Abstract
American families were already facing immense, often unmet, care needs for older adults and people with disabilities before the Trump administration launched an aggressive and chaotic set of policies and actions targeting immigrants. This administration’s actions have set off a cascading crisis in an already-strained care system: fewer direct care workers, increasingly unaffordable and unstable care, more family caregivers being forced to leave the paid labor force, and billions in resultant economic losses. Reforming our broken immigration system to build a strong direct care worker pipeline is an essential part of a plan to meet our nation’s enormous caregiving needs.
Key Words
direct care, immigrant workers, immigration policy
At one Jewish senior living home in Boca Raton, Fla., nearly 1 in 10 staff members are Haitians with Temporary Protected Status (TPS; Lapin, 2026). When TPS for Haiti was set to expire on February 3, 2026, some of the center’s 500 residents—many of whom are Holocaust survivors—began asking whether they could hide Haitian staff members in their apartments to help them avoid deportation to potentially life-threatening conditions in Haiti.
As reported by the Jewish Telegraphic Agency: “ ‘That reminds me of Anne Frank,’ [said] Rachel Blumberg, president and CEO of the center … . ‘There’s a kindred bond between our residents being Jewish and seeing [all] that the Haitians have gone through’ ” (Lapin, 2026).
Families across the country already were facing immense caregiving needs and unbearable costs before the Trump administration launched an aggressive and chaotic set of policies and actions targeting immigrants. This administration’s actions are putting an already strained care system at risk of total collapse. In the United States, we cannot care for our families without immigrant care workers. The future of immigrants and the future of care in the United States are fundamentally connected and interdependent.
Aging/Disability Care and Immigrant Workers Are Fully Interdependent
Every day, 10,000 people in the United States turn age 65 (America Counts, 2019). Driven by the aging of Baby Boomers (the second largest generation after Millennials) and declining fertility rates, the number of older adults is growing 5 times more quickly than the total population and faster than ever before (Caplan, 2023). By 2030, in just 4 years, older adults will outnumber children younger than 18 for the first time in U.S. history (America Counts, 2019; U.S. Census Bureau, 2023). By 2050, there will be more than 80 million people older than age 65, representing more than 20% of the population (U.S. Census Bureau, 2023).
This aging population is driving an immense need for direct care workers who provide essential care and services to older adults and people with disabilities and serious illnesses. The direct care workforce is expected to add more new jobs than any other occupation in the coming years (PHI, 2025). By 2034, at least 9.7 million direct care jobs will need to be filled (PHI, 2025). Even though home health and personal care aides are currently the single largest occupation in the U.S. economy (Rieley & Colato, 2026), demand for long-term care for older adults and people with disabilities is rapidly outpacing the supply of workers (Kreider & Werner, 2023), raising the cost of care, leaving families without critical support, and straining communities across America. In fact, only 13–32% of people who need assistance at home receive any paid care (Kreider & Werner, 2023). The rest rely upon care from family and friends or receive no help at all.
We can’t care for the growing number of older Americans, older adults with complex needs, and people with chronic illnesses or disabilities without immigrants. As of 2024, there were more than 1.3 million immigrant direct care workers, representing more than a quarter of all direct care workers (PHI, 2025). By comparison, immigrants made up about 18% of all workers nationwide and about 19% of all healthcare workers (Zavodny, 2025). Moreover, reliance upon immigrant workers in the direct care industry has only grown in recent years: The share of direct care workers who are immigrants in 2011 was just more than 20% and is now more than 25% (PHI, 2023). Among direct care workers working in home health agencies, an even more striking one-third are immigrants (PHI, 2025; Zallman et al., 2019).
‘As of 2024, there were more than 1.3 million immigrant direct care workers, representing more than a quarter of all direct care workers.’
In short, immigrants play a growing, outsized role in the direct care workforce, disproportionately filling overall workforce shortages and complementary roles to the ones held by more U.S.-born workers (e.g., nurses, therapists, and administrative support roles; Zallman et al., 2019; Zavodny, 2025).
The Harms of Unprecedented Anti-immigration Policy in Aging and Disability Care
The Trump administration’s aggressive immigration enforcement tactics and wide-ranging anti-immigration policy changes have set off a cascading crisis for the already-strained direct care industry. Between the termination of TPS for various countries and humanitarian parole programs for 2.5 million immigrants, elimination of policies barring immigration agents from “sensitive areas” such as care facilities and schools, quadrupling of arrests by Immigration and Customs Enforcement (ICE), and unprecedented militarized presence of immigration agents in multiple U.S. cities (Chishti et al., 2026), workers of all legal statuses are increasingly afraid to go to work (National Domestic Workers Alliance, 2026). Providers also have been forced to terminate experienced employees who lose their legal status and work permits. They struggle to backfill those positions, leaving their teams understaffed and families without trusted caregivers who are difficult or impossible to replace. One home care worker summarized this cascading crisis:
“Home care workers have almost all lost their jobs because of what is happening with immigration. Many of them have moved to housecleaning because they no longer have the option to work in home care. Some people have had the same job for 10 years and lose it. And what you lose is the experienced workers. The patients’ quality of care goes down as a result. The loss of jobs is the result of not having certain certifications, or immigration related constraints, like not being able to get to work.”
