President Trump’s plan to overhaul the immigration system will leave elderly and disabled people in their homes and long-term care facilities as California and the country grapple with the needs of an aging population, health experts and immigration advocates say. The number of workers caring for children may decrease.
President Trump has promised to carry out the largest deportation program in U.S. history. On his first day in office, he suspended refugee admissions for several months, requiring asylum seekers to stay in Mexico following a ruling in a case that granted temporary legal status and work permits to more than 1.5 million people. Signed an executive order rescinding the program. .
It could affect tens of millions of older Americans who may eventually need long-term care. California estimates that by 2030, a quarter of the state’s population will be at least 60 years old. Across the United States, demand for home health aides, nursing assistants, and personal care aides in long-term care is projected to grow 35% to 41% from 2022 to 2037, according to the National Center for Health Care Workforce Analysis.
“Long-term care providers and nursing homes in particular have really struggled to recruit staff for decades,” said David C. Grabowski, a professor of health policy at Harvard Medical School. “The work is challenging. They usually don’t pay well.”
He said the strain of the pandemic has only exacerbated the problem. Now, “the need is greater than ever, as fewer and fewer people seem to want to work in long-term care settings.”
Immigrants make up 28% of workers who provide direct care to people in nursing homes and other long-term care facilities, according to a national analysis by KFF, an independent research group. In California nursing homes, more than half of certified nursing assistants (direct care workers who feed, bathe, and dress residents) were born in other countries, according to a study published last year in Health Affairs. .
Even fewer people are believed to be entering the country without legal permission. The American Immigration Council, a left-wing nonprofit that advocates for immigrants, estimates that 4.2% of nursing assistants and 6.4% of home health aides nationwide are illegal immigrants. Analysis of Census Bureau data.
Those numbers may seem modest, but when faced with the demand for such workers, “when you take away that percentage of the workforce, it becomes a big problem,” said Stephen, senior data scientist at the American Immigration Council.・Mr. Hubbard says:
A recent poll by The Associated Press-NORC Center for Public Affairs Research found that Americans broadly support deporting people convicted of violent crimes, but a significant percentage of adults surveyed (43% ) supports deporting all immigrants living in the United States illegally. the study.
California Congressman Carl DeMaio (R-San Diego) rejected the idea that immigration policy changes expected under the Trump administration would have a negative impact on the long-term care sector, saying, “We need secure borders and a vibrant workforce.” are not contradictory.”
“Those who want open borders cannot demonize or distort the public policy discussion here by singling out one element and not understanding the full range of savings we can achieve. “We’re trying to do that,” DeMaio said.
Groups that want to reduce immigration also argue that limiting immigration would put upward pressure on wages, benefiting American workers who may take on caregiving jobs.
Some questioned the idea, said Priya Chidambaram, KFF’s senior policy manager for Medicaid and uninsured programs. Despite the existing shortage of caregivers, wages for such care remain low and have been exacerbated by the exodus of employees due to the COVID-19 emergency, it said. If wages have not soared so far, “it’s hard to imagine why they will if we continue to reduce the available care workforce.”
Experts say caregivers could also be affected by rollbacks to Temporary Protected Status and future changes to the Deferred Action for Childhood Arrivals program, which protects certain immigrants from deportation.
“Even legal immigrants are experiencing only the processing delays that allow them to continue functioning within our legal market,” said Cecilia Osterlein, senior immigration policy analyst at the Niskanen Center in Washington, D.C. It could have a real impact.”
In Los Angeles, immigrant women work every day to meet the needs of elderly clients, including bathing, changing diapers, and brushing teeth. She prepares meals, cleans bathrooms and kitchens, and changes bed sheets. She helps women go out and walk, and helps them with their daily exercise.
“These people need someone to love them, to understand them, to take care of them,” the Honduran immigrant said in Spanish. The 67-year-old worker requested anonymity due to concerns about his immigration status, saying he was at risk of losing protection from deportation with Trump in the White House.
The woman said she entered the United States without authorization decades ago after fleeing an abusive spouse. She then received Temporary Protected Status, which allowed her to work legally in the country. The program must be renewed regularly, and for Hondurans like her, it expires in a few months. Under the Trump administration, caregivers fear that the government’s home care program will put them and other immigrants out of work.
“And the client is left alone with no one to take care of them,” she said.
Supporters point to an analysis published in the Oxford Journal of Economics and Statistics that found immigration enforcement programs implemented from 2008 to 2014 led to shorter direct care hours for nursing home residents. .
Experts said immigration crackdowns could also have an impact in indirect ways, such as by forcing out migrant workers who share homes with their families, putting them at risk of deportation.
“We do not know to what extent future policies that are enacted will slow the flow of legal immigration, whether by making it harder to immigrate to the United States or simply discouraging people from entering the United States,” the director said. Joanne Spets said. from the Center for Health Workforce Research in Long-Term Care at the University of California, San Francisco.
If immigration crackdowns slow the influx of workers, “not only will the shortage of caregivers across the country worsen, the cost of long-term care services could become even more expensive, and public assistance systems would be strained. There could be additional burdens,” said Gen. Meghan Rose. Attorney and Chief Government Affairs Officer of LeadingAge California, which represents nonprofit providers of senior living and care.
Industry groups are calling for easing the path for immigrant caregivers. “Streamlining the legal pathways for passionate people to come to our country and provide services to older adults is a critical part of how our sector meets the growing demand for long-term care.” said Cliff Porter, president and CEO of the American Health Care Association. The National Living Support Center represents long-term care facilities.
With Trump in office, “the bigger threat to this industry is not enforcement mechanisms,” said Laura Collins, director of the SMU Economic Growth Initiative at the George W. Bush Institute. “I’m far more concerned about the lack of a plan to bring in workers,” she said.
Grabowski’s research found that an influx of immigrant workers into nursing homes in a region has a “negligible impact on wages.” In a study published by the National Bureau of Economic Research, Grabowski and other researchers found that as immigration increased, the number of hours of care for nursing home residents and other indicators of improved care also increased. I discovered it.
Beyond nursing homes and other residential facilities, “the home care industry relies heavily on immigrants,” said Diana Silver, a professor of public health policy at New York University. “These are all minimum wage jobs with relatively minimal skills, but they provide much-needed skills.”
An analysis by PHI, a national organization working to improve employment for such workers, found that about one-third of home care caregivers are immigrants. Jodi Sturgeon, the company’s president and CEO, said this does not include the “gray market,” where workers are directly hired and paid by family members, making it difficult to track the workforce. He said he was likely to be at risk of deportation.
If they are forced out, “people like you and me will have to make the decision to quit our jobs or reduce our hours to look after our families,” Ms Sturgeon said. spoke.
SEIU 2015 President Arnulfo de la Cruz said the union represents California workers in home care, skilled nursing facilities and assisted living, and that California and the country We are in the midst of a “crisis” and far more elderly and disabled people are requesting home care. than existing employees can participate.
In recent years, millions of hours authorized by California’s home care program have gone unfilled each month, highlighting a shortage of needed health care providers, the union said.
Across the country, “some people have to sleep in wheelchairs because they don’t have the support to eat, get dressed, get out of bed, or hire someone to support them,” Stacey Kono said. said. Executive Director of Hand in Hand, a national network of employers of domestic workers, including home caregivers. “It really is a life-or-death outcome.”
Times staff writers Andrea Castillo and Karen Kaplan contributed to this report.
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