The Trump administration’s immigration policies have triggered widespread concern in the home-based care industry, already strained by an insufficient workforce expected to care for a record number of aging Americans.

Seth Sternberg, CEO and co-founder of San Francisco-based home care tech company Honor, is taking actionable steps to make the job of the “care pro” a more attractive and sustainable career.

In 2021, Honor acquired Home Instead, with over 1,100 locations across the world and the largest home care footprint in the U.S., making it not only a home care tech company but a provider as well.

While seeking to improve the job and reputation of a caregiver, Sternberg also advocates for policy changes, including the creation of a fast-track visa, that would encourage additional home care workers to enter the country legally.

Sternberg sat down with Home Health Care News to discuss how current immigration policies will worsen the home care staffing crisis, the importance of take-home pay rates and the role technology will play in the home care industry’s future.

Below is that conversation, edited for length and clarity.

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^{In what ways do you think changes in immigration laws could affect the availability of caregiving services for older adults?}

I want to make an equal opportunity statement here: no political party can claim credit, since I’ve had the honor of observing how each has handled immigration from an elder care perspective. It’s not just Trump or Obama; everyone has made mistakes. The challenge is that many different forces within the U.S. focus on their own industries or specific concerns – such as running a farm or worrying about workers securing specific jobs. I believe most people have good intentions, but the reality is that the U.S. is experiencing the fastest population growth it has seen. By 2034, there will be more Americans over 65 than under 18. That means a larger elderly population than children, and sadly, we simply don’t have enough caregivers for that demographic yet. We’re a bit behind Northern Europe and East Asia, where this shift in demographics has already led to a greater number of older people than younger ones.

Countries like Japan have established immigration systems that enable people to enter legally from nations with a labor surplus, particularly those with a demographic imbalance. We haven’t done that. Instead, in the U.S., we’ve focused on excluding certain groups of immigrants. This is a significant problem because we rely on these individuals to care for a large part of our society. We must find a way to bring in people from other countries who can help care for older adults here – naturalized citizens, immigrants and others – we don’t have enough people. We started Honor 10 years ago, and for that entire time, there has been a [worker] shortage. The truth is, all the administrations I’ve seen during this period haven’t taken proactive steps to increase the workforce. We’re doing our part by training people and searching for incredible talent. We want to create AI systems that make home care jobs more attractive, so that anyone would like to pursue them. Despite these efforts, we haven’t been able to attract enough people. Therefore, we need to examine societal systems to bring more people into the field.

What policy changes would you recommend to ensure a stable and adequate workforce in the health care industry?

I believe, based on my understanding of the current administration’s priorities – though I am not close to them – I hope we can develop an immigration system that incorporates a few key qualities that work for both their goals and the industry’s needs.

One aspect could be opening opportunities for people who want to immigrate temporarily to the U.S. for work in home care. For example, we could offer a fast-track visa to applicants who meet specific criteria, including passing a background check, possessing relevant education and having a work history in caregiving. If applicants meet these requirements, they should be eligible for this expedited visa process, which is crucial because a lengthy two-year application process isn’t practical given our current situation.

The second aspect involves selecting participants from countries that are politically and socially stable. I understand the current administration’s concern about individuals seeking asylum immediately upon arrival. If that’s a priority, then restricting entry from countries known for instability makes sense. Many nations, such as the Philippines and Malaysia, send workers who intend to work temporarily in the U.S., and we can be comfortable with that, as long as it isn’t exploited for asylum purposes – something the current administration seems wary of.

Finally, it’s acceptable to establish that this visa isn’t a pathway to citizenship. For example, a person from the Philippines – a country known for exporting caregivers worldwide – might want to spend five or ten years in the U.S., earning higher wages in a profession the country urgently needs, gaining valuable experience and then returning home or moving to another country. That approach should be considered okay.

