The caregiving industry relies on immigrants. These workers fear deportation under Trump
Corrections & Clarifications: A study on the nation’s growing elderly population was attributed incorrectly. The authors were James R. Knickman and Emily K. Snell, who wrote for the journal Health Services Research.
A home care worker wakes at 3:30 a.m., showers, and prepares for a more than 10-hour day of attending to her clients.
She cooks. She cleans. She replaces catheter bags. She bathes her clients, checks their blood pressure and ensures they take their medication. When she wraps up her shift at the home of a disabled U.S. Iraq War veteran at 4:30 p.m., she is off the clock but returns to the home of her first client, a 92-year-old woman with dementia who lives alone, and cooks her dinner.
She earns $18.50 an hour and is provided no health care benefits. She loves her job but worries President Donald Trump’s crackdown on immigration and plans for mass deportations could threaten her ability to do it.
“Not all immigrants who come here cause harm. Most are here to contribute,” the home care worker told Paste BN in Spanish through a translator. “It’s sad and disheartening to see how immigrants are being treated.”
She has asked that her real name not be used for fear of being targeted for deportation. Paste BN has confirmed her identity, agreed to provide her anonymity, and will refer to her as “Julia.”
Julia is one of many immigrants living in the country with no clear path to citizenship. She came to the U.S. 23 years ago from El Salvador as a Temporary Protected Status holder after an earthquake devastated her home country. She now faces growing uncertainty as Trump targets others with similar legal but fragile immigration statuses, a focus that could disrupt a caregiver industry that is heavily dependent on foreign-born workers.
In February, the Trump administration said it would end an extension of Temporary Protected Status for more than half a million Haitian and nearly 350,000 Venezuelan immigrants this year. The president signed an executive order in January arguing the U.S. should revoke people’s birthright citizenship if they are the children of immigrants without legal authorization. A U.S. appeals court blocked the order in February.
And within days of Trump taking office, the White House announced “the largest massive deportation operation in history” was already well underway.
"Since taking office, my administration has launched the most sweeping border and immigration crackdown in American history," Trump said in his address to Congress March 4.
Julia is one of many immigrants, with legal status and without, on which the U.S. caregiver industry depends. Foreign-born workers help address the growing need for care given the nation’s aging baby boomer population.
In 2020, 55.8 million people in the U.S. were 65 and over, according to census data. A study in Health Services Research estimates that number will reach nearly 70 million by 2030.
A National Center for Health Workforce Analysis estimated the demand for home health aides would rise 35%, the demand for personal care aides would rise 38%, and the demand for nursing assistants would rise 41% from 2022 to 2037.
Without immigrants, the already high cost of caring for seniors, children and people with disabilities will skyrocket, said April Verrett, president of the Service Employees International Union, which represents more than 1 million long-term care workers in the U.S. and Canada.
“Trump’s immigration policies could make a bad situation dramatically worse,” said Donna Norton, executive vice president for MomsRising, a family advocacy nonprofit. “Immigrants are the backbone of our community and care infrastructure."
Although immigrants comprise 17% of the total American labor force, they make up 31% of the home care workforce, 21% of the residential care aide and nursing assistant workforce, and 30% of the nursing home housekeeping and maintenance workforce, according to a 2024 report from Leading Age, an organization representing nonprofit aging services providers.
A much smaller percentage of these workers are believed to be without legal status. American Immigration Council research director Nan Wu told Paste BN the nonprofit estimates that 4.2% of nursing assistants and 6.4% of home health aides across the country are undocumented, based on census data.
What happens to the caregiver industry without immigrants?
Even without mass deportations, Brookings Economic Studies program director Ben Harris said, an increased law enforcement presence at the border, immigrants leaving the country at higher rates, and actions like shutting down the CBP One app, which closed a path to legal residency for asylum-seekers, could be enough to have a “cooling effect” on the amount of migrants available to work in tight labor markets.
Those factors, combined with an existing worker shortage and high turnover rate in the caregiving industry, could quickly affect the cost and quality of care in the U.S.
Harris pointed out nursing and residential care facilities lost 400,000 employees during the pandemic. Studies show increased immigration is linked with higher nursing home staffing levels and improved patient outcomes.
“When some people are cheering these really aggressive anti-immigration policies, they may not be thinking that they mean a higher chance that their parent or grandparent might have a problematic fall,” Harris told Paste BN. “This is not an obvious connection, but it’s established by the research.”
