America's home health workforce is at risk from Trump's immigration crackdown
President Donald Trump's immigration crackdown threatens to shrink the workforce for one of America's fastest growing jobs: Home health and personal care aides.
Demand for such care is expected to swell as the US population ages, and the industry has increasingly relied on immigrants to fill home health positions. Foreign-born people comprise roughly one in five US workers, yet they account for more than 40% of home health aides and nearly 30% of personal care employment, according to US government data.
Trump's push to strip hundreds of thousands of foreign workers of work authorizations, ramp up deportations and curb immigration has providers and industry experts worried about their ability to hire and retain workers.
'The sector has been struggling to retain the workforce outside of immigration,' said Jeanne Batalova, a senior policy analyst at the nonpartisan Migration Policy Institute. 'The impact will be felt in some cities and states very quickly with people losing their status.'
One senior living community in the mid-Atlantic region has already had half a dozen immigrant employees leave their jobs since March. The executive director of the community, who asked not to be identified for fear of backlash, said an estimated 5% to 10% of her facility's staff are believed to be working with temporary work permits — filling jobs in housekeeping, nutrition and other departments. The facility employs more than 300 people.
She said the departures, which reflected workers' worries about impending changes to immigration policy, have already caused disruptions and made residents nervous. The Supreme Court's latest decisions to allow the White House to end the legal status of roughly 850,000 people from places like Venezuela and Haiti, paired with other pending litigation, threaten to make things worse.
If all of her employees with temporary work permits are forced to leave their jobs, the executive director said they'd have to trim services or stop admitting new residents.
Katie Smith Sloan, chief executive officer of LeadingAge, which advocates for nonprofit aging services providers, said some member agencies are already notifying employees that they may be forced to let them go if the administration proceeds with plans to cancel work permits.
The Department of Homeland Security announced Thursday that over half a million parolees from Cuba, Haiti, Nicaragua and Venezuela were being notified that their status was being terminated. The government has encouraged those people to leave the US on their own.
'There is no shortage of American minds and hands to grow our labor force,' White House spokeswoman Abigail Jackson said in a statement. 'President Trump's agenda to create jobs for American workers represents this administration's commitment to capitalizing on that untapped potential while delivering on our mandate to enforce our immigration laws.'
Growing Need
The Bureau of Labor Statistics projects home health and personal care aides, which is already the most common occupation in the country, will also be one of the fastest growing professions over the next decade – soaring 21% by 2033.
That depends on workers wanting the job. Hospitals, nursing homes and other providers are still scrambling to fill nearly 1.5 million open positions. And nearly two-thirds of home care workers leave their job within the first year of employment, an industry survey found.
The jobs are physically demanding and low paid. In 2024, home health and personal care aides made $34,990 annually — roughly half the average pay across all US occupations.
Even New York, which has the most home health and personal care aides adjusted for employment of any state by far, is struggling to keep up with demand.
'The shortage is entirely driven by bottomless demand,' said Bill Hammond, senior fellow for health policy at the think tank Empire Center for Public Policy. 'I'm not sure we can sustain it. We've already gotten to the point where there are more home health aides than there are fast-food counter workers and retail-sales clerks combined.'
Some states have sought ways to bolster the home health workforce, like paying friends and family members to serve as caregivers. Even so, immigration has played a key role in filling job openings in the space.
Trump recently acknowledged that farming and leisure and hospitality are feeling the impact of his immigration crackdown and vowed to address the issue.
Immigrant Workforce
The number of immigrants — legal and undocumented — working as home health aides jumped by 24% between 2018 and 2023, three times the rate of increase in the overall immigrant workforce, according to the Migration Policy Institute.
One of those workers is Parmah Njoh, 41, who makes at-home calls for Goodwin Living in the Washington region. Njoh, who moved to the US from Cameroon in 2019 with a visa and is now a US citizen, is one of the many African employees working at the senior-living and at-home care provider.
It's 'about the lives of these elderly people,' said Njoh. 'The importance here is the life of these adult people. Without us, I don't think they're going to do well.'
The Census Bureau estimates the number of people 65 and older will grow by roughly 8 million to 71 million by the end of the decade, and surpass 100 million people by 2075. While only a share of that group will require special care, many Americans with disabilities also need support.
'We have a shortage of care workers already, they're aging, and the pay is not attractive to bring people into these jobs,' said Cassandra Zimmer-Wong, an immigration policy analyst at the think tank Niskanen Center. 'That makes for a really dangerous scenario where people want to age at home, they want home health, there's demand, but we don't really have the supply.'
Saraiva and Caldwell write for Bloomberg.
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