PHI Celebrates the Vital Contributions of Immigrant Direct Care Workers
Today, October 28, is National Immigrants Day, when we recognize the invaluable contributions that immigrants have made to the character and spirit of the United States. Established by a proclamation from President Ronald Reagan in 1987, the day commemorates the “millions upon millions of courageous souls” who have graced American culture with their “gifts of hardiness and heart, of intellect and hope.”
Today and every day, PHI celebrates immigrant direct care workers. They hail from more than 160 different countries, most prominently Mexico, the Philippines, the Dominican Republic, Jamaica, and Haiti. They provide care in the homes of older adults and people with disabilities, allowing them to live in their own communities with dignity and independence. In a range of settings that also includes nursing homes and residential care, immigrant direct care workers provide essential support, while also helping to alleviate the emotional and financial strain felt by family caregivers.
Immigrants do not merely augment the direct care workforce—they anchor it. PHI data shows that immigrants comprised 28 percent of all direct care workers in 2023, the last year for which data was available, compared to 17 percent of the overall workforce in the U.S. (In 2011, the percentage of immigrants in the direct care workforce was 21 percent.) Millions in the United States rely on foreign-born workers each day for essential personal care, assistance with daily activities, and emotional support.
Like all direct care workers, immigrants in the workforce perform difficult and potentially dangerous labor every day. These jobs involve heavy lifting, exposure to communicable diseases, and tending to the needs of people with physical and/or cognitive disabilities. These workers provide critical care under challenging conditions.
Yet despite the importance of this workforce, direct care workers—whether immigrant or American-born—continue to face shamefully poor job quality. Direct care jobs are among the lowest compensated in the U.S., in terms of both wages and benefits. PHI’s most recent Key Facts report, released last month, found that 49 percent of direct care workers rely on public assistance, such as Medicaid and nutrition assistance, to make ends meet. Additionally, few career-advancement opportunities exist within the field, training can be woefully inadequate, and many workers say they face a general lack of respect or recognition. These conditions must improve immediately because demand for direct care is surging. By 2060, the number of adults aged 65 and older is projected to increase to nearly 89 million, up from 57.8 million in 2022; those aged 85 and older will triple in number during the same period.
One way to grow this workforce is to enact policies designed to ease immigrants’ entry into the field and better support those already in it. In our report, Bridging the Gap, PHI proposed a number of concrete ways to do just that. The report urged the federal government to enact specific bills that would create pathways to citizenship for undocumented essential workers, develop a special caregiver visa to attract talented direct care workers from abroad, and fund and evaluate a range of immigrant-specific direct care workforce interventions designed to improve training, recruitment, and retention.
Today, the Trump administration’s harsh policies targeting immigrants endanger not just direct care workers, but also the millions of older Americans and people with disabilities who rely on their care. Restrictions on immigration, combined with anti-immigrant sentiment, have been shown to correlate with reduced staffing levels in nursing homes, straining an already overburdened long-term care system. Conversely, increased immigration leads to higher nursing-home staffing levels, which in turn results in better care for residents. The current administration’s efforts to limit immigration, carry out deportations, and demonize immigrants are therefore not just morally wrong — they directly harm millions of individuals who receive long-term care.
PHI reaffirms our commitment to supporting and growing the direct care workforce, a goal that cannot be accomplished without protecting and supporting its large, and growing, foreign-born contingent. Research demonstrates that immigrant direct care workers remain in their jobs longer, improve health outcomes for patients and clients, and relieve the caregiving burdens faced by millions of families in the U.S. These workers are essential to our long-term care system, and they deserve respect, safety, and quality jobs.
