One in Four Direct Care Workers Are Immigrants

Nearly one quarter of the direct care workforce, which includes home health aides, personal care aides and nursing assistants, are immigrants, according to a recent report from Paraprofessional Healthcare Institute (PHI), an organization centered on improving the direct care workforce. And this sector of the direct care workforce would benefit from “an array of policy supports and industry practices,” PHI found.

There are 4.4 million direct care workers providing long-term care for Americans, 860,000 of whom are immigrants, PHI found. When accounting for individual providers, that figure swells to 1 million immigrant direct care workers.

Compared to nursing assistants, a greater percentage of home care workers are immigrants. Immigrants make up 20% of nursing assistants and 28% of home care workers.


One of the top supports that would help this workforce is higher wages, PHI reported. Among the immigrant direct care workforce, 44% are at or below 200% of the federal poverty line; 26% are at or below 138% of the federal poverty line; and 15% are at or below 100% of the federal poverty line.

A significant portion—44%—of immigrant direct care workers rely on public benefits, including Medicaid and nutrition assistance, according to PHI.

Under the Radar Contributions


Undocumented immigrants are likely a big part of the direct care workforce, PHI also noted. More research is needed to understand just how many undocumented immigrants contribute to long-term care, as some consumers circumvent Medicaid or traditional agencies to directly hire immigrant workers for their care.

However, there are several barriers to understanding the contributions of undocumented immigrants, according to PHI, including social, economic and political obstacles.

“Given the harsh political sentiment surrounding undocumented immigrants, as well as the centrality of this population to various sectors, including long-term care, more research is needed to understand the relationship between direct care and undocumented immigrants,” the report reads. “Immigrant direct care workers who are hired directly by consumers outside the Medicaid system—the ‘gray market’—also remains an understudied topic of distinct interest to researchers, policymakers and providers alike.”

Written by Amy Baxter

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