If the Trump administration follows through on its stated commitment to deporting 4 million workers over 4 years, the direct care industry could lose 394,000 jobs—274,000 from the loss of immigrant workers and the remaining 120,000 from U.S.-born workers in complementary roles (Zipperer, 2025). States like New York, Massachusetts, and Texas are expected to lose 45%, 38%, and 22% of their direct care workforce, respectively, reflecting the high concentration of immigrants in the direct care sector (Zipperer, 2025). Family caregivers are already noticing increased difficulty finding care workers for their loved ones. In August 2025, a National Domestic Workers Alliance (NDWA) supporter who moves between Cape Cod and Florida to care for her 90-year-old mother relayed that “…the workforce shortage on Cape Cod and Florida is worsening now as Haitian caregivers lose their Temporary Protected Status and other immigrant caregivers are threatened with deportation.”
These anti-immigration actions also are affecting the cost of care. In 2024, the median annual cost of aging and disability care ranged from $70,720 for a home health aide for 40 hours per week to $127,750 for a private room in a nursing home (Genworth, 2025). By the end of 2025, the cost of in-home care rose more than 3 times as much as the cost of all other goods and services (Peck, 2025). Intertwined issues with worker supply and care cost are likely to worsen as the Trump administration’s actions to severely restrict access to asylum, halt almost all refugee resettlement, and increase barriers to other forms of legal immigration continue to undermine the ability to attract new immigrant direct care workers for years to come (Chishti et al., 2026).
‘As an old person, I want to be cared for by people who have secure lives, not by people who are living desperately.’
The consequences of these losses of experienced direct care workers, exacerbated worker shortages, and increases in care cost will be felt by care consumers, their families, and the overall U.S. economy. Past research shows that mass deportation campaigns and increased immigration enforcement activity lead to fewer older Americans receiving the help they need at home and huge numbers of family members leaving the labor force to care for their loved ones (Herbst & Tekin, 2025; Jung & Mockus, 2025; Kreider & Werner, 2025). As family members cut back on paid work, lose wages, or exit the labor force entirely, the United States will lose out on billions of dollars’ worth of potential economic growth.
According to one analysis from 2022, the United States is already expected to lose around $290 billion each year in 2030 and forward due to unfilled direct care and childcare jobs and family members missing or leaving paid work to take on unpaid care duties (Kos et al., 2022). Given the dire implications of this administration’s anti-immigration agenda, the U.S. economy is likely to lose even more—perhaps closer to this prior report’s worst-case scenario of $500 billion lost each year.
We Need a Robust Immigration Policy to Support a Strong Direct Care Worker Pipeline
Aggressive anti-immigration policy is creating unstable and unsustainable living and working conditions for the immigrant direct care workers this country relies upon, with serious consequences for the rest of the direct care system, families, and the overall economy. To meet our nation’s immense direct care needs, we must protect and grow our direct care workforce. In the words of one NDWA supporter: “As an old person, I want to be cared for by people who have secure lives, not by people who are living desperately.”
By 2034, at least 9.7 million direct care jobs will need to be filled (PHI, 2025). Research shows that increasing immigration leads to more immigrant healthcare workers, better quality aging care, and fewer deaths among older adults (Grabowski et al., 2026). It follows that growing the immigrant care workforce will be a critical part of any solution to our nation’s care crisis. We must start by ending current policies that are exacerbating shortages. And we must also reform our immigration system in a manner that contributes to a strong direct care worker pipeline.
The latter will require a pathway to legal status and green cards for current and future direct care workers who are in the United States, as well as a legal pathway for individuals to come to the United States to fill direct care jobs in a manner that ensures protections for both U.S.-born and foreign workers. We can and must do a better job of leveraging immigration policy to help meet labor market needs in the long-term care sector, addressing rapidly changing economic and demographic realities, and meeting the caregiving needs of our nation’s families.
Emily Wright, PhD, is director of Research, and Haeyoung Yoon is vice president, Policy and Advocacy, both at the National Domestic Workers Alliance in New York City.
Photo credit: Shutterstock/buritora
References
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