Latest Trump Immigration Proposals Raise Alarms in Home Health

Since President Donald Trump took office last year, home health industry advocates have been raising red flags over his administration’s positions on immigration. The latest proposals, related to so-called “chain migration” and the expiration of protected status for Haitians, are no exception.

Both The New York Times and Kaiser Health News recently reported on the issue, in separate articles that ran on March 25 and March 26, respectively. The Times focused on chain migration.

“A proposal favored by a number of Congressional Republicans and the Trump administration would replace the current family-preference immigration system, which critics call ‘chain migration,’ with one that favors skilled immigrants, while reducing admissions over all,” the article states.


Specifically, under a bill introduced in the House of Representatives, immigrants would no longer be able to bring family members such as parents, adult children, and siblings into the country. In addition, there would be a point system based on education level and other factors to determine eligibility for legal entry.

The issue for home health is that it is facing an increasingly dire caregiver shortage and relies on immigrants to fill these “low-skill” jobs. About a quarter of all personal care aides and home health aides was foreign born as of last year, according to an analysis cited by the Times. That number is even higher in some states—reaching 62% in New York.

Supporters of the House bill argue that restricting immigrant labor will force employers to raise wages, making positions more attractive to U.S. citizens. However, home health providers that rely largely on Medicare and Medicaid for revenue cannot easily raise wages to compete with other employers.


Adding to providers’ concerns, the White House has also decided to end temporary protected status (TPS) for Haitians. Kaiser Health News shone a light on this policy, under which people who came to the United States after the devastating 2010 earthquake in Haiti have had permission to stay in the country and find work.

Now, TPS is set to end as of July 22, 2019, after which Haitians could face deportation.

This policy appears to be a significant threat for the senior care industry. Take Massachusetts, where 4,300 Haitians are employed in nursing facilities, according to the state’s Senior Care Association. Home care providers also tap into this immigrant group, and KHN highlighted a home care worker, Nirva, who declined to use her full name. Her experience in the earthquake inspired her to enter the caregiving field when she got the United States, and she now cares for clients such as 96-year-old Isolino Dicenso.

Dicenso fears losing Nirva once TPS expires, she told KHN. Her daughter said that she believes few people will step in to fill the cargiver void should immigrants like Nirva leave the country.

However, a supporter of the policy disagreed, with some tough words for employers.

The health care industry “needs to take a hard look at its recruiting practices and compensation packages,” David Ray, spokesman for the Federation of American Immigration Reform, told KHN.

Written by Tim Mullaney

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