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February 18, 2018

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If immigrants are pushed out, who will care for the elderly?

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Jenna Schoenefeld / The New York Times

Norma, an immigrant who fled with her family from El Salvador, moves a chair at the home of her 91-year-old neighbor, who she provides care for through a state program, in Burbank, Calif., Jan. 30, 2018. One in four direct care workers are foreign-born; on the so-called gray market, the proportion is likely much higher.

In Dallas, a 93-year-old is worried about the woman who, for years, has come to her house four days a week to help with shopping, laundry, housecleaning and driving. “She’s just a wonderful person, someone I feel I can trust completely,” said the older woman.

But because her helper is a Mexican immigrant who entered the country illegally, both women increasingly fear that she’ll be detained and deported. (I’m withholding their names for that reason.)

“If this woman gets pulled over today, who will help my mother tomorrow?” said her daughter, a lawyer in Oakland, California.

In New York City, Mary DiGangi, the human resources director at the Menorah Center for Rehabilitation and Nursing Care, recently asked local employment agencies to find 20 to 25 new nursing assistants and practical nurses.

It’s a typical request, and usually, she said, “I’m flooded with applications the next day.” This time, she saw only five applications over a month.

She thinks the Trump administration’s immigration policies and rhetoric have discouraged potential workers. Menorah, part of MJHS Health Systems, draws heavily on immigrants for its 3,500 employees.

Among them are 25 Haitian-American nursing assistants and practical nurses whose temporary protected status was terminated in November. They will have to leave by July 2019, unless the secretary of homeland security changes her mind. Other Menorah staffers brought to this country as children, now DACA recipients, also remain in limbo.

“Employees have told me they know it’s going to be OK,” DiGangi said. “I’m not sure if they’re convincing me or themselves.”

One in four of the direct-care workers in the nation’s nursing homes, assisted living facilities and home care agencies are foreign-born, according to an analysis of census data by PHI, the New York research organization.

In the so-called gray market, where consumers hire home care workers directly and often pay them under the table, the proportion is likely far higher.

“We’re seeing a growing work force shortage in direct care,” said Robert Espinoza, vice president of policy for PHI. “It’s affecting the entire industry, and it’s affecting older and disabled people and their families.”

The shortage stems partly from a growing economy, said Robyn Stone, a veteran researcher at Leading Age, which represents nonprofit long-term care providers.

When employers are hiring, she explained, “these folks are likely to look down the street at a hospital that pays more, or another industry like fast food, and leave.”

Mostly, however, what drives the labor shortage is long-term demographic change. Older people are living longer, most developing chronic diseases and disabilities; the sheer numbers of baby boomers further increases the demand for assistance.

But the population of working-age women, who typically provide care both paid and unpaid, has shrunk — and they have more career options than they once did.

So providing care for older people, in their homes or in facilities, has become the classic example of a job native-born Americans would rather not take.

It’s physically demanding work that pays poorly — the median wage for home care workers was $10.49 an hour in 2016, PHI reports — and usually doesn’t include benefits. The aides, mostly women, who serve in this crucial but low-income role frequently qualify for federal programs like food stamps or Medicaid.

Their advocates have long argued for ways to improve these jobs, with more training and higher pay. For now, though, what PHI calls the “caregiving gap” has been filled by immigrants.

The number of immigrants in direct care ballooned from 520,000 in 2005 to approximately 1 million in 2015, including those who work independently through state home care programs, PHI estimates. In New York, California, New Jersey and Florida, more than 40 percent of direct-care workers are immigrants.

If large numbers of immigrants become unable to work or fearful of attracting unwanted attention, “this is going to create tremendous strain,” Stone said. Already, “we’ve heard of nursing homes that have shut down, or stopped admissions, because they could not hire enough people.”

Excluding the gray market, the majority of aides and nursing assistants are American citizens. But PHI has calculated that nearly 35,000 come from Haiti, El Salvador, Nicaragua and Honduras, whose immigrants have had temporary protected status in the United States.

The administration has so far terminated TPS status for Haitians, Salvadorans and Nicaraguans; other nationalities may follow. Immigrants from Sudan, whose TPS status was also terminated, will have to leave the United States as early as this fall.

Another nearly 11,000 direct care workers come from largely Muslim countries affected by the Trump travel ban and might leave if family members can never join them. An unknown number of workers are DACA recipients who might eventually be forced to leave.

Even when workers are legal residents, though, they may consider moving when relatives are deported. Whole neighborhoods and communities feel targeted.

“Just the scrutiny is casting a pall,” Stone said. “If they’re afraid, if they won’t apply for jobs, we could see more shortages.”

In the San Fernando Valley in Southern California, a home care worker named Norma, who fled El Salvador with her family almost 20 years ago, assists her 91-year-old disabled neighbor under a state program. She works every day from 8 a.m. to 2 p.m., helping her client bathe, dress, eat, and circle the block in a wheelchair.

Both Spanish speakers, the women have drawn close. “In the morning, when I arrive at the house, she brightens and says, ‘Norma, you’re here!'” Norma told me through an interpreter. But the administration has terminated Salvadorans’ temporary protected status as of September 2019. “I feel scared,” Norma said. “There’s so much unknown.”

While she worries for herself and her husband — and her two daughters, who are DACA recipients — she also fears for her client.

“If one day I don’t show up to work, nobody will be there to get her out of bed and change her,” she said. “This could be my own mom, who would be alone one day if nobody came to help.”