When President Donald Trump took office in January, he pledged a sea change in the way the U.S. manages legal and undocumented immigration. In his first 100 days in office, Trump has delivered the disruption he promised, with immigration down dramatically and many foreign-born nationals rethinking working in the U.S. This effort may affect the ability of older Americans to get the home healthcare help they need, either because it becomes more expensive or because workers are harder to find.
The U.S. does not have a specific visa program for home healthcare aides to work in the U.S. A patchwork of temporary or permanent visa arrangements allows some workers to immigrate, but these visas are limited. Most people enter through "chain migration," via family members who are already citizens or green card holders. This is a form of legal migration that Trump has pledged to end or reduce.
A perfect storm is brewing. Trump's immigration crackdown coincides with an existing shortage of home healthcare workers, a Congressional budget that would cut Medicaid and a rapidly aging U.S. population. And that could be detrimental to people who rely on that care in their older age.
A worsening healthcare worker shortage
The U.S. had a severe nursing shortage well before Trump took office. According to a report by JAMA, nearly half of nursing homes report having to limit admissions due to staff shortages, and healthcare personnel shortages caused two-thirds of hospitals to operate below full capacity in 2023.
We need a vast number of new workers to satisfy the growing demand. Immigration Impact reports that the U.S. will need to fill roughly 712,000 open jobs for home health workers and personal care aides every year through 2031. An aging population of baby boomers and increased longevity are driving this need.
Meanwhile, roughly 332,000 home health and personal care aides are expected to leave the labor force each year due to retirement or other reasons, while 287,000 are expected to leave the profession for different jobs. But with more Americans opting to age in place, this trend couldn’t be unfolding at a worse time.
In 2019, about one-third of home health aides in the United States were immigrants. This includes undocumented workers, who made up almost 7% of home health aides and more than 4% of personal care aides.
Immigrant healthcare workers also played a crucial role in ensuring that older Americans got the care they needed during the pandemic. In 2021, there were roughly 56,000 undocumented personal care aides and 34,000 home health aides, according to the Center for American Progress.
But with President Trump cracking down on immigrants and more aggressively threatening mass deportations, there's a real risk of seeing the broad healthcare worker shortage increase drastically.
NPR reports that almost 17% of healthcare workers were born outside the U.S. And more than 366,000 are assumed to be immigrants without legal status.
Certain regions of the U.S. are particularly reliant on non-citizen immigrants, including New York, Florida, and California. Stricter immigration policies could create a real crisis among retired Americans who need at-home support.
Costs are likely to rise
Even if potential home health aide shortages are addressed, many older Americans who need that assistance can't afford it. Genworth estimates the average annual cost of a home health aide to be $77,792 on a national level. If immigrant home health workers are replaced by workers who can demand higher wages, it could put that care out of reach for millions of people.
Don't forget that Medicare does not cover home health care in almost any scenario, as it is often considered custodial rather than medical in nature. Instead, Medicaid usually covers the cost of home health aides. However, lawmakers are considering significant Medicaid cuts that could limit older beneficiaries' access to care.
All told, more than 350,000 healthcare workers face deportation in the wake of Trump's immigration policies. And while the issue isn’t specific to retirees, those who rely on home health workers face higher costs or reduced care as Trump’s immigration policies come to a head.
