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When President Donald Trump assumed office in January, he vowed to transform the approach the United States takes toward legal and undocumented immigration. In the initial 100 days of his administration, he has indeed enacted significant changes, resulting in a considerable decline in illegal border crossings and prompting many foreign nationals to reconsider employment opportunities in the U.S. This shift may impact the availability of essential home healthcare services for older Americans, potentially increasing costs and making it harder to find qualified workers.
The United States currently lacks a dedicated visa program specifically for home healthcare aides. Instead, a mix of temporary and permanent visa options permit limited immigration for some healthcare workers. However, these visas are not widely available. Many individuals immigrate through “chain migration,” where family members who are citizens or possess green cards sponsor their entry. This form of legal migration, which Trump aims to limit or restructure, is crucial for many healthcare roles.
A perfect storm may be developing as Trump’s immigration policies align with a pre-existing shortage of home healthcare workers, proposed Congressional budget cuts to Medicaid, and the increasing number of older citizens in the United States. Consequently, this may adversely affect those who depend on such care in their later years.
A worsening healthcare worker shortage
Even before Trump’s presidency, the U.S. faced a critical nursing shortage. A report from JAMA indicates that nearly half of nursing homes were compelled to restrict admissions due to staff shortages, as two-thirds of hospitals operated below capacity in 2023 because of personnel shortages.
The demand for home healthcare employees will need substantial fulfillment, with an anticipated need for roughly 712,000 home health workers and personal care aides annually through 2031, as reported by Immigration Impact. This demand is driven by an aging population and increased life expectancy.
Simultaneously, approximately 332,000 home health aides are projected to exit the workforce each year due to retirement or other factors, with another 287,000 transitioning to different jobs. Given the trend of more Americans choosing to age in place, the timing could not be more critical.
In 2019, around one-third of home health aides in the U.S. were immigrants, including nearly 7% who were undocumented and over 4% working as personal care aides. During the pandemic, immigrant healthcare professionals were vital in ensuring that older Americans received essential care. By 2021, there were about 56,000 undocumented personal care aides and 34,000 home health aides, according to the Center for American Progress, highlighting their significant contribution.
However, with Trump intensifying immigration enforcement and threatening mass deportations, the risk of exacerbating the existing healthcare worker shortage becomes very real.
NPR has reported that nearly 17% of healthcare workers in the U.S. were born abroad, with an estimated 366,000 being undocumented immigrants.
Certain states, including New York, Florida, and California, depend significantly on immigrant labor, particularly for healthcare roles. Stricter immigration regulations could precipitate a crisis for senior citizens needing support in their homes.
Costs are likely to rise
Even if the projected shortages of home health aides are addressed, many older Americans may find this assistance unaffordable. According to Genworth, the average annual cost for a home health aide is approximately $77,792 nationally. Should immigrant workers be replaced by employees commanding higher salaries, this could make care unattainable for many.
Additionally, it is important to note that Medicare typically does not cover home health services, considering them as custodial rather than medical. Medicaid often serves as the primary coverage option, yet lawmakers are debating significant reductions to Medicaid that could further restrict access to care for older beneficiaries.
In total, over 350,000 healthcare workers risk deportation as a result of Trump’s immigration policies. While the implications are broad, older individuals who depend on home health services will likely face increased costs or reduced access to care as the situation unfolds.
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