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Immigrants Can Help ‘Bridge the Gap’ in Direct Care

September 27, 2023

Immigrants have long been critical to the direct care workforce, ensuring that employers are better able to fill job openings in this sector and that consumers can access quality care. Egregiously, the divisive political climate on immigration has so far limited the enactment of policy reforms to maximize immigrant workers’ contributions in this sector.

Our new policy brief—Bridging the Gap: Enhancing Support for Immigrant Direct Care Workers and Meeting Long-Term Care Needs—provides a range of policy recommendations across four critical areas: providing work authorizations and pathways to citizenship; creating workforce innovations that recruit, train, retain, and support immigrant direct care workers; strengthening immigrant-specific supports; and improving data collection and research to capture the realities of immigrant direct care workers. We’ve also produced new data on immigrants in direct care to understand their challenges and potential for this job sector.


Our new research underscores the importance of immigrants to the direct care workforce, especially as the long-term care sector struggles to fill an estimated 9.3 million job openings in direct care in the decade ahead. Here are the most relevant findings:

  • One in Four Direct Care Workers. At least 27 percent of direct care workers in the U.S. are immigrants—and many more likely work in the “gray market,” where consumers directly hire home care workers using private funds. (Unfortunately, data limitations prevent a clearer understanding of this segment of long-term care.) For comparison, about 17 percent of the total U.S. labor force and 18 percent of all health care workers are immigrants.
  • Growing Proportions in the Last 10 Years. The proportion of direct care workers who are immigrants grew from about 21 percent in 2011 to 27 percent in 2021.
  • Home Care vs. Other Long-Term Care Settings. As illustrated below, 32 percent of home care workers are immigrants, while 26 percent and 21 percent of residential care aides and nursing assistants, respectively, are immigrants.
  • Surging Demand. Between 2021 and 2031, the long-term care sector will need to fill 9.3 million direct care job openings, including new jobs and job vacancies that will be created as existing workers leave the field or exit the labor force. These total job openings were estimated at 7.9 million for 2020 to 2030—indicating a nearly 18 percent increase in 10-year projected job openings in the last year.


The most notable recommendation from this section of our policy brief is for the U.S. Department of State to create a special “caregiver visa” for direct care workers to help long-term care employers fill job openings while allowing immigrants to live permanently in this country. Because temporary visa programs have historically linked the visa status of temporary migrant workers to their employers, which creates a host of problems, we recommend that this caregiver visa not tie workers’ immigration status to one employer and include a range of specific workforce protections, including an appropriate wage mandate, barring employers who commit labor abuses from the program, protecting workers from retaliation, and much more.


This section of the policy brief recommends that the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Labor (DOL) fund and evaluate a broad range of immigrant-specific direct care workforce interventions that improve training, recruitment, and retention among these workers. For example, Encuentro in New Mexico runs a highly regarded training and support program for Latino, Spanish-speaking immigrants to enter home care, which supports their employment and helps home care agencies recruit more workers. Another important recommendation from this section is for HHS to fund a national technical assistance center to support health and long-term care employers dealing with chronic workforce shortages to recruit and employ immigrant workers already in the U.S. and from abroad.


Among the recommendations in this section of the brief is for DOL to boost legal services to immigrants in the U.S. working in sectors with chronic workforce shortages—including the long-term care sector—who need legal help navigating the immigration system, among other concerns. In addition, the brief urges DOL to produce, translate, and disseminate a range of resources, such as sample employment agreements, to ensure direct care workers and other care workers understand their rights—and that employers comply with them.


Two critical recommendations from this section of the brief are for the Bureau of Labor Statistics, the U.S. Census Bureau, and other agencies to integrate additional questions related to immigrants in relevant federal surveys to build knowledge on immigrant direct care workers and for HHS and DOL to collaborate to fund new studies on immigrants working across the gray market, including the home care sector, which would increase understanding of the unique experiences of this nearly invisible segment of the direct care workforce.

As advocates propose—and government leaders consider—these policy recommendations, attention must be placed on simultaneously strengthening direct care jobs as a whole so that all workers, regardless of immigration status, can pursue and thrive in these roles. All direct care workers deserve high-quality jobs that offer adequate compensation, robust training and advancement opportunities, and much more, as delineated in PHI’s 5 Pillars of Direct Care Job Quality framework. We can draw the lens on immigrants as we fulfill this broader imperative.

Click here to read the full policy brief.


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