Immigrants represent a substantial portion of the workforce in the senior caregiving market, while they only represent 17% of the overall workforce3. According to a 2017 study published in Health Affairs, immigrants accounted for 23.5% of workers in the formal and nonformal long-term care sector4. More than a quarter (27.5%) of direct care workers and 30.3% of nursing home housekeeping and maintenance workers were immigrants4. These figures highlight the significant role immigrants play in providing care to older adults in the US.
Other research supports these findings. In 2019, immigrants comprised approximately 25% of direct care workers in the home care industry and 19% in nursing homes5. A separate analysis found that over 18% of the early care and education workforce are immigrants6. Immigrants also hold a significant presence in home health aide positions (28%) and housekeeping and gardening roles (46%)3. At least 27% of direct care workers in the US are immigrants7. The proportion of direct care workers who are immigrants grew from about 21% in 2011 to 27% in 20217. Many more likely work in the "gray market," where consumers directly hire home care workers using private funds7. Unfortunately, data limitations prevent a clearer understanding of this segment of long-term care7.
To better illustrate the breakdown of immigrant workers in the senior caregiving market, the following table summarizes the data:
Caregiving Role: % of Immigrant Workers
Formal and nonformal long-term care sector workers: 23.5%
Direct care workers: 27.5%
Nursing home housekeeping and maintenance workers: 30.3%
Direct care workers in the home care industry: 25%
Direct care workers in nursing homes: 19%
Home health aides: 28%
Housekeepers and gardeners: 46%
Immigrant caregivers provide a wide range of services that enable seniors to age in place and receive high-quality care in institutional settings. They often take on roles that are physically and emotionally demanding, including assisting with daily activities, providing personal care, and offering companionship5. Studies have shown that immigrants are more likely to work in direct care support occupations, such as home health aides and nursing assistants, compared to their US-born counterparts8. This may be attributed to several factors, including immigrants' willingness to take on jobs that are often perceived as less desirable and their strong work ethic.
Nursing homes in regions with a higher share of immigrant certified nursing assistants (CNAs) were associated with better patient care. High percentages of immigrant CNAs resulted in more direct care staff hours per resident day and better overall nursing home quality performance9. Furthermore, immigrant caregivers often bring cultural sensitivity and language skills that are valuable in caring for diverse elderly populations10. They can bridge cultural gaps and provide comfort to seniors who may feel isolated or struggle to communicate their needs10.
Despite their significant contributions, immigrant caregivers often face numerous challenges in the workplace. The job is incredibly demanding—workers report "chronic understaffing, workplace violence, undue risk of injury or illness, chronic fatigue, and significant mental health strain." 5 Nursing assistants face heavy workloads that require them to support multiple residents simultaneously per shift, often with insufficient time to meet the needs of those they care for5.
Mass deportation plans could have a devastating impact on the senior caregiving market. The removal of a significant portion of the immigrant workforce would exacerbate the existing shortage of caregivers and create a crisis in elder care11. This could lead to longer wait times for essential services, reduced quality of care, and increased financial burdens on families and the healthcare system4. Families who rely on the affordability of immigrant caregivers may be forced to reduce the quality or quantity of care they can afford, or even place their loved ones in institutional care prematurely12. This could lead to a decline in the well-being of seniors and place an even greater strain on the already overburdened healthcare system12.
One of the challenges of implementing mass deportation is the difficulty in identifying and targeting undocumented individuals13. The incoming administration may explore ways to expand local law enforcement's authority to make it easier to arrest people suspected of being undocumented during routine stops13. This could lead to increased reliance on state and local law enforcement partnerships and raise concerns about racial profiling and potential violations of civil liberties13.
The economic consequences of mass deportation could also be substantial. Studies suggest that removing workers from key industries, including the caregiving sector, could lead to higher inflation and increased costs for goods and services14. The financial burden of mass deportation on the government would also be significant. A one-time mass deportation operation that would remove 13.3 million immigrants without legal status would cost at least $315 billion15. If the US government were to instead invest in expanding the current infrastructure to a point where it could arrest, detain, process, and deport 1 million people a year, we estimate this would average out to $88 billion annually, for a total cost of $967.9 billion over more than a decade15. This raises questions about the allocation of resources and the potential trade-offs between immigration enforcement and other critical social programs.
