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New Policy Brief Reveals the Critical Role of Immigrant Direct Care Workers in U.S. Long-Term Care

September 29, 2023

PHI, the nation’s leading expert on the direct care workforce, announces the release of its latest publication, Bridging the Gap: Enhancing Support for Immigrant Direct Care Workers and Meeting Long-Term Care Needs. The policy brief provides new data on the critical role that immigrant workers play in the direct care sector, offering policy recommendations aimed at supporting immigrants to succeed in these roles and addressing the growing staffing crisis in long-term care.

The brief calls for a multi-pronged approach to these issues that spans providing work authorizations and pathways to citizenship; supporting workforce innovations for immigrant direct care workers; strengthening immigrant-specific supports for these workers; and improving data collection and research to fully capture the realities of these specific workers.

“This publication emphasizes how important immigrants are to a sector harmed by staffing shortages rooted in poor job quality, low wages, and a general lack of advancement opportunities,” said Jodi M. Sturgeon, president & CEO of PHI. “Direct care workers are lifelines for older adults and people with disabilities, and we should be designing policy interventions that improve these jobs while supporting segments of the workforce, such as immigrants.”

Key Takeaways

  • Significance of Immigrant Workers: Immigrants make up at least 27% of the direct care workforce, a figure that has grown from 21% in 2011. They are also more likely to be employed in home care settings and have slightly better economic outcomes compared to their U.S.-born counterparts. Additionally, immigrant direct care workers earn a median hourly wage of $13.50 and a median annual income of $25,275, compared to $13.00 and $21,862 for U.S.-born direct care workers.
  • Staffing Crisis: Despite their critical role, the direct care sector faces a severe staffing crisis, rooted in poor job quality and a limited pipeline of workers. Between 2021 and 2031, the long-term care sector will need to fill 9.3 million direct care job openings. This represents a nearly 18% increase in 10-year projected job openings compared to last year.
  • Economic Impact: According to the American Immigration Council, immigrants added $1.2 trillion to the U.S. GDP in 2016 and paid $458.7 billion in taxes in 2018.
  • Extensive Policy Recommendations: PHI outlines a range of federal-level policy interventions across four key areas: Pathways to Citizenship, Workforce Innovation, Immigrant Worker Supports, and Research and Data Collection. For example, creating a special “caregiver visa” for direct care workers that would build the pipeline into this workforce and provide immigrants who obtain this visa with an opportunity to live permanently in the U.S. The brief also suggests Congress should enact the Citizenship for Essential Workers Act, which would allow undocumented persons who worked as essential workers during the COVID-19 pandemic to be eligible for a path to citizenship.

“Federal leaders have an opportunity to ensure immigrants play an even bigger role in addressing the workforce shortage in direct care and this report provides a roadmap for government leaders to invest in humane and effective solutions,” says Robert Espinoza, executive vice president of policy at PHI and author of the policy guide.

Read the full report at:

Contributing Authors

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

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From wages to employment statistics, find the latest data on the direct care workforce.