President Donald Trump‘s crackdown on immigration is deepening a crisis in America’s caregiving system, straining the already limited workforce that supports the country’s rapidly aging population, experts have warned.
Trump pledged to remove millions of undocumented migrants as part of his aggressive immigration agenda. Yet immigrants are integral to the U.S. care workforce, accounting for 28 percent of workers in nursing homes and 32 percent in home care, according to nonpartisan organization KFF (formerly Kaiser Family Foundation).
“The crisis in the home care industry is here, whether the elected officials choose to acknowledge it or not. It’s no secret that we have a shortage of workers in the care industry and that immigrants play a critical role in filling that gap,” Service Employees International Union (SEIU) Secretary-Treasurer Rocío Sáenz told Newsweek.
Giovanni Peri, an economics professor at UC Davis, warned the combination of an aging population, low labor supply and fewer immigrants will exacerbate a crisis.
Photo-illustration by Newsweek/Getty
“Very few older people in the U.S. can afford home care, and care in facilities will become higher cost and deteriorate. I think this will become much worse in the next four years,” Peri told Newsweek.
Without immigrant caregivers, experts fear that the nation’s elderly could face rising costs, reduced quality of care and fewer options for aging with dignity.
Department of Homeland Security Assistant Secretary Tricia McLaughlin rejected this notion. “If people want to come to our country to be caregivers for our seniors, they need to do that by coming here the legal way. The days of open borders releasing unvetted aliens into American communities and allowing criminals to terrorize American citizens are over,” she said.
She referred to recent news reports about Alfredo Orellana, a green card holder who is facing deportation and who is caregiver to a young man in Virginia with severe autism. McLaughlin described Orellana as “a violent criminal whose record included charges for distributing drugs, drug possession, assault and battery, failure to appear to court (twice), theft at the second degree, and larceny.”
“The assertion that the only way we can take care of our seniors is by allowing unvetted illegal aliens and foreigners with criminal records to remain in the country is grossly false and lazy,” she added.
Newsweek has contacted the Department of Health and Human Services via email for comment.
The Trump administration’s plan to end Temporary Protected Status (TPS) for thousands of people could worsen the U.S. labor shortage, especially in sectors like health care, Sáenz said. TPS has allowed immigrants to live and work legally; without it, many face potential deportation.
SEIU reports that many care workers under their union are TPS holders from Venezuela, Haiti and El Salvador—individuals providing essential support for seniors and people with disabilities.
“Forcing people with TPS out of their jobs and their homes is both inhumane and economically irresponsible,” Sáenz said.
“When seniors and people with disabilities don’t have a care worker at their side in hospitals and nursing homes, one reason is because of this administration’s reckless attempts to end legal protections for immigrants. Consumers, employers, businesses and entire communities will suffer.”
With around 10,000 Americans having turned 65 every day between the 2010 and 2020 Census surveys, experts argue the care system cannot meet demand without immigrant labor. Peri estimates stricter enforcement could reduce less-skilled immigrant workers by 400,000 annually, with care sectors losing 1–2 percent of workers per year.
However, others believe that while the consequences for vulnerable industries may be felt initially, the employment market will adapt.
‘There Is No Labor Shortage’
“In the short term, deportations may have some impact on the home health care industry, but over time the markets always adjust to the new circumstances. It is also true that attrition of illegal aliens in the home health care industry will occur over time, not all at once,” Ira Mehlman of the Federation for American Immigration Reform told Newsweek.
Others say that the issue is not a shortage of workers, but rather a systemic dependence on low wages.
“Too many employers in the United States view illegal immigration as an inexhaustible supply of low-wage, exploitable workers. The direct care industry is full of them. There is no labor shortage in the home care or nursing home industries—or any other sector of the U.S. labor market—and claims that Americans can’t or won’t perform these jobs are completely false,” Eric A. Ruark, director of research and sustainability at NumbersUSA—a nonprofit organization campaigning for immigration for reform—told Newsweek.
Jason Richwine of the Center for Immigration Studies echoed this sentiment. “When employers assert that Americans will not do particular jobs, or when they raise the related specter of a ‘labor shortage,’ what they really mean is that not enough Americans accept the low wages that employers prefer to pay. In the absence of immigration, the market wage rises and more natives become open to jobs they supposedly wouldn’t do,” he said.
Darron Cummings/AP
Many disagree with this assessment, warning that these changes will have long-lasting, harmful consequences.
Clif Porter, CEO and president of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), urged lawmakers to consider legal pathways for immigrants working in the care industry.
“When it comes to meeting the needs of our aging population, we need to think beyond our borders,” he said. “Streamlining legal pathways for passionate people to come to our country and serve our seniors is an important part of how our sector will answer the growing demand for long-term care.”
The economic toll of mass deportation could be staggering. The American Immigration Council estimates a one-time cost of $315 billion to remove the entire undocumented population, with annual expenses for deporting one million individuals reaching up to $88 billion.
In 2030 and beyond, the U.S. could face an annual $290–$500 billion GDP loss from the caregiving crisis, driven by 1.8 million vacant care jobs and workers leaving other sectors to provide unpaid care, the Boston Consulting Group warns.
Adam Lampert, CEO of Manchester Care Homes, highlighted the inflationary ripple effects that occur when undocumented workers are removed from the workforce.
“Imagine that your neighbor’s undocumented caregiver leaves the country—who will fill that position? Your neighbor may proposition my staff, and I either lose my staff or pay them more money to stay. That is the inflationary impact of deportation,” Lampert told Newsweek.
“Most undocumented workers in our industry are hired privately,” he added. “If they self-deport or are deported, it still creates a shortage of workers.”
Lampert said that 80 percent of his caregiving staff are foreign-born, describing them as “excellent caregivers” who take on difficult work that many Americans are unwilling to do.
“If we didn’t have immigrants filling these roles, many Americans would go without care or would have at least limited care, and this would absolutely affect their health,” he added.
Waiting Lists
The U.S. already faces a severe and widespread shortage of direct care workers, with nearly every state reporting staffing challenges in 2023. According to the American Network of Community Options and Resources (ANCOR), 95 percent of respondents from human services organizations across 45 states and the District of Columbia indicated experiencing moderate to severe shortages in direct care staffing in 2023.
As of 2024, over 710,000 in 2024 individuals across 38 U.S. states were on waiting or interest lists for Medicaid Home and Community-Based Services (HCBS), according to KFF.
Immigration crackdowns are threatening the quality of care for millions of seniors, according to Ai-jen Poo, president of the National Domestic Workers Alliance, who painted a dire picture of a home care sector already buckling under the weight of low wages, workforce shortages and rising demand.
“We are already in the throes of a crisis in home care,” she said. “These policies don’t just create workforce shortages—they create suffering. People will go without essential care, families will be forced to leave work to provide it themselves and care homes will be pushed beyond capacity.
Meanwhile, the nonprofit Paraprofessional Healthcare Institute (PHI) estimates that between 2021 and 2031, the long-term care sector will need to fill 9.3 million direct care job openings, including both new positions and vacancies left by workers retiring or leaving the field.
“Care businesses are left struggling to recruit and retain staff under unstable conditions, while the families they serve face higher costs and reduced access to support,” Poo said.
“Care employers—whether agencies or families—are operating under constant strain. While demand for care is surging, the workforce is shrinking due to turnover, low wages, fear, legal limbo and now the threat of deportation.”
With the number of Americans aged over 65 projected to rise from 58 million in 2022 to 82 million by 2050, per Population Reference Bureau (PRB) figures, the demand for long-term care is only increasing. Whether or not the U.S. will have the workforce required to meet that demand remains to be seen.