COVER SERIES
A Key Staffing Solution
Immigrants make up a significant part of the direct care workforce
More than half of people older than 65 will at some point need help with at least two activities of daily living and more than half will use some form of paid long-term care, according to government data. People younger than 65 with disabilities also rely on the same kind of assistance, often paid through Medicaid. That means a constant need for direct care workers, both in the home and in institutions—and, as everyone in the industry knows, creates one of the greatest challenges for the sector as jobs become harder to fill.
The solution for many? Immigrant labor.
The numbers aren’t easy to track, but, the Immigrant Research Initiative (IRI) estimates that 251,000 immigrants work as home health aides. Another 599,000 are registered nurses and 98,000 are licensed practical and vocational nurses. According to a recent analysis by KFF, three in 10 direct care workers are immigrants, including naturalized citizens and noncitizens—some of them lawfully present, some of them undocumented. Given that statistics estimate there are about 2.3 million direct care workers in the U.S., that means almost 700,000 of the people providing direct care were born in another country.
We break down where they come from, where they work and the type of work they do here.
33% of homecare direct workers are immigrants, a higher share than nursing facilities (25%) and residential care facilities (23%). (Editor’s note: KFF includes home health and non-medical homecare services in homecare.)
The prevalence of immigrant care workers
65% of immigrant direct care workers come from 13 countries.
These six countries account for the largest portions of immigrant direct care workers:
Mexico
Dominican Republic
Philippines
Jamaica
China
Haiti
At least 1 in 5 come from a country that is part of the Trump administration’s immigrant visa pause.
(Editor’s note: A judge vacated the visa pause Aug. 21, leaving it on hold at press time. The administration may choose to challenge the decision or find another pathway.)
Caregivers by country of origin
The portion of the care workforce that hails from overseas varies widely by state. New York state alone counts 144,000 immigrant home health aides, or 71% of the total, along with 64,000 registered nurses working in all settings, according to the IRI.
Direct care workers by state
On June 27, the Trump administration ended Temporary Protected Status (TPS) for Haitians and Syrians legally living and working in this country. The loss of Haitian immigrants—a central part of the direct care workforce—is expected to be a blow for many homecare agencies and other service providers. Six percent of immigrant direct care workers hail from Haiti. An estimated 13,000 Haitians who hold temporary protected status are estimated to work as nursing assistants and another 8,000 as caregivers, according to The Arc, a nonprofit group dedicated to protecting the rights of people with intellectual and developmental disabilities, many of whom receive home- and community-based services and supports.
The impact will be felt more in some areas than in others. Florida, for example, is home to about half of the nation’s 350,000 Haitian TPS holders, and Haitians make up 28% o the state’s immigrant direct-care workforce, according to the research and advocacy group PHI. The Home Care Association of Florida (HCAF) told the Wall Street Journal that cited two Miami area homecare agencies shut down after each losing more than 80 Haitian TPS holders. Agencies in New York and Massachusetts have also expressed concern.
“Ultimately what this is, it’s about patients and continuity of care,” HCAF’s senior director of policy, advocacy and communications, Kyle Simon, said on MS NOW. “When a caregiver disappears, a patient does not simply lose an employee; they lose a trusted, trained person who helps make it possible for them to live safely at home.”
On August 13, a coalition called The Care for Seniors, Care for America Coalition—which includes aging-services providers (including LeadingAge), labor unions and business leaders—announced it was launching a national campaign to protect the senior care workforce.
“The termination of TPS for Haitian workers will place an unbearable strain on American families as they scramble to shoulder increased caregiving responsibilities. According to an AARP report, 59 million family caregivers provide care equivalent to 23.8 million full-time workers. Removing this critical TPS workforce will force more Americans to bridge this gap while already navigating higher costs and limited options in care homes,” said Rebecca Shi, CEO of the American Business Immigration Coalition.
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