One study Harris highlighted found the increasing cost of care in the U.S. is partly fueled by nursing home staffing shortages leading to greater reliance on temporary workers from staffing agencies that charge hourly rates 50% to 60% higher than what is paid to directly employed nurses.
“If there are not folks here to take care of our loved ones, that means folks are going to have to choose: Do I go to work? Do I stay home with my aging parents?” Verrett said. “Families are going to have to make real tough choices at a time where it’s already so hard for families to make ends meet.”
Immigrants worry about what happens next
Without her, and with ongoing threats to government health care programs, Julia worries her clients would be left uncared for.
“Even though these two individuals have extended family, they are alone,” Julia said through the translator.
In her time off, Julia and other home care workers she knows care for those in the community who can’t afford or don’t qualify for their services. Julia said that without workers like her, people would be “left to die.”
Still, Julia thinks about her own backup plan if she loses her legal status. Her U.S. home care license would not transfer to El Salvador, but she worked there as a nurse before moving to the U.S. and imagines she could again. However, she said, it's painful to think about leaving her daughter, who is a U.S. citizen, behind.
Nursing assistant Jaz Vergara has treated patients with COVID-19 and cancer, along with people injured in the Southern California wildfires. A Deferred Action for Childhood Arrivals recipient, she also worries about her legal status as the program shielding her from deportation remains under legal challenge.
“They know where I live, where I work. They know everything. I’m an easy target,” Vergara said, emphasizing that she and other immigrants are “trying to contribute. We’re not looking for the high-paying jobs or something that we didn’t earn.”
Vergara’s parents brought her to the U.S. from Mexico when she was 6 years old. She listens to her lawyers’ advice and keeps enough in her savings account in case she loses her legal status and is deported. She researches whether her U.S. nursing assistant certification would transfer if she moved to Canada but doesn’t want to leave the country she has called home for 20 years.
After decades spent living in the U.S., both Vergara and Julia feel a return to their home countries would require starting over.
Lawmakers look for solutions
House lawmakers reintroduced a bill Feb. 26 that would create a legal pathway to citizenship for DACA recipients and a pathway to Lawful Permanent Resident status for current TPS holders.
"Imagine building a life here only to be told to leave for a country you don't even remember, much less sometimes even speak the language," said Rep. Sylvia Garcia, D-Texas, who reintroduced the bill on the House floor. "Congress must act."
The American Dream and Promise Act of 2025 has been co-sponsored by 202 members of Congress, including Florida Rep. Maria Elvira Salazar, the only Republican to sign on.
“I’m constantly engaging my colleagues in Congress to push forward with practical immigration reform,” Salazar said in an email to Paste BN. “I think this is the most important conversation we need to have at a national level. We need to be honest about how immigration affects American citizens, our job market, our economy, our national security, and our national character.”
Salazar added it's important to find a balance between deporting those who “truly don’t deserve to be here,” such as violent criminals and gang members, and “giving dignity” to those who work hard, pay taxes and contribute to the economy.
“This has always been a challenging topic, but I believe now is the moment,” Salazar told Paste BN. “Take some time in both Miami and across the country and you’ll see that the appetite to fix these problems is very real among the American people.”
Even with the bill’s 202 co-sponsors, it still needs to advance through the House Judiciary and Education and Workforce committees. Then it must survive votes in the Republican-controlled House and Senate before it lands on Trump’s desk. At that point he could veto the bill, send it back to Congress for revisions, or sign it into law.
When Paste BN asked whether Trump would sign the bill, White House spokesman Kush Desai responded: "President Trump was given a resounding mandate from the American people to enforce our immigration laws and put Americans first. The Trump administration is committed to delivering on that mandate."
He added that Trump was focused on requiring health care price transparency through an executive order in February.
Rep. Jim Jordan, R-Ohio, who chairs the House Judiciary Committee, and Rep. Tim Walberg, R-Mich., who chairs the Education and Workforce Committee, did not respond to Paste BN's request for comment.
Lawmakers have been trying to codify a path to lawful permanent resident status for DACA recipients and TPS holders since 2017. An earlier version of the American Dream and Promise Act and other legislation aimed at protecting health care and essential immigrant workers failed to get a vote in the last Congress.
Reach Rachel Barber at rbarber@usatoday.com and follow her on X @rachelbarber_