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This week, my screens have been full of images and videos of Marines and National Guard members attempting to quell Los Angeles protests denouncing the Immigration and Customs Enforcement (ICE) agency’s aggressive raid strategy.
As people across the U.S. take to the streets to decry ICE and the Trump administration’s approach to the L.A. protests, my attention drifts back to the potential consequences of the immigration policies on the home-based care industry. Finding sufficient caregivers to meet rising demand is a never-ending challenge for the at-home care industry. With one in three home care workers being an immigrant, and 139,000 home health aides, nursing assistants and personal care aides being undocumented, stringent immigration policies stand to make a challenging workforce environment almost insurmountable.
Still, the industry has survived fluctuations in immigration policies in the past.
While President Donald Trump may be the first president to mobilize the National Guard against a governor’s wishes since 1965, he is far from the first president in recent decades to take an active approach to arresting and deporting immigrants.
Trump deported 37,660 people in his first month in office, Reuters reported in March – substantially below the average of 57,000 deportations that occurred in the last year of former President Joe Biden’s tenure.
While some called Former President Barack Obama the “deporter in chief,” he deported an average of 36,019 people per month in 2013, the year with the highest number of deportations while he was in office, according to data from the Office of Homeland Security Statistics.
So the home-based care industry has experienced even more significant numbers of deportations. But I think the Trump administration’s focus on ramping up ICE arrests (reportedly looking to triple daily arrest quotas) and his continued expansion of executive powers will make for continued and worsening hardships for an industry seeking to care for older adults wishing to age in place.
In this week’s exclusive members-only HHCN+ Update, I cover Trump’s immigration policies and what arrests and deportations mean for home-based care worker shortages. I’ll offer analysis and key takeaways, including:
– Why the Trump administration’s deportation strategy shift matters
– What the home-based care industry’s response to current immigration policies means
– That Trump’s vision of a “Golden Age” could be a dark age for home care
Trump’s ‘all about the numbers’ strategy and potential fallout
Immigration policy is among the top concerns for employers, with 75% of respondents to Littler’s 13th Annual Employer Survey, released in May, reporting that they expect Trump’s immigration policy to impact their businesses.
The home-based care industry in particular stands to feel the consequences of more stringent immigration policies – and Trump’s actions in the last days and weeks promise to hurt the industry even more than I previously expected.
In terms of what could most impact home-based care providers, the Trump administration’s new focus on increased ICE apprehensions could be much more burdensome than arrests at the border.
Despite Trump’s promise to focus on the “worst of the worst,” his administration’s focus is now “all about the numbers, not the level of criminality,” according to anonymous sources familiar with the matter cited by Reuters.
ICE’s daily arrest quota has increased from 1,000 people to 3,000 people, according to Reuters.
To me, it seems apparent that ICE will have to increasingly apprehend workers supporting the American economy to meet its new quotas, and the home-based care industry, already plagued by worker shortages, will feel the toll.
“While [Trump’s deportation] actions are focused on undocumented immigrants, they likely will have ripple effects across immigrants of all statuses and millions more people living in immigrant families,” a KFF report read.
Immigrants account for 28% of the overall direct care workforce in long-term care (LTC), according to the KFF report, which amounts to 820,000 workers. Over 500,00 of these workers are naturalized citizens, and over 300,000 are noncitizen immigrants.
Immigrants are particularly concentrated in the home care industry, with one in three home care workers being an immigrant, per KFF.
“Together the data show that immigrants comprise a large and growing role of the direct care workforce providing LTC services, particularly in home care settings,” the KFF report read. “Restrictions on immigration and mass deportations could lead to reductions in immigrants available to fill these roles, which would exacerbate workforce shortages, making it harder for people to find caregivers for themselves and their loved ones.”
Home health won’t be immune to immigration policy fallout. Undocumented immigrants account for 139,000 home health aides, nursing assistants and personal care aides, according to the Center for American Progress.
Additionally, the aggressive immigration strategy is startling immigrants who possess documents proving their legal right to be in the country. If concern rises among this population, all the visa reform in the world may not be enough to keep home care job positions filled.
The home-based care industry has survived previously high rates of ICE apprehensions, however.
Over 51,000 people were in ICE detention facilities as of June 1, according to the Transactional Records Access Clearinghouse. That figure is notably high – higher than it’s been since 2019. In August 2019, 55,654 people were in ICE detention facilities.
While at least a few points in the first Trump administration had more people in ICE detention than are currently there, I still predict that the president’s approach to immigration is set to break more arrest and deportation records. Trump is actively ratcheting up his goals for ICE arrests, has thus far wielded executive power to a larger extent than his last four years in office and seems even less likely to employ or listen to advisors with alternative opinions. So I anticipate that current numbers, already shattering records from the past six years, will only compound current home-based care workforce woes.
I heard from several home care providers at HHCN’s Capital+ Strategy event in April that deportations were a concern. I can only imagine that the renewed focus on ICE deportations would increase the reason for their worries.
The home-based care industry’s advocacy approach
Home-based care advocates have spoken out to encourage pathways for immigrants to enter the U.S. The Home Care Association of America (HCAOA) actively supports the introduction of a new temporary Home Care Visa and reform of the EB-3 visa. It also supports making caregiving a Schedule A occupation, which it says will remove some of the hurdles facing home care providers seeking to acquire visas for foreign-born workers.
“You have to be able to find a way to make sure that people can age in place,” Senior Helpers CEO Peter Ross, a member of HCAOA, previously told HHCN. “Sixty percent 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.”
New ways for people to enter the country and fill much-needed open job positions will surely alleviate some of the industry’s workforce shortages. However, visa advocacy alone cannot solve at-home care workforce shortages.
Advocating for enhanced visa policies is likely a more comfortable position for home-based care advocates than taking a direct stance against one of the key components of Trump’s platform. There are political considerations to keep in mind, and urging lawmakers to adopt a few safer bet policies is likely an easier task than pushing back against controversial deportations and arrests.
I wonder about the potential consequences of taking a more divisive stance with patients and their families, too. Trump won 49.8% of the popular vote in 2024, and Trump supporters have a track record of not taking kindly to companies that disagree with their leader. Just this week, a far-right group called on Trump supporters to boycott Walmart after one of its stakeholders published an ad supporting “No Kings Day.”
Still, with thousands upon thousands of home-based care workers’ ability to work at stake, I don’t think the home-based care industry can afford to take a back seat.
“[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, previously told HHCN. “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.”
The bottom line of Trump’s new push for increased ICE apprehensions – his “Golden age of America” could be one with significantly reduced access to in-home care.
