The Trump plan to start significant deportations may disrupt the lives of untold numbers of seniors who rely on undocumented US residents for daily caregiving. Additionally, If President Donald Trump keeps his signature campaign promise to deport millions of undocumented residents, he will aggravate the serious shortage of senior caregivers, one of the most severe in the United States labor market.
The acute shortage of senior caregivers, who are categorized by the U.S. Department of Labor as "Direct Care Workers", is already having a major effect on millions of families throughout the United States who must care for their senior members. The Department says that in 2010 there were 3.4 million Direct Care Workers and are expected to grow to 4.8 million by 2018, fueled by an expected 50% growth in personal care aides and home health workers, according to a report by the Institute for Women's Policy Research. The report found that immigrants make up 28% of home health workers, including personal care attendants, nursing assistants, and similar positions. Documented and undocumented immigrants also provide in-home care under other job descriptions.
One-Quarter of Caregivers are Immigrants; 29% of Them Undocumented
It is estimated that 24% of senior caregivers in the United States are immigrants and that up to 29% of them are undocumented. They are employed by staffing agencies, senior living communities, and the families of seniors. Many work inside the homes of seniors. Their pay is often reimbursed by Medicare or Medicaid.
According to the Institute for Women's Policy Research, native-born U.S. citizens do not meet the present demand for senior caregivers. The reason is not because immigrants take these jobs, but because U.S. citizens normally will not accept the lower pay and limited upward mobility these jobs offer. This leaves immigrants to fill the void in caregiving positions.
In addition to leaving many seniors without care, mass deportations will cause an added strain on the families of seniors who require care.
While Senior Population Grows, Caregiver Shortages Exist Even Without Deportations
The U.S. Department of Labor projects that demand for Personal Care Aides between 2014 and 2024 will grow at a higher rate than nearly all career categories. Despite this, the caregiver shortage persists because of low pay and a scarcity of reliable transportation to the homes of their senior clients, especially in rural areas.
Low caregiver pay is often a function of Medicaid and Medicare reimbursements, which usually do not reach livable wage levels. A 2015 Department of Labor study found that average hourly rates for Home Health Aides and Personal Care Aides were $11.40 and $10.48, respectively. Thus, in a 40-hour week they earn $456 and $419.20, rates that do not attract many native-born workers who have other job options. In retail sales, for example, the average hourly rate is $12.67, according to the same study. Nevertheless, the low caregiver hourly rates are often acceptable to immigrants looking for a starting point.
While it is desirable to increase Medicaid and Medicare reimbursements to reach an adequate wage for direct care workers, the atmosphere of budget reductions in the federal government does not bode well for increases in senior caregiver pay. Recruiting and employing immigrants who seek entry level positions and advances in their education and training for future opportunities may produce a new generation of caregivers if immigration and deportation policies permit.
Trump's 'Merit-Based' Immigration Clashes with 'Family Immigration' Policy
The political and social setting of this important issue gains context with statistics.
Surveys between 2005 and 2007 found that 24% of "Personal Care Aide" workers are immigrants.
Mexicans form the largest part of U.S. undocumented immigrants. In 2014, about 66% of Mexican immigrant adults had been in the U.S. for at least 10 years.
The Trump administration says it favors a "merit-based" immigration policy, which may conflict with the traditional U.S. immigration system stressing "family immigration". According to the "We Belong Together" campaign of the National Domestic Workers Alliance, about 70% of female immigrants obtain legal status through the sponsorship of immediate family members. Their chances of entering or staying in the U.S. could be diminished under a merit-based system.
Impact of Immigrants on Workforce and Wages is Misunderstood
It is little-known that undocumented workers who earn paychecks contribute substantial amounts to Social Security. In 2013, The New York Times reported that undocumented immigrants pay approximately $15 billion annually into the Social Security fund. Since they cannot receive Social Security benefits, they effectively make a major financial gift to the sacrosanct entitlement program.
There have been reports that the fear of deportations from the U.S. may keep undocumented immigrants inside their homes instead of at work. Other reports say Immigration and Customs Enforcement (ICE) agents may arrest people "collaterally", (meaning the agents have an arrest warrant for an undocumented immigrant who is facing, or has been convicted of, criminal charges and simultaneously arrest others in the vicinity who do not produce proper documents). The fear of deportation may cause some to find employment in private homes as caregivers. Employment in private homes is often "off the books" meaning no Social Security or taxes are collected and the worker is more likely to be abused in wages, hours and working conditions.
Senior Caregiver Shortage Will Grow in Coming Years
Long term care communities, home health care agencies and nursing homes are already experiencing senior caregiver shortages and will face a growing demand for senior caregivers in the future. About four million caregivers now work in direct care, but by 2018 one million more direct care workers, especially home health and personal care aides, will be required. If 20% of the immigrants who work in direct care are undocumented and are deported under the Trump policies, the senior caregiving population will lose about 200,000 persons from its ranks.
Threat of deportation also has emotional impact
The emotional aspect of the expulsions can have a stressful effect on caregivers who already face a risk of burnout. Statistics on the caregiver shortage and deportations may give pause to those who observe the senior population. However, for a family that depends on a caregiver who does not appear for work for fear of arrest and deportation it can have a very personal impact.
The psychological impact on seniors receiving care may also be significant, especially for those with cognitive impairment. For them, consistency is an important factor in their quality of life.
The caregiver shortage will be made worse if immigrants are not given a path to mainstream employment in the U.S. As the Trump policy and approach to immigration unfold, senior housing communities, home health agencies and millions of families who will be affected by the proposed deportations will be avid followers of these developments in Washington and the courts.
Ball, M. (Feb. 28, 2017). Trump's First Month: An Evaluation. The Atlantic. Available at https://www.theatlantic.com/politics/archive/2017/02/trumps-first-month-an-evaluation/518058/. Accessed March 1, 2017.
Bazeldon, E. (February 28, 2017).The Department of JU.S.tification. New York Times magazine. Available at https://www.nytimes.com/2017/02/28/magazine/jeff-sessions-stephen-bannon-jU.S.tice-department.html?rref=collection%2Fsectioncollection%2Fmagazine&_r=1. Accessed March 1, 2017.
Davidson, A. (Feb. 12, 2013). Do illegal Immigrants Actually Hurt the U.S. Economy? The New York Times. Available at http://www.nytimes.com/2013/02/17/magazine/do-illegal-immigrants-actually-hurt-the-U.S.-economy.html). Accessed March 1, 2017.
Institute for Women's Policy Research. (February 2013). Increasing Pathways to Legal Status U.S. for Immigrant In-Home Care Workers. Washington, D. C. Available at https://iwpr.org/wp-content/uploads/wpallimport/files/iwpr-export/publications/I924_.pdf. Accessed March 1, 2017.
Lind, D. (Feb. 14, 2017). The first immigration raids of the Trump era explained. Vox. Available at http://www.vox.com/policy-and-politics/2017/2/14/14596640/immigration-ice-raidsVox. Accessed March 2, 107.
Passel, J.S., and Cohn, D'V. (Nov. 3, 2016). Size of U.S. Unauthorized Immigrant Workforce Stable after Great Recession. Available at http://www.pewhispanic.org/2016/11/03/size-of-u-s-unauthorized-immigrant-workforce-stable-after-the-great-recession/. Accessed March 1, 2017.
Pew Research Center. (November 3, 2016). The number of undocumented immigrants has not changed in the last five years and is lower than it was in 2007. Hispanic Trends. Available at http://www.pewhispanic.org/interactives/unauthorized-trends/. Accessed March 1, 2017.