Who’ll Take Care of Grandma? How Trump’s Immigration Policies Threaten Elder Care

Demand for elder care is set to skyrocket as baby boomers age, with the number of Americans 85 and over projected to reach 13.7 million by 2040, a 111% increase from 2022. But new immigration policies spearheaded by the Trump administration could make it harder for you or an aging loved one to find care. Here’s why these policies could be leading to a caregiver crisis.

How Immigration Policy Affects Long-Term Care

Immigrants make up a big share of elder care—about 28% of overall staff and nearly a third of home care workers, research organization KFF reports. Many of these workers are noncitizens, making them especially vulnerable to President Donald Trump’s ongoing immigration crackdown.

This crackdown includes revoking Temporary Protected Status (TPS), cancelling work permits, restricting employment-based visas, and expanding enforcement and deportation efforts. A recent analysis of Freedom of Information Act (FOIA) data by The Guardian found that average daily U.S. Immigration and Customs Enforcement (ICE) arrests were up 286% this June compared to June last year. 

“From what we hear at community meetings and from families in San Diego, the fear of ICE is very real,” said Ocean Van, owner of Home Helpers Home Care, a California-based in-home services agency near the Mexican border that relies heavily on immigrant workers. “Even those who are legal residents worry about what might happen.”

That worry has made it harder for Van to fill roles and retain talent for his agency.

“People either leave us or choose not to enter [the workplace] in the first place,” he said. “Some caregivers have lost their work authorizations, so their clients lose people they know and trust. We scramble to find replacements.”

‘A Very Difficult Job’

Elder care roles can already be challenging to fill, given that these jobs are traditionally low-paying and demanding.

According to the Economic Policy Institute (EPI), the typical worker in the residential long-term care industry earns $15.22 per hour; the typical worker across all sectors earns $20.07. Access to benefits, such as health insurance or employer-sponsored retirement plans, is also less common among working caregivers.

Gender and race wage disparities, uneven Medicaid reimbursement across the country, and systemic skill devaluation for care workers also contribute to the industry’s low pay.

Long-term care providers and facilities can attempt to address new immigration-related labor shortages by raising wages, introducing sign-on bonuses, and offering benefits, but there’s no guarantee that these measures will attract more non-domestic or domestic workers.

Caregiving is “a very difficult job,” said Christina Bremner, founder and owner of Purple Door Finders, an online platform that helps seniors and their families find living and care facilities. “It requires a tremendous amount of empathy. It’s hard work. It’s labor-intensive.” 

Even if providers and facilities can find replacement staff by paying more, “that cost is going to get passed along to customers,” she said. 

That could put significant financial strain on aging adults and their loved ones, as elder care is already quite pricey. Per the Federal Long-term Care Insurance Program, the national average annual cost for a semiprivate room in a nursing home is $100,740, while a year’s worth of home care (six hours a day, five days a week) costs $42,120.

“It’s very expensive to hire someone for 24 hours,” elder care attorney Harry Margolis said, referencing the need for facilities to provide round-the-clock care. Staffing shortages and higher expenses could drive up these elder care costs even more for you and your family. 

Caring for an Aging Population

Price increases and workforce-related issues couldn’t come at a more inopportune time. Long-term care facilities continue to experience staffing shortages in the wake of the COVID-19 pandemic, while demand is set to grow. 

In 2031, the oldest baby boomers will turn 85, the age limit when retirees are substantially more likely to need care; and the share of the age 65-plus population that’s over 85 is projected to double by 2050.

In other words, the need for elder care is likely to spike, “and our system is pretty inadequate as it is,” Margolis said.

Policy reform that increases worker wages, overhauls federal reimbursement programs, and funds new and redesigned supportive elder care communities—which allow fewer workers to care for more patients efficiently—could alleviate pain points, as could targeted immigration reform. 

“We need faster visas and work authorization pathways for people who are already trained and already working in caregiving,” Van said.

The Department of Homeland Security did not respond to a request for comment on how its policies might be affecting the long-term care industry and whether any policy changes were planned as a result.

How to Find Long-Term Care for You or Your Loved Ones

New government policies and the caregiver landscape are troubling to say the least. If you’re in your 50s and want to ensure you have access to quality, affordable elder care when you’re older, consider long-term care insurance, which covers stays in nursing homes or assisted living facilities as well as in-home care. That said, these policies can be expensive and you usually need to buy them in your 50s and 60s at the latest to qualify. Learn how to determine whether long-term care insurance is right for you.

For anyone approaching age 75 or with loved ones that age, here are steps you can take to secure good care in the coming years. 

• Start exploring options early. “Don’t wait for a crisis,” said Bremnar. “That’s what most people do, and then they’re in a situation where they don’t have choices.” Instead, proactively start researching and contacting both facilities and at-home care services to determine what you can afford and what seems like the right fit.
• Interview providers. “It helps to ask about workforce stability and whether the agency has a plan to maintain continuity of care,” Van said. This is especially important given the ongoing workforce disruptions.
• Seek assistance from an elder care attorney or Aging Life Care Professional® (ALCP). “They can advise you on what’s available for care, whether it’s paid or subsidized,” said Margolis. They can also discuss your options for qualifying for government financial support through Medicaid.

Hopefully policy reform will come soon to alleviate these serious problems. Until then, by planning ahead and following these tips, your family can manage a tough situation as best as you can.