The Trump Administration’s increasingly tough crackdown on immigrants threatens to worsen an already severe shortage of aides who care for frail older adults and younger people with disabilities. The shortage of direct care workers will affect those living at home as well as those receiving residential care.

The problem already is squeezing nursing homes and assisted living facilities, as well as home health agencies. This is especially true in large cities, where many aides are immigrants. Turnover among direct care workers is high, in part because pay is so low. Home health aides, for example, are paid an average of only $10.33 an hour, and their median annual salary is only about $23,000.

Coming shortages

At the same time, demand for aides is exploding. According to CareerCast, Americans will require a half-million more home health aides and 750,000 more personal care aides by 2025.

But there is already a shortage. As the economy nears full employment, it will become even harder  to find people willing and able to do this difficult work at low pay.  Even the president sometimes acknowledges the risk of curbing immigration when the nation nears full employment. Yet, his policies continue to be extremely restrictive.

And care workers, and the families who rely on them, will pay the price.  PHI, which advocates for direct care workers, estimates that about one-quarter of aides, or roughly 1 million people, are immigrants

The real number may be much higher since official estimates exclude  “gray market” aides–those who are often unlicensed and work “off the books” but who provide a significant amount of assistance at lower cost to people with physical and cognitive limitations.


While there is little information about these workers, it is likely that many also are immigrants. Some are documented though others may not be.

While the one million workers who show up in the official employment data likely are in the US legally and have green cards or other work permits, they are not immune from the Administration’s immigration crack-down.

For example, they may have spouses who are undocumented. Or they may be the” dreamers,” who came to the US as children with parents who were not documented. And who the president wants to deport.

Then there are residents from countries such as Haiti, El Salvador, and Honduras, who are in the US  under a program called Temporary Protected Status (TPS). PHI estimates that about 35,000 direct care workers are in the US under TPS, which allowed them to stay because of armed conflict or natural disasters such as earthquakes in their home countries.

But the Trump Administration has been eliminating TPS for many of these countries. Earlier this month, the Department of Homeland Security ended the program for Honduras. As a result, everyone from those countries who is in the US under the TPS program will be deported over the next several months.

Higher costs

While it is harder to quantify, there will also be the future costs of immigration curbs. How many potential aides will not come to the US, either because they cannot or because they’ll choose to move to another, more welcoming country. Remember, the rest of the developed world is aging rapidly. The US is not the only country that needs personal care workers.

More than anything, caregiving the future will be driven by the inexorable demographics of aging. In the US,  Baby Boomers are living historically long lives and, because they had few children, they will be less likely to have family members to care for them in old age. As a result, paid aides will become increasingly important to their well-being.

We know that American-born workers often are unwilling to do this work. Not only is pay low, but injury rates are among the highest of all occupations. In recent years, immigrants have filled his gap. And because many were trained as nurses in their home countries, they are often more qualified than their US-born colleagues.

But current immigration policy will mean limit growing shortages of qualified aides, and inevitably, higher pay.  And that will increase the already-difficult financial burdens on families. They will have only two choices: Pay aides more (if they can find them at all) or do the work themselves.

I have seen no evidence that anyone in the Trump Administration has considered these consequences. But that makes them no less real for those who need personal care and their families.