Despite his vow to close the U.S. borders to nearly all immigrants and deport millions of others, President-elect Donald Trump says he’ll continue special H-1B work visas for tech workers. That decision came in response to some of his Silicon Valley supporters, who insist foreign labor is critical because there are not enough U.S.-born engineers and others to do this important work.
By that logic, Trump also ought to protect the direct care workers who assist people with disabilities and frail older adults from his mass deportation plans and even create a new special immigration status for them. Why? Because, well, there are not enough U.S.-born people willing to do this important work.
Making America Strong
Elon Musk, who led the charge to convince Trump to continue the H-1B visa program, has called immigrants “critical people who built SpaceX, Tesla and hundreds of other companies that made America strong.”
But in reality, the argument for direct care workers may be even more powerful than it is for tech. That’s because some tech companies have used the H-1B visa program to replace native-born employees with temporary, lower-cost foreign-born workers.
That is not the case with care workers, where severe shortages of U.S.-born aides and nurses are real, not just an opportunity to lower labor costs.
Besides, caring for frail older adults and younger people with disabilities also makes America strong.
It helps maintain quality of life for those who need care, many of whom pay taxes and were enormously productive during decades of their working lives. But more than that, access to paid aides, nurses, and other direct care workers can make it possible for their family members to continue to work at productive paid jobs (perhaps some are even computer engineers).
And the personal care they provide may help avoid costly preventable acute medical episodes, emergency department visits, and hospitalizations — all of which can reduce the amount the U.S. spends on health care. This might be of some interest to Musk, who is advising Trump on how to lower government spending.
A Severe Shortage
The need for more care workers is clear.
For example, the U.S. will need nearly 200,000 additional nurses by 2030, according to the Bureau of Labor Statistics. A different report concludes the U.S. will face a shortage of nearly 79,000 RNs this year alone.
The research and advocacy organization PHI estimates nearly 5.5 million home care job openings will need to be filled in the decade 2022 to 2032, an estimate that includes replacing current workers who leave their jobs and meeting new demand from an aging population.
The worker shortage should be no surprise. Home care aides have among the most dangerous jobs of all occupations, largely caused by back injuries from moving patients. They make an average hourly wage of a bit more than $16 and their median annual income is only about $22,000. Nearly one in six live in poverty and about 60% receive some public assistance.
Interestingly, the total home care workforce is expected to grow by more than 700,000 jobs over the period, more than any other occupation and by twice as much as software developers.
Just as with tech workers, immigrants are critical to filling the deep gap between demand for direct care workers and supply of those willing to do these difficult jobs.
An Immigrant Workforce
Currently about 18% of nursing home aides are foreign-born, according to the Baker Institute at Rice University. One-third of on-the-books home care workers are immigrants. And of the many unlicensed home care aides who work in gray market, many are immigrants, including many who are undocumented.
Without those foreign-born workers, long-term care as well as the health care system would collapse. It is no exaggeration to say people would die.
Trump’s plan for mass deportations, even if he scales it back from his campaign vow to deport as many as 20 million people, will have a substantial impact on the health of millions of Americans. Closing the border to new immigrants will make the problem even worse.
The president-elect seems to be listening to those high-tech executives who have given him millions of dollars in campaign and inaugural gifts and have his ear on immigration.
Few families have that kind of access. But millions of them already are suffering from the current shortage of direct care workers. At the very least, the new administration needs to take care it does not make the situation worse.
It could even take some modest steps to reverse the crisis. For example, Trump could revive an old visa program for nurses and create one for aides. Because, just like tech workers, they are providing critical services that native-born Americans are unwilling to do.
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