Mass deportation could disproportionately affect certain groups of seniors. Seniors who rely on immigrant caregivers for in-home care may face significant challenges in finding replacement care, potentially leading to premature institutionalization or a decline in their quality of life12. Undocumented older adults who are ineligible for Social Security and healthcare programs are particularly vulnerable16. These individuals may face increased healthcare costs, limited access to essential services, and a greater risk of poverty and social isolation16.
Geographically, regions with a higher concentration of immigrant caregivers, such as California, Texas, and Florida, would likely experience the most severe impact on the senior caregiving market. This could create regional disparities in access to care and exacerbate existing inequalities in healthcare provision17. Any contact an undocumented person has with a local police officer or other local law enforcement agencies could lead to questions about their immigration status and potential arrest. This creates an environment of fear and uncertainty for both immigrant caregivers and the seniors who rely on their care13.
While data limitations prevent a complete understanding of the proportion of undocumented immigrant caregivers in the senior caregiving market, available evidence suggests that both documented and undocumented immigrants play a significant role in this sector7. In 2017, unauthorized immigrants accounted for 2% of all healthcare workers and 3.7% of long-term care workers in the US4.
Immigrants make significant contributions to the US economy, including through their role in the senior caregiving market. In 2022, immigrant households paid $579.1 billion in total taxes, including $35.1 billion paid by undocumented households18. This helps fund a wide range of social services, from public schools to food stamp programs and healthcare insurance for low-income families18. Immigrants also play a key role in keeping Medicaid and Social Security afloat18. They paid $194.5 billion to Social Security and $53.6 billion to Medicare in 202218.
Several policies and regulations relate to immigrant caregivers in the senior caregiving market. Some policy proposals aim to address the caregiver shortage by expanding visa categories for frontline care workers and providing a path to citizenship for immigrants who work in the elder care sector19. The Healthcare Workforce Resilience Act, introduced in November 2023, would recapture up to 40,000 previously authorized but unused employment-based visas19. These visas would then be distributed to immigrant nurses and physicians, with the majority intended for nurses19. Another bill, the Citizenship for Essential Workers Act, was introduced in May 2023 and would give immigrants who performed essential work during the pandemic the opportunity to apply for a green card19.
Other policies focus on protecting immigrant caregivers from exploitation and abuse20. These include initiatives to foster job readiness, provide training in cultural competence, and address discriminatory practices that impede healthcare delivery20. Immigration restrictions can limit the number of family caregivers, thereby jeopardizing the health of older adults and straining the US healthcare system20.
In many states, a modified placement approval process exists for kinship caregivers, such as unlicensed provider options or waivers of non-safety-related licensing standards21. However, in many cases, failure to obtain full licensure may disadvantage caregivers by, for example, precluding receipt of full foster care maintenance payments21.
Under current laws, certain immigrants who have lived in the US for 10 years, have passed background checks, and whose removal from the country would cause exceptional and extremely unusual hardship to a US citizen (or green card holder) family member may request "cancellation of their removal" before an immigration judge23. This option could support family caregivers who are facing deportation23.
Immigrant caregivers play a vital role in the US senior caregiving market. They provide essential support to elderly Americans, often taking on demanding roles and contributing to the quality and affordability of care. Mass deportation plans pose a significant threat to this sector, with potential economic and social consequences. The removal of immigrant caregivers could exacerbate the caregiver shortage, increase healthcare costs, and burden families. Moreover, it could worsen existing inequalities in healthcare access and disproportionately affect vulnerable seniors.
Policymakers should consider the crucial contributions of immigrant caregivers when formulating immigration policies. Expanding visa programs for care workers, providing pathways to citizenship, and ensuring fair labor practices are essential steps toward stabilizing the caregiving workforce and meeting the growing needs of the aging population. A balanced approach that considers both the needs of seniors and the contributions of immigrant workers is crucial.
