Alanys Ortiz reads Josephine Senek鈥檚 cues before she speaks. Josephine, who lives with a rare and debilitating genetic condition, fidgets her fingers when she鈥檚 tired and bites the air when something hurts.
Josephine, 16, has been diagnosed with , severe autism, severe obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder, among other conditions, which will require constant assistance and supervision for the rest of her life.
Ortiz, 25, is Josephine鈥檚 caregiver. A Venezuelan immigrant, Ortiz helps Josephine eat, bathe, and perform other daily tasks that the teen cannot do alone at her home in West Orange, New Jersey. Over the past 2陆 years, Ortiz said, she has developed an instinct for spotting potential triggers before they escalate. She closes doors and peels barcode stickers off apples to ease Josephine鈥檚 anxiety.
But Ortiz鈥檚 ability to work in the U.S. has been thrown into doubt by the Trump administration, which to the temporary protected status program for some Venezuelans on April 7. On March 31, a federal judge , giving the administration a week to appeal. If the termination goes through, Ortiz would have to leave the country or risk detention and deportation.
鈥淥ur family would be gutted beyond belief,鈥 said Krysta Senek, Josephine鈥檚 mother, who has been trying to win a reprieve for Ortiz.
Americans depend on many such foreign-born workers to help care for family members who are older, injured, or disabled and cannot care for themselves. Nearly 6 million people receive personal care in a private home or a group home, and about 2 million people use these services in a nursing home or other long-term care institution, according to a .
Increasingly, the workers who provide that care are immigrants such as Ortiz. The foreign-born share of nursing home workers rose three percentage points from 2007 to 2021, to about 18%, according to an by the Baker Institute for Public Policy at Rice University in Houston.
And foreign-born workers make up a high share of other direct care providers. More than 40% of home health aides, 28% of personal care workers, and 21% of nursing assistants were foreign-born in 2022, compared with 18% of workers overall that year, according to .
That workforce is in jeopardy amid an immigration crackdown President Donald Trump launched on his first day back in office. He signed executive orders that without a court hearing, , and more recently for nationals of Cuba, Haiti, Nicaragua, and Venezuela.
In to deport Venezuelans and attempting to for others, the Trump administration has sparked fear that even those who have followed the nation鈥檚 immigration rules could be targeted.
鈥淭here's just a general anxiety about what this could all mean, even if somebody is here legally,鈥 said , president of LeadingAge, a nonprofit representing more than 5,000 nursing homes, assisted living facilities, and other services for aging patients. 鈥淭here's concern about unfair targeting, unfair activity that could just create trauma, even if they don't ultimately end up being deported, and that's disruptive to a health care environment.鈥
Shutting down pathways for immigrants to work in the United States, Smith Sloan said, also means many other foreign workers may go instead to countries where they are welcomed and needed.
鈥淲e are in competition for the same pool of workers,鈥 she said.
Growing Demand as Labor Pool Likely To Shrink
Demand for caregivers is predicted to surge in the U.S. as the youngest baby boomers reach retirement age, with the need for home health and personal care aides over a decade, according to the Bureau of Labor Statistics. Those 820,000 additional positions represent the most of any occupation. The need for also is projected to grow, by about 65,000 positions.
Caregiving is often low-paying and physically demanding work that doesn鈥檛 attract enough native-born Americans. The median pay ranges from about to a year, according to the Bureau of Labor Statistics.
Nursing homes, assisted living facilities, and home health agencies have long struggled with high turnover rates and staffing shortages, Smith Sloan said, and they now fear that Trump鈥檚 immigration policies will choke off a key source of workers, leaving many older and disabled Americans without someone to help them eat, dress, and perform daily activities.
With the Trump administration , which runs programs supporting older adults and people with disabilities, and Congress considering deep cuts to Medicaid, the largest payer for long-term care in the nation, the president鈥檚 anti-immigration policies are creating 鈥渁 perfect storm鈥 for a sector that has not recovered from the covid-19 pandemic, said , an executive vice president of the Service Employees International Union, which represents nursing facility workers and home health aides.
The relationships caregivers build with their clients can take years to develop, Frane said, and replacements are already hard to find.
In September, LeadingAge to help the industry meet staffing needs by raising caps on work-related immigration visas, expanding refugee status to more people, and allowing immigrants to test for professional licenses in their native language, among other recommendations.
But, Smith Sloan said, 鈥淭here's not a lot of appetite for our message right now.鈥
The White House did not respond to questions about how the administration would address the need for workers in long-term care. Spokesperson Kush Desai said the president was given 鈥渁 resounding mandate from the American people to enforce our immigration laws and put Americans first鈥 while building on the 鈥減rogress made during the first Trump presidency to bolster our healthcare workforce and increase healthcare affordability.鈥
Refugees Fill Nursing Home Jobs in Wisconsin
Until Trump suspended the refugee resettlement program, some nursing homes in Wisconsin had partnered with local churches and job placement programs to hire foreign-born workers, said Robin Wolzenburg, a senior vice president for LeadingAge Wisconsin.
