This article is part of the HHCN+ membership
This week, my screen is filled with images and videos of Marines and National Guard members trying to suppress the Los Angeles protests, denounced the Immigration Customs Enforcement Agency (ICE) agency's aggressive raid strategy.
As people all over the US take them outside and condemn the ice and the Trump administration's approach to the LA protest, my attention goes back to the potential consequences of immigration policies in the home-based care industry. Finding enough caregivers to meet the growing demand is an endless challenge for the home care industry. One in three home care workers are immigrants, and 139,000 home health aides, nursing assistants and personal care aides are undocumented, with strict immigration policies making it hard to overcome the challenging workforce environment in the future.
Still, the industry has overcome fluctuations in immigration policy in the past.
President Donald Trump may be the first president since 1965 to mobilize the National Guard from the governor's wishes, but he has been far from the first president in recent decades, as he takes an aggressive approach to arresting and deporting immigrants.
Trump deported 37,660 people in the first month of March, but Reuters reported in March. That's well below the average deportation that occurred last year during former President Joe Biden's tenure.
Someone called former President Barack Obama, who deported 36,019 people a month in 2013, according to data from the Office of Homeland Security Statistics.
As a result, the home care industry has experienced even more deportations. But the Trump administration's focus on strengthening ice arrests (reportedly tripling the daily arrest quota) and his expanding enforcement power will be ongoing difficulties for industries seeking care for older people who want to age.
This week's exclusive member-only HHCN+ update covers Trump's immigration policy and the implications of arrests and deportation for a shortage of home care workers. We provide analysis and key points including:
– Why is the Trump administration's deportation strategy important?
– What does the home care industry's response to current immigration policies mean?
– Trump's vision for the “golden age” could be a darker time for home care
Trump's “all numbers” strategy and potential fallout
Immigration policy is one of employers' biggest concerns, with 75% of respondents in the 13th Annual Employer Survey released in May reporting that Trump's immigration policy would impact business.
The home care industry in particular feels the consequences of a more stringent immigration policy. And Trump's actions over the last few days and weeks promise to hurt the industry even more than I had previously expected.
As for what could most impact home-based care providers, the new focus on Trump administration's growing ice concerns could be far more burdensome than border arrests.
According to an anonymous source familiar with the issue cited by Reuters, his administration's focus is “everything about numbers, not the level of crime.”
Ice's daily arrest quota rose from 1,000 to 3,000, according to Reuters.
For me, it is clear that ICE will need to more and more arrest workers in support of the US economy and meet new quotas, and the home-based care industry, already suffering from a labor shortage, will feel a sacrifice.
“While (Trump's deportation) actions focus on undocumented immigrants, they will likely have a ripple effect on millions of people living in immigrants of all positions and immigrant families,” the KFF report read.
According to the KFF report, immigrants account for 28% of all direct care workers in long-term care (LTC), equivalent to 820,000 workers. Of these workers, more than 500,000 are naturalized citizens, and more than 300,000 are non-citizen immigrants.
Immigration is particularly concentrated in the home care industry, with one in three immigrants per KFF.
“The data shows that immigrants constitute a large, growing role for direct care workers providing LTC services. “Restrictions on immigration and massive deportation could lead to reductions in the number of migrants available to fill these roles, which exacerbate the labor shortage and make it difficult for people to find caregivers for themselves and their loved ones.”
Home hygiene is not affected by the fallout of immigration policy. Undocumented immigrants account for 139,000 home health aides, nursing assistants and personal care aides, according to the Center for Progress in America.
Furthermore, an active immigration strategy is an astonishing immigrant who owns documents that prove their legal rights in the country. If concerns rise among this population, all visa reforms around the world may not be sufficient to fill the home care position.
However, the home care industry has survived the previously high rate of ice anxiety.
As of June 1st, more than 51,000 people were in ice detention facilities, according to the Transaction Record Access Clearinghouse. That number is particularly high, higher than in 2019. In August 2019, 55,654 people were in ice detention facilities.
At least some points in the first Trump administration were in more ice detention than they are currently there, but I still predict that the president's approach to immigration is to break more arrests and deportation records. Trump has been aggressively ratcheting his ice arrest goals, and so far has wielded enforcement power significantly over his past four years of office, and is even less likely to hire or listen to an advisor in alternative opinions. Therefore, we expect current figures, which have already crushed records for the past six years, will only complicate the struggles of current home care workers.
I've heard from several home care providers at HHCN's Capital+ Strategy Event in April that deportation is a concern. I can imagine that a new focus on the ice summary would increase the reason for their concern.
Advocacy approach for the home care industry
Home-based care advocates spoke out to encourage immigrants to enter the United States. They also support the profession of scheduling caregivers. It says it will remove some of the hurdles facing home care providers seeking to obtain visas for foreign-born workers.
Peter Ross, CEO of Senior Helper, a member of HCAOA, previously told HHCN. “60% of all seniors need to support care for life, which puts great pressure on Medicare, Medicaid, the government, county, state, local and federal governments to meet this need.
New ways for people to enter the country and fill the much-needed open duties will certainly alleviate some of the industry's workforce shortage. However, Visa's advocacy alone cannot solve the shortage of the home care workforce.
Advocating for an enhanced visa policy could be a more comfortable position for advocates of home care than taking a direct stance on one of the key elements of Trump's platform. There are political considerations to keep in mind, and urging lawmakers to adopt some safer betting policies is likely to be a simpler task than opposing controversial deportations and arrests.
I also wonder about the potential consequences of taking a more divided attitude from patients and their families. Trump won 49.8% of the popularity vote in 2024, and Trump supporters have a track record of not taking kindly to businesses that don't agree with their leaders. Just this week, the far-right group called on Trump supporters to boycott Walmart after one of the stakeholders released an ad supporting “No Kings Day.”
Still, I don't think the home care industry can afford to take the backseat, as it has the capacity to put thousands of home care workers at risk.
“(Immigrants) play a major role as doctors, but nurses, especially in long-term care, such as nursing home care and home care,” Dr. Steffie Woolhandler, a professor of public health at Hunter University and one of the authors of the study, told HHCN previously. “If Trump follows a massive deportation plan, there will be a huge shortage of healthcare workers, which will undermine access to care and the quality of care for Americans.”
The bottom line of Trump's new push for growing ice concerns – his “golden age America” could significantly reduce access to home care.
