy

Immigration policies that drive direct care workers out of the long-term care workforce will create massive economic and caregiving challenges for millions of families. As direct care workers are deported, prevented from entering the country, lose their work authorization, or leave the workforce due to fears of immigration enforcement, ongoing workforce challenges will only worsen. Employers will struggle even more to find and retain workers, leading to greater caseloads, burnout among current direct care workers, and more workers being driven to leave this field.

To fill the gap, family members will be forced to leave the workforce to care for their loved ones, impacting economic wellbeing (disproportionately for women) and undermining the economy overall. Many individuals who cannot find care at home will be institutionalized, at significantly greater cost to themselves and placing greater burden on programs like Medicaid. Many others will simply go without care, with far-reaching impacts on their health and well-being, including greater use of acute care services (like hospitalizations and emergency room visits) that drive up public health care expenditures.

A Call to Action:

Punitive immigration policies will undermine the contributions of immigrant direct care workers. It is essential to support these caregivers and the vital work they do for American families. We call on Congress to take action against the Administration’s efforts to dismantle our immigration system, which will cause irreparable harm to our nation’s long-term care workforce and our overall economy.

As immigration enforcement efforts widen, long-term care employers have been making preparations for potential raids. States should distribute guidance materials—such as this Maryland memorandum and resources from the National Immigration Law Center designed for healthcare providers, consumers, and workplaces—to ensure that organizations and immigrant direct care workers understand their rights and are as prepared as possible for ongoing shifts in immigration policy.

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