Terry Hodge would have a tough time caring for the 150 or so elderly women at Bethany Health Care Center without the dozens of immigrant nursing assistants, housekeepers, dietary aides and other staffers at the Framingham, Massachusetts, facility.
More than 40% of her employees were born abroad, hailing from 26 countries, including Haiti, Guatemala, El Salvador and Ghana, said Hodge, the center’s administrator. Among the certified nursing assistants, the figure is 84%.
They are workers whom Bethany “can’t afford to lose,” she said, noting they help residents get out of bed, escort them to the bathroom, dress and feed them, give them medication and talk to them.
“Our residents rely heavily on the care and companionship of the nursing staff and the housekeeping staff,” Hodge continued. “The immigrant workers are very crucial to the functioning of this facility and to the physical and mental health of the people they serve.”
That’s why President Donald Trump’s vow to deport millions of immigrants in the US and restrict the influx of new arrivals has so concerned Hodge and her workers particularly those who are asylum seekers and beneficiaries of the Deferred Action for Childhood Arrivals, or DACA, and Temporary Protected Status programs since Trump has tried to target these measures in the past.
“They are extremely anxious about what the future holds for them,” she said. “We, as a facility, are anxious about losing any staff.”
Trump’s promised crackdown on immigration comes at a time when the US desperately needs more workers to care for the swiftly growing ranks of senior citizens. His rhetoric alone could dissuade immigrants from coming to the US and hinder efforts to recruit foreign-born workers for the health care sector, experts said.
The president has not provided many details on the actions he intends to take, so many in the elder care industry can only take a wait-and-see approach for now. But they also intend to underscore for the new administration and Republicans in Congress the key role immigration plays in the field and encourage them to open additional legal pathways for foreign workers.
“We have a group of older adults that are going to live longer than we have ever seen, and they will need and require access to care and services,” said Nicole Howell, director of workforce policy at LeadingAge, which represents more than 5,400 nonprofit aging services organizations, including nursing homes and home-based care providers. “Disrupting the workforce is harmful to those individuals and their families.”
Asked earlier this month for comment on the industry’s concerns, Karoline Leavitt, then a spokeswoman for the Trump-Vance transition, said in a statement that the president will “institute the largest deportation operation of illegal criminals, drug dealers, and human traffickers in American history while simultaneously lowering costs for families and strengthening our workforce.”
Immigrants have long flocked to caregiving jobs. While the foreign-born make up 17.7% of the US workforce, they account for 42.4% of home health care aides, said Steven Hubbard, senior data scientist at the American Immigration Council, citing 2023 Census Bureau data. Some 6.4% of them are undocumented immigrants.
Nearly a quarter of nursing assistants working in the health care industry are foreign born, which includes those who have become citizens or permanent residents, along with unauthorized migrants and others. Some 4.2% of nursing assistants are undocumented immigrants, Hubbard said.
Immigrants also fill many support roles in long-term care facilities, said David Grabowski, professor of health care policy at Harvard Medical School. More than 30% of non-direct care workers, such as housekeepers and dietary services staff, are foreign born.
“Caregivers are the backbone of long-term care, and foreign-born workers are a big part of that backbone,” he said. “Without them, we’d have huge staffing shortfalls and individuals’ quality of care and quality of life would be worse.”
Plus, there’s the so-called gray market, where aides are hired directly by individuals or their families. Those caregivers are more likely to be undocumented, Howell said.
The aging of the Baby Boomers is reshaping the elder care landscape.
The number of people ages 65 and older is expected to skyrocket 47% in coming decades, from 58 million in 2022 to 82 million by 2050, according to the Population Reference Bureau, a research organization. This cohort will make up 23% of the US population in the middle of the century, up from 17%.
That surge will put increasing pressure on the long-term care industry, which already suffers from staffing shortfalls and high turnover rates.
Demand for direct care workers, including home health aides, personal care aides, nursing assistants and psychiatric aides, is projected to increase by 39% between 2022 and 2037, according to the 2024 National Center for Health Workforce Analysis. The report notes that employment among home health aides and personal care aides is expected to expand at a slower pace.
“We have a long way to go in terms of making sure that we have coverage,” said Jason Lee, CEO of the Home Care Association of America, a trade group for agencies that provide personal care aides to senior citizens, people with disabilities and others. The association is advocating for the creation of a specific home care visa to help ease the worker shortage.
An increase in immigrants’ arrivals in a community significantly boosts staffing in nursing homes, particularly among full-time workers, and leads to improved patient care, Grabowski’s research has found. Immigrants fill the gaps in the ranks of certified nursing assistants, who provide critical services such as feeding, bathing and dressing patients, helping reduce their psychological stress.
“This is very basic care, but it’s really essential,” he said. “And when you don’t have enough workers, bad things happen.”
Some in the elder care industry are trying innovative ideas to attract more immigrants into the field.
When Robin Wolzenburg saw an influx of Afghan refugees several years ago, the LeadingAge Wisconsin senior vice president reached out to the state’s resettlement agencies to collaborate on preparing the newcomers for housekeeping, laundry and other support jobs, with the goal of training them for nursing positions. At least two dozen have been placed.
Since the presidential election, Wolzenburg has fielded questions from LeadingAge members about how the Trump administration will affect the effort.
“My answer is, ‘I don’t know yet,’” she said.
