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The Trump administration has pledged mass deportations and has implemented an aggressive strategy to carry out this plan. At a time when home-based care providers are already struggling with a staffing crisis, mass deportation could spell trouble for providers and create roadblocks for seniors in need of care services.
Home-based care executives, already concerned about workforce shortages, are pushing for policies that would make it easier to expand the limited pool of health care workers to support older adults at home, including through expanded visa programs.
Sara Wilson, CEO of Home Assist Health, said she believes that creating meaningful and effective pathways to U.S. citizenship should be the priority for the home-based care industry, as a way to attract qualified workers.
“Prioritizing and emphasizing the importance of positive, healthy, productive immigration reform is very important for all sectors and for home care, in particular,” she told HHCN. “I am proud and glad that there are efforts to do this. I know that HCAOA has brought up some proposals for the home care visa program and reform for the EB-3 visa. I think those are some examples that we can lean into and discuss more, and refine further so that we can shore up some of our workforce scarcity issues.”
Home Assist Health is a home-based care provider that provides a variety of care services, such as personal care, housekeeping and respite care.
The fallout from Trump immigration policies
President Donald Trump signing an executive order that “expands the use of expedited removal” is just one of the steps the administration has taken since announcing this course of action. Trump has also suspended the refugee admissions program.
Most recently, the Supreme Court allowed Trump to end temporary protected status, which allows nationals from certain countries to live and work in the U.S. This lifts protections for almost 350,000 Venezuelan immigrants who’ve been residing in the U.S.
In general, the larger health care workforce relies on immigrant workers. Over 1 million immigrants work in health care in the U.S., and one-third of them are undocumented, according to a research letter published in JAMA last month.
When taking a closer look at home-based care, researchers found that undocumented immigrants make up at least 10% of personnel at these agencies.
“[Immigrants] play a major role as doctors, as nurses, but particularly in long-term care like nursing home care or home care,” Dr. Steffie Woolhandler, a professor of public health at Hunter College and one of the research letter’s authors, told Home Health Care News. “If Trump follows through on his plans for mass deportations, there’s going to be major shortages of health care workers, and that’s going to compromise access to care and the quality of care for Americans.”
Between now and 2031, the home care industry will have almost 5.5 million total positions open, according to PHI data.
With this in mind, Woolhandler explained that a 10% loss across home care companies would be a major blow to the industry and have far-reaching consequences across the larger health care continuum.
“The shortages in home care really reverberate throughout the system, because hospitals and emergency rooms often want to send frail patients home after the hospital or emergency room has dealt with the acute problems,” she said. “If they can’t send them home because there’s no home care available, they back up the emergency room. or the hospital and other patients can’t be admitted. If you lose 10% of your workforce in home care, that creates a bottleneck, that creates problems throughout the health care system.”
Visa advocacy
Home-based care leaders and stakeholders have turned to political advocacy to urge lawmakers to create new pathways for immigrants to fill critical in-home care roles.
Senior Helpers CEO Peter Ross is an HCAOA member. The organization has advocated for visa programs for home care workers. Ross is also a member of the Healthcare Leadership Council, which pushes to repurpose unused immigrant visas to expedite health care workers’ entries into the U.S.
He stressed that without these efforts, the industry isn’t well-positioned to meet the growing demand of seniors who need care services.
“The country is not ready for this silver tsunami,” Ross told HHCN. “There are 80 million seniors, baby boomers, who start to turn 80 next year. You have to be able to find a way to make sure that people can age in place. 60% of all seniors need assisted care in their lifetime. That’s going to put tremendous pressure on Medicare, Medicaid, the government, counties and states and localities, as well as the federal government, to meet this need. We can do much better at that by having people coming into the country who want to provide that care.”
Maryland-based Senior Helpers is a home care company that operates over 400 franchise locations in the U.S., Canada and Australia. Senior Helpers is one of the largest franchise companies in the home care space. The company was acquired by Waud Capital, a Chicago-based middle-market private equity firm, in 2024.
Immigration pathways have also been top of mind for Right at Home CEO Margaret Haynes.
“[We are focused on] how can we make it easier for caregivers to come into the country, and so we’re asking caregiving to be added to schedule A, where nurses and some other key professions are being listed, so that it can be easier to bring in some quality caregivers to supplement this caregiver shortage that we know is happening today and will continue to be exacerbated in the future,” she said during a recent appearance on HHCN’s Disrupt podcast.
Based in Omaha, Nebraska, Right at Home provides in-home companionship, personal care and support to seniors and adults with disabilities seeking to live independently through more than 750 locations across the U.S. and five other countries.
Leveraging visa sponsorships to recruit new employees is not a simple process, Ross said. However, the CEO is exploring the tactic using examples set by other health care industries.
“I know they’ve done that in nursing, and they’ve done that in other parts of some facilities,” Ross said. “We’ll try to find a way to do that. We haven’t done it in a very serious way before because it’s a very challenging process … but we’re willing to find ways that we can work with the government. We want people here legally too.”
Going forward, Wilson said home-based care providers must continue advocating for immigration reform.
“It’s really just about using your voice, speaking to the right people, advocating and getting involved,” she said. “I really think that no matter who’s in the administration, they need to hear what the communities need from community members.”