Failing to recognize the importance of immigrant caregivers and implementing mass deportation policies could have devastating consequences for seniors, their families, and the US healthcare system as a whole. Addressing this issue is paramount to ensuring the well-being of the aging population and the stability of the healthcare system
1. The role of immigrants in the market for elder care - Brookings Institution, https://www.brookings.edu/articles/the-role-of-immigrants-in-the-market-for-elder-care/
2. An Aging World Relies on Migrant Care Workers | Current History - UC Press Journals, https://online.ucpress.edu/currenthistory/article/123/849/27/198688/An-Aging-World-Relies-on-Migrant-Care-Workers
3. Immigrant Workers and Care for America's Elderly (UPDATED) - Econofact, https://econofact.org/immigrant-workers-and-care-for-americas-elderly
4. Care For America's Elderly And Disabled People Relies On Immigrant Labor - Health Affairs,https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05514
5. Aging Americans Face Bleak Futures Unless We Let New Immigrants Help - Time, https://time.com/6310841/aging-americans-new-immigrants/
6. Immigration and the crisis of care work - Niskanen Center, https://www.niskanencenter.org/immigration-and-the-crisis-of-care-work/
7. Immigrants Can Help 'Bridge the Gap' in Direct Care - PHI, https://www.phinational.org/immigrants-can-help-bridge-the-gap-in-direct-care/
8. Immigrant Health-Care Workers in the United States -https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states-2021
9. Study Finds Immigrant Caregivers Essential for a Growing Population in Need of Care https://hcp.hms.harvard.edu/news/study-finds-immigrant-caregivers-essential-growing-population-need-care
10. Mental Health Outcomes of Immigrant- and US-Born Caregivers: California Health Interview Survey, 2019–2020 | AJPH | Vol. 114 Issue S2,, https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307396
11. The labor market impact of deportations - Brookings Institution, https://www.brookings.edu/articles/the-labor-market-impact-of-deportations/
12. Near Certain Cataclysmic Consequences of a Mass Deportation Programhttps://www.socialworkers.org/Advocacy/Social-Justice/Social-Justice-Briefs/Near-Certain-Cataclysmic-Consequences-of-a-Mass-Deportation-Program
13. What Will Mass Deportations Look Like? - Ihttps://immigrationimpact.com/2024/12/06/what-will-mass-deportations-look-like/
14. Trump's mass deportation plan could threaten workforces in industries from agriculture to health care - https://www.nbcphiladelphia.com/news/business/money-report/trumps-mass-deportation-plan-could-threaten-workforces-in-industries-from-agriculture-to-health-care/4049042/?os=windhgbitylo7b3ag3u&ref=app
15. New Report Details Catastrophic Impact of Mass Deportation and Family Separation Plans,-https://www.americanimmigrationcouncil.org/news/new-report-details-catastrophic-impact-mass-deportation-plans
16. Aging and undocumented: The sociology of aging meets immigration status - PMC,https://pmc.ncbi.nlm.nih.gov/articles/PMC8047879/
17. Which places would be most affected by the Trump administration's immigrant deportation proposals? - Brookings Institution, https://www.brookings.edu/articles/which-places-would-be-most-affected-by-the-trump-administrations-immigrant-deportation-proposals/
18. New Data Analysis: Immigrants Driving Opportunity, Prosperity in the U.S., Including in Swing States, https://www.americanimmigrationcouncil.org/news/new-data-immigrants-driving-prosperity-in-united-states-2022
19. Immigration to address the caregiving shortfall - Brookings Institution, https://www.brookings.edu/articles/immigration-to-address-the-caregiving-shortfall/
20. Immigrants and the Eldercare Workforce, accessed December 20, 2024, https://eldercareworkforce.org/research/issue-briefs/immigrants-and-the-eldercare-workforce/
21. Immigrant Caregivers:, https://defensenet.org/wp-content/uploads/2018/01/Immigrant-Caregivers-The-Implication-of-Immigration-Status-on-Foster-Care-Licensure-ABA-Center-on-Children-and-the-Law-2017.pdf
22. Parole for Caregivers of Critical Medical or Special Needs Individuals - USCIS, , https://www.uscis.gov/laws-and-policy/other-resources/us-immigration-law-in-the-commonwealth-of-the-northern-mariana-islands-cnmi/parole-for-caregivers-of-critical-medical-or-special-needs-individuals
23. SIGN ON: Tell DHS & DOJ to work together and help immigrant family caregivers!, https://action.momsrising.org/sign/immigrant_family_caregiver_rule/