Tags: caregiving crisis, immigration policy, long-term care, healthcare workforce, home health aides, Trump immigration crackdown, aging population, foreign caregivers
A Vital Bond Under Threat
In West Orange, New Jersey, caregiver Alanys Ortiz instinctively understands Josephine Senek’s needs before a word is spoken. Sixteen-year-old Josephine lives with tetrasomy 8p mosaicism, severe autism, OCD, and ADHD. She requires constant care — a responsibility Ortiz, a Venezuelan immigrant, has faithfully taken on for over two years.
Ortiz helps Josephine with everyday tasks such as eating and bathing. She knows how to spot subtle behavioral changes and ease anxiety by adjusting the environment. But now, her ability to remain in the U.S. is uncertain due to the Trump administration’s decision to end Temporary Protected Status (TPS) for Venezuelans. If enforced, Ortiz could face deportation — a possibility that would devastate the Senek family.
An Industry Powered by Immigrants
Millions of Americans rely on caregivers for daily support in homes and care facilities. Increasingly, those providing this essential labor are immigrants. Foreign-born workers accounted for 18% of nursing home staff by 2021. In 2022, they made up more than 40% of home health aides, 28% of personal care workers, and 21% of nursing assistants — compared to just 18% of the overall workforce.
However, recent immigration crackdowns have created widespread fear among these workers. Policies enacted by President Trump include expanding fast-track deportations and suspending humanitarian parole for nationals from several countries, including Venezuela. Even immigrants who are legally present now question their security and future in the U.S.
A Shrinking Labor Pool Amid Rising Demand
As the baby boomer generation retires, the U.S. is seeing surging demand for caregiving services. Home health and personal care aide positions are expected to grow by 21% over the next decade — the largest increase of any occupation. Yet these roles are typically low-paid and physically demanding, with median annual wages between $34,000 and $38,000.
Many native-born Americans are reluctant to fill these positions, creating a heavy reliance on foreign workers. Staffing shortages and high turnover have long plagued nursing homes and home care agencies. Industry leaders now fear that hardline immigration policies will further strain an already struggling system.
A “Perfect Storm” for Long-Term Care
The caregiving sector is still recovering from the COVID-19 pandemic. Advocates warn that immigration restrictions, combined with cuts to Medicaid and reorganizations of federal elder care programs, could collapse support systems for aging and disabled Americans.
The Service Employees International Union (SEIU), which represents thousands of healthcare workers, emphasizes how relationships between caregivers and patients take years to build — and are not easily replaced. Families like the Seneks rely on this deep trust to function and thrive.
Innovation Stalled by Policy
Some states, like Wisconsin, have made progress by hiring refugees to fill caregiver roles. Local churches and job placement programs helped immigrants find work in nursing homes, while training programs offered English and professional education in multiple languages. But with the refugee resettlement program suspended, such efforts have been halted, leaving critical vacancies unfilled.
In many immigrant households, cultural and language connections are crucial. In places like San Francisco, for example, Chinese-speaking caregivers are preferred by families who want culturally familiar care for their elders. Advocates argue that this level of personal connection is irreplaceable.
The Backbone of Family Life
Caregiving enables families to stay afloat. Without it, daily life becomes logistically and emotionally unsustainable. In Josephine’s case, Ortiz’s care has led to noticeable improvements — fewer meltdowns, increased independence, and improved communication. Her presence is a stabilizing force in the Seneks’ lives.
“She’s not just an au pair,” said Krysta Senek. “She’s family.”
If Ortiz is forced to leave, Josephine would lose not only a caregiver, but also her trusted companion and support system. The family is desperately appealing to lawmakers, even rallying support from relatives who voted for Trump.
A Workforce Under Siege
The chilling effect of immigration enforcement is felt across the nation. Even authorized workers are afraid — like Nelly Prieto, a U.S. citizen who supports clients with Alzheimer’s and Down syndrome in Washington state. She says colleagues on temporary visas live in constant fear, preparing notarized documents outlining care plans for their children in case they’re detained.
Despite their essential contributions, immigrant caregivers often feel devalued. “We’re only doing the work that their own people don’t want to do,” Prieto said.
Ortiz echoes this sentiment. Though fearful of deportation, returning to Venezuela is not an option due to safety concerns. Carrying her documents wherever she goes, she remains determined to continue supporting the people who depend on her.
“I might not mean anything to someone who supports deportations,” she said, “but I know I’m important to three people who need me.”
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