Mass Deportations Spell Trouble for Some Families Needing Long-Term Care
What experts think President Trump’s sweeping policy could mean for care at home, in nursing homes and in assisted-living centers
President Donald Trump's immigration policy, which he describes as the "largest deportation operation in American history," could make life harder for tens of thousands of American citizens who need care for their parent, spouse or partner, especially those who arrange home care on their own.

Unauthorized immigrants represent roughly 150,000 — or roughly 4% — of all health care workers providing long-term care, according to a 2019 Health Affairs study.
"I can only imagine that it'll get more challenging for families looking to provide care for their loved ones," said Priya Chidambaram, senior policy manager for KFF's Program on Medicaid and the Uninsured. "Immigration policies are so closely tied to the experience people are going to have trying to get care."
Why Many Caregivers Are Immigrants
Immigrants doing direct care work (people providing home care as well as care in nursing homes and assisted living facilities) in America come from at least 163 countries, according to Leading Age.
"It has a low barrier to entry because the skills aren't valued."
Many become caregivers because the field "offers a pathway to employment that doesn't exist in other industries," said Jodi Sturgeon, president and CEO of PHI, a nonprofit that seeks to improve the job quality of direct care workers.
"It has a low barrier to entry because the skills aren't valued," Sturgeon said. The pay is also often low — home care aides earn about $16 an hour, on average.
Trump's "border czar" Tom Homan said that the White House will ask Congress for $86 billion to initiate the mass deportation plan and that public should expect quick immigration action that creates "shock and awe."
Caregiving Costs Could Rise
But if the deportations shrink the supply of America's home care workers, the cost of such care could rise as a result.
"When there are fewer workers coming into any given industry, it can increase the wages paid to those who are available."
"When there are fewer workers coming into any given industry, it can increase the wages that are paid to those workers who are available," said Julia Gelatt, associate director of the U.S. Immigration Policy Program at the Migration Policy Institute.
The nation is already dealing with severe shortages in the direct-care workforce. Meantime Americans aged 85 and older, who are often candidates for caregiving, is the country's fastest growing age group.
Sturgeon said mass deportations could lead to situations where "older adults will be in isolation and not receiving the care that they want."
She called Trump's immigration policies "a significant threat to roughly a third of direct care workers and their families."
That's because the urgency and breadth of Trump's policy may prompt documented immigrants — people hired through agencies or employed by nursing homes and assisted living facilities — to leave the United States. These legal immigrants comprise nearly 27% of the direct-care workforce and 32% of home care workers.
"In the formal system, immigrants are documented," Sturgeon said.
The Gray Market of Home Care
The bigger disruption is expected to be in the "informal" or "gray market" caregiving system where families hire home health aides and personal aides on their own, without going through agencies.
"Gray market caregivers typically don't need to show naturalization documentation or meet licensing requirements as they do with agencies, hospitals and assisted-living facilities."
"These caregivers are more likely to be undocumented than ones in the formal direct care market," Chidambaram said. "That's because gray market caregivers typically don't need to show naturalization documentation or meet licensing requirements as they do with agencies, hospitals and assisted-living facilities."
Sturgeon concurred. "I feel like there are a lot of families who say, 'I would like to go through an agency for home care, but my mom needs her medications and the agencies won't allow their caregivers to give them," she said. "So, I have no choice but to hire in the gray market.' "
Families looking for home care in rural America often can't find agencies providing it. "When you're in a rural community, you are five times more likely to access care on the gray market, where there is a dearth of care options," said Howell.
Where the Deportations Will Start
In general, said Gelatt, "the risk of deportation is higher in states where the local police actively cooperate with ICE (the U.S. Immigration and Customs Enforcement agency). Those tend to be in red states."
Trump said he'll initially focus deportations on undocumented criminals. "We will begin the process of returning millions and millions of criminal aliens back to the places from which they came," the president said in his inaugural address.
"There's certainly bipartisan and common-sense support" for deporting criminals, said Nicole Howell, director of workforce policy at LeadingAge, a consortium of nonprofit aging services providers.
The Fear Facing Caregivers
Sturgeon believes Trump's deportation policies will lead some immigrant direct care workers to leave the United States out of fear.
They also think the new immigration rules could frighten some people out of leaving their countries to be caregivers here. "We're concerned that the rhetoric could dissuade individuals from wanting to come to the U.S. through legal pathways," said Howell.
The Inability to Keep Working
Another concern: some immigrants may not be deported but may lose their ability to work in the United States. They're able to work here through the government's Temporary Protected Status (TPS) program for immigrants who can't safely return to their home countries.
Roughly 864,000 people currently have TPS status. They come from 17 countries, including ones with many caregivers and nurses in the U.S., such as Ukraine, Haiti and Venezuela.
During the election campaign, Trump said he would revoke the TPS program and Vice President J.D. Vance said temporary protected status would only be permitted on a case-by-case basis. (On January 21, Trump ended a similar program, known as humanitarian parole, for migrants fleeing Cuba, Haiti, Nicaragua and Venezuela.)
If the Trump administration ends the TPS program, its immigrants without naturalization will lose the ability to work legally in the United States. Some, Gelatt acknowledged, might stay and provide care without work authorization through the gray market.
Constraints on Mass Deportations
Immigration and caregiving experts note that U.S. government budget and legal constraints will likely mean fewer undocumented immigrants will be deported than the 1 million a year the president announced. In the Biden administration's last fiscal year, ICE deported about 271,000 immigrants.
"It takes a lot of facilities to detain migrants," said Gelatt. "It takes a lot of buses and planes to transport people back to their home countries." However, she said Congress is expected to appropriate a lot more money for immigration enforcement.
Deportations will also take time, said Drishti Pillai, Director of Immigration Health Policy at KFF, a nonprofit organization formerly known as The Kaiser Family Foundation
Gelatt said they will need to go through the nation's immigrant courts, which have a backlog of 3.7 million cases. "So, if somebody in the United States doesn't already have a formal deportation order, they would have to go through court and it could take many years to get that order," she added.
The Wall Street Journal said Congress would have to hire about 5,000 immigration judges — 10 times the current number — to process all current cases plus new ones.
What One Analyst Wants to See
LeadingAge's Howell hopes the Trump administration and Congress realize the effect mass deportations could have on people desperately needing caregiving.
"We should be prioritizing individuals who want to come to the country to work," she said. "Let's look at what jobs we need filled and let's recruit those individuals and figure out immigration policy that meets that."
