COVER SERIES

Homecare Needs a Pathway for

IMMIGRANT LABOR

Immigration policy is hurting homecare providers’ ability to staff properly

By Richard T. Herman

Every homecare operator knows the basic demographic problem: More Americans want to age at home, but too few workers are available to help them do it safely.

What the industry has not fully confronted is that immigration policy is becoming a direct threat to workforce continuity.

The United States is moving toward unprecedented demand for home health aides, personal care aides and other direct care workers while at the same time federal policy is making a critical part of that workforce less secure. If policymakers continue to treat immigration and senior care as separate issues, providers, families and older adults will bear the consequences.

Looking at the Numbers

The statistics are already daunting. The Bureau of Labor Statistics projects that employment of home health and personal care aides will grow 17% from 2024 to 2034, adding nearly 740,000 jobs. It also projects approximately 765,800 openings every year as demand grows and workers leave the occupation.

Those openings will be difficult to fill under any circumstances. Median annual pay was only $34,900 in 2024, and the work remains physically demanding, emotionally taxing and often unpredictable. Providers face reimbursement constraints, high turnover and competition from retail, hospitality, logistics and other industries that can offer comparable wages with fewer caregiving responsibilities.

Now add immigration instability.

Foreign-born workers make up a substantial share of the direct care workforce. The Paraprofessional Healthcare Institute’s (PHI) national workforce research documents the importance of immigrant workers across homecare, residential care and nursing facilities. Recent reporting has estimated that immigrants comprise roughly 28% to 30% of the long-term care workforce, with Haitian workers representing an especially important segment.

That dependence is not accidental. Homecare has long drawn workers from immigrant communities because the industry needs a large, geographically dispersed workforce willing to perform difficult and deeply personal work. Many caregivers also bring multilingual skills and cultural knowledge that help providers serve increasingly diverse clients.

Yet the immigration system offers remarkably few practical pathways for the workers the industry needs most.

Protections for Certain Categories

Employment-based immigration generally favors highly educated professionals, specialized occupations or employers with the resources to navigate complex sponsorship systems. Home health aides and personal care workers rarely fit comfortably within those categories, even when the local labor shortage is severe.

As a result, many providers rely on workers who are already in the U.S. through a patchwork of statuses: lawful permanent residence, asylum, temporary protected status, humanitarian parole, family-based status or employment authorization connected to a pending application.

When those protections are revoked, narrowed or allowed to expire, the effect can be immediate. A trained caregiver may lose work authorization. Another may stop accepting shifts because she fears immigration enforcement while commuting. A supervisor must rebuild the schedule, remaining employees absorb overtime and clients face gaps in care.

For an agency, losing a caregiver is not simply a matter of reopening a job posting.

Family Members Filling the Gaps

Care is built on trust and familiarity. A caregiver may know how to transfer a particular client without causing pain, recognize early signs of infection, understand how to calm someone with dementia or know which family member must be called when a condition changes. Those relationships take time to develop and cannot be replaced overnight.

When the schedule breaks down, the cost moves elsewhere. Another aide works extra hours and risks burnout. A daughter reduces her work schedule. A spouse attempts tasks he is not physically able to perform. A hospital delays discharge because safe care cannot be arranged at home.

The pressure on families is already enormous. AARP and the National Alliance for Caregiving estimate that 63 million Americans now provide care, a sharp increase over the past decade. Many are also employed, raising children or managing their own health problems.

If the professional workforce shrinks, more families will be forced to fill the gap themselves. That can mean lost wages, reduced hours, early retirement or complete withdrawal from the labor force. It can also increase emergency-room use, hospital readmissions and premature placement in institutional care.

Putting the Pieces Back Together

Immigration policy is therefore not merely a political or compliance issue for homecare providers. It is a workforce risk issue, a client safety issue and a business continuity issue.

The argument is not that immigration alone can solve the caregiver shortage. The industry must improve wages, training, benefits, scheduling and career advancement. Better jobs are essential to attracting and retaining both U.S.-born and immigrant workers.

But improved job quality and sensible immigration policy are complementary solutions. The shortage is too large to solve by simply redistributing the existing labor force.

Congress should create a workable immigration pathway for direct-care workers in communities with documented shortages. Any such program should include wage protections, freedom to change employers and safeguards against recruitment abuse. States or regional healthcare systems could also be authorized to sponsor workers in areas facing acute shortages.

Federal agencies should assess healthcare and workforce consequences before terminating work authorization for large groups already employed in long-term care. No responsible homecare organization would remove a significant share of its staff without first evaluating the effect on clients. Government should apply the same standard.

Providers also have work to do now.

Agencies should identify how many of their employees rely on temporary forms of work authorization, review reverification procedures and prepare contingency plans for abrupt policy changes. They should provide workers with access to reputable legal information, train supervisors not to give unauthorized immigration advice and document how staffing disruptions affect client admissions, overtime and continuity of care.

Industry associations should gather that data and present it directly to lawmakers. General warnings about a caregiver shortage are no longer enough. Policymakers need to see how immigration changes translate into missed visits, delayed discharges, reduced service areas and clients who cannot safely remain at home.

This is not about asking homecare companies to take a position on every immigration controversy. It is about recognizing a material threat to the workforce on which the industry depends.

An older adult waiting for help getting out of bed does not care whether the caregiver was born in Haiti, Ohio or the Philippines. The client cares that the caregiver arrives, understands the care plan and can be trusted inside the home.

America is building an eldercare system that increasingly depends on immigrant workers while making those workers harder to retain and nearly impossible to replace through lawful channels.

Homecare leaders should say plainly what policymakers have not yet acknowledged: Immigration policy is now care policy.

The country cannot meet the coming demand for home-based care while destabilizing a workforce it already cannot afford to lose.

Richard T. Herman is the founder of Herman Legal Group and the co-author of Immigrant, Inc.: Why Immigrant Entrepreneurs Are Driving the New Economy. He has practiced immigration law for more than 30 years and writes frequently about immigration, labor markets and economic development. He has been quoted by the New York Times, the Washington Post, USA Today, NPR, Forbes and numerous international media.