On January 20, President Trump took office and swiftly rolled out bold immigration measures, ending birthright citizenship. Apart from being a controversial constitutional question that is likely to face immediate legal challenges, the policy, along with the rest of the President's immigration agenda, could have far-reaching consequences for the elder care sector, which heavily relies on foreign-born workers. An Aging Population and Rising Demand for Caregivers The U.S. is heading straight into a caregiving crisis, thanks to our rapidly aging population and the growing need for long-term care services. Just look at the numbers: back in 2012, seniors aged 65 and older made up 13% of the population. By 2022, that jumped to 17%, and by 2030, over 20% of Americans will be 65 or older. It’s a huge demographic shift, and with about 70% of people over 65 likely to need some kind of long-term care, we’re going to need a much bigger caregiving workforce. Right now, there are around 5.2 million workers handling care in nursing homes, hospitals, and personal homes, but that’s nowhere near enough. Demand for direct care workers—like nursing assistants, home health aides, and personal care aides—is expected to soar by 35% to 41% from 2022 to 2037. The problem? Employment in these roles is only projected to grow by 22% in the next decade. That’s a big gap. And here’s where immigration becomes a game-changer for the caregiving industry. Without it, meeting this skyrocketing demand would be nearly impossible. Immigration’s Critical Role in the Caregiving Workforce Immigrants constitute a substantial portion of the caregiving workforce, making their role indispensable. According to the American Immigration Council, over a third of home health aides in the U.S. are immigrants, and in states like California, New York, and New Jersey, that number jumps to over 40%. They’re absolutely essential in meeting the needs of our aging population, whether they’re documented or not. Around 27% of direct care workers are immigrants, compared to just 17% of the overall workforce. A lot of them work in the "gray market," where they’re hired directly by families instead of through formal agencies. This kind of setup is especially common in rural areas, where there aren’t many official caregiving options, so families rely on private arrangements. But Trump’s immigration policies? They could throw a major wrench into this system and leave a lot of families scrambling for help. Trump’s Immigration Policies and Their Potential Effects Trump’s immigration plans aim to slash legal immigration, cut out family-preference immigration (a.k.a. “chain migration”), make it harder to get asylum, and ramp up deportations. If these go through, they could seriously shake up the caregiving workforce. Here’s how: Reduction in Legal Immigration: Trump’s proposal to prioritize “highly skilled” workers would disadvantage caregivers, who are not typically classified as highly skilled under the current immigration system. This shift could limit the entry of new caregivers into the U.S., exacerbating the workforce shortage. Impact on Undocumented Workers: An estimated 6.9% of home health aides and 4.4% of personal care aides are undocumented. Mass deportations, as advocated by Trump, would not only reduce the caregiving workforce but also destabilize mixed-status households, where some members may be U.S. citizens or documented immigrants. Restrictions on Temporary Protected Status (TPS): Temporary Protected Status, which allows individuals from unstable countries to work legally in the U.S., is crucial for many caregivers. Trump’s efforts to end or limit TPS could impact workers from countries like El Salvador, Honduras, Venezuela, and Haiti. In states like Florida and California, where 30% to 40% of the long-term care workforce comprises immigrants, the loss of TPS protections would be devastating. Discouraging Future Immigrants: Aggressive immigration enforcement and restrictive policies could deter prospective immigrants from considering caregiving roles in the U.S. Countries like Canada, which recently introduced a permanent residence program for foreign-born caregivers, may become more attractive alternatives. The Caregiver Shortage and Its Consequences The U.S. caregiving sector is already grappling with severe labor shortages. The ratio of unemployed workers to job openings remains low, and the broader labor force participation rate is projected to decline over the decade. This tight labor market, combined with an aging population, has led to rising costs and declining quality of care. Rising Costs The shortage of caregivers has driven up the price of long-term care. For instance, the median monthly cost of a room in assisted living facilities increased by nearly 19% between 2021 and 2023. Staffing shortages force facilities to rely on expensive temporary workers, further escalating costs for families. Declining Quality of Care Overworked caregivers often manage more patients than they can handle effectively, leading to poorer outcomes for both caregivers and care recipients. Turnover rates in the caregiving sector are alarmingly high, with nursing home staff experiencing a median annual turnover rate of 94% even before the pandemic. The stress of caregiving, combined with inadequate compensation, frequently drives workers out of the profession. Impact on Families When professional caregiving services are unavailable or unaffordable, the burden often falls on family members, particularly women. This unpaid caregiving can lead to physical and mental health challenges, financial strain, and career disruptions. Women who provide intensive care to aging parents face a significant wage penalty and long-term financial repercussions. A Way Forward Given the critical role immigrants play in the caregiving workforce, addressing the labor shortfall will require immigration policies that support, rather than hinder, the sector. President Trump’s immigration policies have the potential to significantly impact the U.S. caregiving market, worsening an already dire labor shortage. With the country’s aging population set to grow substantially in the coming decades, ensuring a robust and sustainable caregiving workforce is more important than ever. Policymakers must recognize the vital contributions of immigrant caregivers and adopt policies that support their integration into the workforce. Failure to do so could leave millions of older Americans without the care they need, straining families and the healthcare system alike.