Many work in food service and housekeeping, roles that free up nurses and nursing assistants to work directly with patients. Wolzenburg said many immigrants are interested in direct care roles but take on ancillary roles because they cannot speak English fluently or lack U.S. certification.
Through a partnership with the Wisconsin health department and local schools, Wolzenburg said, nursing homes have begun to offer training in English, Spanish, and Hmong for immigrant workers to become direct care professionals. Wolzenburg said the group planned to roll out training in Swahili soon for Congolese women in the state.
Over the past 2陆 years, she said, the partnership helped Wisconsin nursing homes fill more than two dozen jobs. Because refugee admissions are suspended, Wolzenburg said, resettlement agencies aren鈥檛 taking on new candidates and have paused job placements to nursing homes.
Many older and disabled immigrants who are permanent residents rely on foreign-born caregivers who speak their native language and know their customs. Frane with the SEIU noted that many members of San Francisco鈥檚 large Chinese American community want their aging parents to be cared for at home, preferably by someone who can speak the language.
鈥淚n California alone, we have members who speak 12 different languages,鈥 Frane said. 鈥淭hat skill translates into a kind of care and connection with consumers that will be very difficult to replicate if the supply of immigrant caregivers is diminished.鈥
The Ecosystem a Caregiver Supports
Caregiving is the kind of work that makes other work possible, Frane said. Without outside caregivers, the lives of the patient and their loved ones become more difficult logistically and economically.
鈥淭hink of it like pulling out a Jenga stick from a Jenga pile, and the thing starts to topple,鈥 she said.
Thanks to the one-on-one care from Ortiz, Josephine has learned to communicate when she鈥檚 hungry or needs help. She now picks up her clothes and is learning to do her own hair. With her anxiety more under control, the violent meltdowns that once marked her weeks have become far less frequent, Ortiz said.
鈥淲e live in Josephine鈥檚 world,鈥 Ortiz said in Spanish. 鈥淚 try to help her find her voice and communicate her feelings.鈥
Ortiz moved to New Jersey from Venezuela in 2022 as part of an au pair program that connects foreign-born workers with people who are older or children with disabilities who need a caregiver at home. Fearing political unrest and crime in her home country, she got temporary protected status when her visa expired last year to keep her authorization to work in the United States and stay with Josephine.
Losing Ortiz would upend Josephine鈥檚 progress, Senek said. The teen would lose not only a caregiver, but also a sister and her best friend. The emotional impact would be devastating.
鈥淵ou have no way to explain to her, 鈥極h, Alanys is being kicked out of the country, and she can't come back,鈥欌 she said.
It鈥檚 not just Josephine: Senek and her husband depend on Ortiz so they can work full-time jobs and take care of themselves and their marriage. 鈥淪he's not just an au pair,鈥 Senek said.
The family has called its congressional representatives for help. Even a relative who voted for Trump sent a letter to the president asking him to reconsider his decision.
In the March 31 court decision, U.S. District Judge Edward Chen wrote that canceling the protection could 鈥渋nflict irreparable harm on hundreds of thousands of persons whose lives, families, and livelihoods will be severely disrupted.鈥
鈥楧oing the Work That Their Own People Don鈥檛 Want To Do鈥
News of immigration dragnets that sweep up and are causing a lot of stress, even for those who have followed the rules, said Nelly Prieto, 62, who cares for an 88-year-old man with Alzheimer鈥檚 disease and a man in his 30s with Down syndrome in Yakima County, Washington.
Born in Mexico, she immigrated to the United States at age 12 and became a U.S. citizen under authorized by President Ronald Reagan that made any immigrant who entered the country before 1982 eligible for amnesty. So, she鈥檚 not worried for herself. But, she said, some of her co-workers working under are very afraid.
鈥淚t kills me to see them when they talk to me about things like that, the fear in their faces,鈥 she said. 鈥淭hey even have letters, notarized letters, ready in case something like that happens, saying where their kids can go.鈥
Foreign-born home health workers feel they are contributing a valuable service to American society by caring for its most vulnerable, Prieto said. But their efforts are overshadowed by rhetoric and policies that make immigrants feel as if they don鈥檛 belong.
鈥淚f they cannot appreciate our work, if they cannot appreciate us taking care of their own parents, their own grandparents, their own children, then what else do they want?鈥 she said. 鈥淲e鈥檙e only doing the work that their own people don鈥檛 want to do.鈥
In New Jersey, Ortiz said life has not been the same since she received the news that her TPS authorization was slated to end soon. When she walks outside, she fears that immigration agents will detain her just because she鈥檚 from Venezuela.
She鈥檚 become extra cautious, always carrying proof that she鈥檚 authorized to work and live in the U.S.
Ortiz worries that she鈥檒l end up in a detention center. But even if the U.S. now feels less welcoming, she said, going back to Venezuela is not a safe option.
鈥淚 might not mean anything to someone who supports deportations,鈥 Ortiz said. 鈥淚 know I'm important to three people who need me."
This article was produced by 麻豆女优 Health News, which publishes , an editorially independent service of the .听
