Immigration Reform Could Lead To Unintended, Poor Consequences For Home-Based Care Providers

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When talks of immigration reform come out of Washington D.C., home-based care providers take note.

While Democrats push for increased funding for Ukraine and potentially Israel, Republicans have seemed to take the strategy of going after immigration concerns as a negotiating piece. That’s particularly important to providers who often rely on immigrants to hold caregiver roles at their agencies.

If an agreement is reached that toughens immigration policies, it may inadvertently impact home care providers — bringing about unintended consequences that warrant close attention.


“What’s going to have an impact is the potential for the reduction of the Department of Homeland Security’s (DHS) ability to parole — which basically means admit — individuals at the border into the United States,” Jeffrey Bell, the chair of immigration and workforce mobility at Polsinelli, told Home Health Care News. “If a foreign national is paroled into the United States, they have the ability to apply for employment authorization and then will basically be under the jurisdiction of the Department of Homeland Security, with respect to their immigration status and if they’re seeking asylum or other benefits.”

Why Bell pointed to that specific regulation first is because that’s one of the quickest avenues to employment for immigrants crossing the southern border.

As home care providers know, filling caregivers roles in a timely manner is critical to providing high-quality care to seniors.


From now until 2031, it’s estimated that 332,000 home health and personal care aides will drop out of the workforce each year.

According to a report from PHI, at least 27% of direct care workers in the U.S. are immigrants, compared to 17% of the total U.S. labor force. The proportion of immigrants in direct care is also on the rise: the number of immigrant workers grew from about 21% in 2011 to 27% in 2021.

If Congress passes tougher immigration policy, there are other avenues for providers to take to try to attract and recruit immigrants.

In May, the DHS announced a new immigration grant process that advances travel authorization to up to 30,000 noncitizens each month to seek parole on a case-by-case basis. However, only people from Cuba, Haiti, Nicaragua and Venezuela are eligible.

“It requires an application process and a financial sponsor in the United States, but these individuals from those countries are able to get employment authorization fairly quickly,” Bell said.

Then again, Bell pointed out that if there is any sort of reform at the southern border, it certainly could impact those individuals.

The other group that home care providers should be aware of are the immigrants who already work for agencies in the U.S. but have been authorized to do so on a temporary basis. Oftentimes, work authorizations for immigrants have to be renewed on a yearly or semi-regular basis.

“If Congress were to pass a new law that would prevent or restrict individuals already in the United States from renewing their work authorizations, that would be another issue in home health and the caregiving space,” Bell said.

Possible reform

On the other side of the coin, PHI has recommended a number of immigration reform policies that would potentially help the workforce shortage.

In a recent report, PHI recommended Congress pass a slew of initiatives such as the Citizenship for Essential Workers Act, the U.S. Citizenship Act of 2021 and the American Dream and Promise Act of 2021.

Each would provide pathways to citizenship for millions of undocumented immigrants — including direct care workers, PHI says.

Another option is for the government to grant a “caregiver visa,” aimed at streamlining entry into the direct care workforce and offering immigrants opportunities for permanent residency.

Source: PHI

“Following the ‘bridge visa’ model proposed by the Migration Policy Institute, this caregiver visa program should include employer sponsorship and precertification based on a history of compliance with labor and immigration laws,” PHI wrote in its report. “It should also include portability measures that allow workers to move easily from one employer to another, visa renewal opportunities, strong employer oversight mechanisms and a pathway to citizenship.”

One of the biggest challenges the home-based care space faces is the fact that many of the immigrants who are looking for caregiving work don’t have the strongest protections in these D.C.-based negotiations.

“Typically what we see is those foreign nationals at the lower end — perhaps in terms of education, what they’re seeking in terms of opportunity, it’s usually harder for those individuals to gain legal status to work in the United States,” Bell said. “So in an industry like home health and in-home care, if immigration laws are made tougher, I think it would be very likely that it is going to cause greater difficulty for those in the industry to find qualified workers who are properly authorized to work in the United States.”

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