President Donald Trump’s promises to implement mass deportations and other potential changes to immigration policies could strain an already-understaffed health care workforce, making it harder for older adults and people with disabilities to receive care at home and in nursing facilities.
“It’s really hard to make predictions, but if deportation were to happen, as he describes, it would destroy our care economy — destroy it — and we have to fight against that,” said Jodi Reid, executive director at the California Alliance for Retired Americans, a nonprofit that organizes and advocates for older adults.
Local and state-level advocates, as well as a union representing care workers, fear that mass deportations and the removal of certain immigrant protections could affect care workers’ ability to work and remain in the United States, including those with documentation. Many expect this to worsen staffing shortages and reduce access to services that older adults and people with disabilities rely on.
Nearly a third of San Franciscans are projected to be age 60 and older by 2030. Across California, an increasing number of older adults and people with disabilities depend on caretakers, many of whom are immigrants, to help with daily tasks and often to remain in their homes. For years, the state has been dealing with a shortage of direct care workers, as low wages fail to attract recruits. Care workers’ hourly rates often can’t keep up with San Francisco’s ever-climbing cost of living, and high cost of doing business in the city compared to the meager financial returns for providing this care is contributing to a shortage of care facilities in the city.
“The impact that mass deportations could have on a workforce that is nearly half immigrant could be devastating,” said Arnulfo De La Cruz, president of Service Employees International Union Local 2015, which represents California’s long term care workers.
Besides causing direct loss of undocumented workers as a result of deportations, Trump’s policies could further shrink the number of professionals working legally in this industry and make it harder for new people to come in. The administration is “not really being careful about how they pick people up and deport them,” said Maura Gibney, executive director of California Advocates for Nursing Home Reform. Trump could also strip people with temporary protected status of their documentation, making them ineligible to work and allowing them to be deported. Anti-immigrant policies could further reduce the inflow of new workers.
“We already have major staffing shortages in nursing homes. We already have provider wait lists,” she said. Gibney noted also that a lot of people approved to receive in-home health services are not able to find a provider for months. “This effort to get rid of a workforce that is legally able to work is definitely going to only exacerbate that problem.”
De La Cruz questioned whether people would be able to get adequate support and remain in their homes if the caregiver workforce is decreased. “Do they become sicker? Do they become less able to care for themselves? Do they visit the emergency room or have to go to a skilled care facility?” he asked, adding that these outcomes come at increased public cost.
Numerous studies suggest cause for concern. One 2023 paper from the Global Labor Organization, a nonpartisan and nongovernmental research network, found that “stringent immigration enforcement may exacerbate the healthcare worker shortage.” Another study, from the American Journal of Health Economics, found that an immigration enforcement program led to increased cost of in-home help and more elderly people living in nursing homes. Conversely, a 2023 working paper from the National Bureau of Economic Research showed that increased immigration raised nursing homes’ staffing levels, which was associated with a positive effect on patient outcomes.
Staff at the San Francisco advocacy group Senior and Disability Action have worried about the threat of mass deportations heading into Trump’s second term.
There are low- to medium-income people in San Francisco ineligible for government programs that provide in-home supportive services. They must independently hire support workers like health aides, some of whom are undocumented, said Ligia Montano, the organizing and partnership director at Senior and Disability Action.
She asked what might happen to these clients “if people get caught, if people get deported, if people get incarcerated for being undocumented?”
Existing Shortages
The U.S. is already facing a “crisis of care” partly caused by a rapid growth in the number of people who need a caregiver, De La Cruz said.
Projections from the National Center for Health Workforce Analysis estimate that the demand for direct care professionals in California will be 51.1% higher in 2037 than it was in 2022.
Compounding this issue are severe existing staffing shortages in nursing homes and at-home positions.
A person’s immigration status can also be a barrier to working in some care positions. Programs like the state’s In Home Supportive Services require that employees have legal work authorization, meaning undocumented people cannot fill those jobs even if they want to — limiting the pool of new hires who could otherwise alleviate the shortage.
“That just creates enormous challenges for both the workers themselves, but also people who employ them or need and rely on home care and other forms of domestic work,” said Lindsay Imai-Hong, the California director of Hand in Hand, a nonprofit that focuses on domestic care workers’ rights.
Other Policy Changes
Trump is cutting off entry and ending protections for immigrants, creating fear and uncertainty for local immigrant caregivers.
The Trump administration has moved to end a Biden-era humanitarian parole program that allowed immigrants from Cuba, Haiti, Nicaragua and Venezuela to apply for entry to the U.S. and to stay and legally work for up to two years.
In San Francisco, there is “a large concentration of people who came in on that parole program,” especially from Nicaragua and other Central American countries, Gibney said. Many of them are caregivers, and today, a lot of those people “don’t really know what the future holds. They don’t know if they could be legally deported,” she said. Then she added, “I don’t even know if ‘legally’ is the word.”
Even if caregivers, such as in-home support workers, are residing in the country legally, they may have family members who are not, meaning they could see their loved ones deported. De La Cruz noted that raids have created a lot of fear and anxiety in immigrant communities, and in particular affect children who may face separation from their parents. In response, the union is educating immigrant workers on their rights.
