Think Immigration: Where Are the Healthcare Aides?

Imagine your mother suffers a heart attack, or your spouse has a work injury, and in-home care for their recovery suddenly becomes necessary, but there are no caregivers available to help. This is a reality that many are already facing, and that many more could face in the future. There are physician shortages in some states, a staffing crisis for nurses due to retirements coupled with pandemic burnout, and now aggressive anti-immigrant rhetoric and policies. The latter item may not seem connected, but home healthcare aides are the link. These aides provide essential care to our elderly and disabled, but the increasing need for their services raises an important question – where will these workers come from? In 2021, nearly 40% of home healthcare aides in the United States were immigrants, reflecting the critical role immigrant workers have in this sector.

Over the next forty years, the number of Americans ages 65 and older will more than double. As the American population ages, the demand for home healthcare aides is set to rise dramatically. An analysis of the United States Bureau of Labor Statistics data by the American Immigration Council revealed that an average of 711,700 jobs will open annually over the next ten years, indicating this demand has already started. It is also projected that in that same period, 332,300 home health and personal care aides will drop out of the workforce.

Our federal immigration policies have created significant barriers to filling these roles, resulting in a decline in the influx of caregivers from abroad. Anti-immigrant sentiment has now grown. In addition, gaps in state-wide policies leave immigrant home healthcare aides vulnerable to undesirable working conditions like low wages and unregulated working hours. This decline and the associated conditions have exacerbated existing challenges in the home healthcare industry, especially in states like Massachusetts and New York. Proposed mass deportations and a negative sum immigration mindset will further decimate a physically demanding healthcare occupation reliant on foreign nationals.

For example, in our area of New England, Massachusetts is home to more than 1.2 million immigrants and heavily relies on immigrant labor in its home healthcare sector. Americans are not rushing to fill these roles and a decrease in immigrant talent will further exacerbate the situation. The state is experiencing a looming crisis due to an insufficient number of home healthcare workers. The turnover rate is alarmingly high, ranging from 40 to 60%. This is attributed to the physically demanding nature of the job, overwhelming patient loads, and inadequate pay. Reform is necessary to address these issues and retain home healthcare aides. This includes improving wages, enhancing work conditions, and providing better support services for workers.

New York faces similar challenges in its home healthcare sector. Immigrant workers are crucial in meeting the high demand for home healthcare services as over 60% of home health aides are immigrants. However, despite New York’s reliance on immigrant labor, many home healthcare workers rarely earn above minimum wage and are vulnerable to wage theft and retaliation. In a state with one of the highest costs of living in the nation, these workers are often unable to sustain themselves, despite many working 24-hour shifts. Strict rules and regulations are essential state-wide to protect workers who are already afforded less protection. The issue is not only the demand for these jobs, but also the undesirable working conditions.

Our immigration system lacks a temporary work visa option and a simplified green card path specifically for these critical workers. Several methods can be used to address this ongoing issue, including creating a “caregiver visa,” or building career pathways for internationally trained immigrants. State governments along with the federal government must recognize the crisis is at hand and take substantive actions for our vulnerable patient population. Aggressive anti-immigrant policies will only worsen this labor crisis.

The future of home healthcare in states like Massachusetts and New York is inextricably linked to the role of immigrant workers. Addressing turnover rates, low wages, and demanding working conditions – as well as ensuring immigration policies support the flow of skilled workers into the country – are necessary to retain current workers and attract new ones, regardless of immigration status. Mass deportations and isolationist immigration policy will do nothing to help. By fostering a supportive environment for immigrant home healthcare aides and occupational reform can the United States better meet the needs of their aging populations and ensure the delivery of high-quality care.