If I were addressing the Trump administration, I would say, I understand some of your priorities, but I also recognize the importance of caring for our aging population. Let’s find a solution that balances these priorities. Ideally, an immigration system for this industry would have three main qualities: first, the ability to fast-track applicants with the right background; second, including individuals from stable countries and third, ensuring this isn’t a path to citizenship. Everyone involved would benefit more than they do now, which is frankly quite damaging.

What is Honor doing today to bridge the care gap?

We focus on [creating] a better job for what care pros really want, and deliver them more of that. Then we can have more people who can serve our prospective clients, and then put them in a better place, so that they will serve those prospective clients better. That is the number one thing that we are doing, which is we are trying to create a really attractive job. Additionally, it can increase the number of people who decide to enter the profession. Because if you take a profession that has not been thought of as a profession, but rather just a job with no path, but you turn it into your profession with a path, you can convince some people who might lose their jobs to AI to go into this profession if we create a good enough job. 

In the same vein, we don’t just go around saying, the way to create the best job is [a better] hourly rate. The more important variable actually is the take-home pay. So now we’re doing rate times hours, and we’re not trying to subtract out other costs, like driving across bridges with tolls to get to work, because that would go to take-home pay too. We must consider both the rate multiplied by the hour, as well as the expense.

How many care pros have you actually interviewed and sat down with and asked what they really care about? How much data science have you actually done on what care pros want? Do you statistically know what they want?

I’m also passionate about stability. For example, if one of my clients moves into a facility and the care pro, Janet, doesn’t have any work anymore, she has just taken a 50% pay cut because I don’t have work for her. That’s devastating for a care pro, and so the stability of the take-home pay matters a lot. People often overlook this when considering how to compete for care pros. If you give a dollar-per-hour increase without addressing other issues, you won’t see better retention than your current rate. It will be a total failure. However, if you identify all the factors that care pros truly care about – beyond just the simple dollars per hour – your retention will improve dramatically.

You’ve discussed the caregiving crisis as well as the need to transform the caregiver role. What is Honor doing to make caregiving a more sustainable career?

We don’t know what we don’t know. Instead of approaching it with the assumption that we know everything the care pro wants, we built an entire ecosystem that listens to data and then processes that data against the kind of outcome you’re looking for.

Let’s examine the turnover of care pros. How often do they leave your system? If you do that, you can figure out what they really care about, and then you can build your system to deliver them as many of those things as you possibly can. It’s not because you intuited it yourself. It’s not because you thought you knew the answer. It’s not even from directly interviewing those care pros.

Care pros also hate being put into a home where they are not able to fulfill the client’s needs, because they feel like they’re not performing well. They don’t want to fail. They want to succeed. That’s another set of data science. Where will you succeed based on your skills and what those needs are?

What we know how to do is build systems that listen to data and process the data so that we can, at scale, with a ton of data points, get to what the people actually want, and then provide, believe it or not, a massively more human, personalized system for those employees. That is the way we approach things.

What role does technology have in increasing access to care, and how does it support Honor’s larger mission?

There’s a statistic that $800 billion a year in economic value flows from children and neighbors to older adults or issues affecting older adults. $800 billion a year. It dwarfs Medicaid. It dwarfs private pay home care. It is massive, and all of those people are basically unserved by the industry today. That drives me crazy.

When I started Honor, that $800 billion was $400 billion. It’s going to be much larger in another five years because of the rapid expansion of the aging population. The only way we can solve this is by figuring out how to care for people in their homes more cost-effectively and efficiently. That will be a mix of human and machine. That requires a deep, technical ability to integrate the device world, the machine world and the human world. It also requires a massive human network with depth that covers the country. Turns out we have that.

This is probably the thing I’m most excited about as a problem to go solve, because I hate it when you’ve got large swaths of the population here that have literally no choice. They have nothing today that can help them. We have to fix that, and we will, and technology is going to be the thing that does it. We’ll build that technology. There’s only that kind of human-device fusion to solve that massive problem for the biggest chunk of our society.