The Fragile Backbone: Immigrant Caregivers Fear Deportation Amidst Growing Demand

The pre-dawn darkness finds Julia, a homecare worker, already awake and preparing for a grueling day. Her routine is a testament to dedication: a quick shower, a moment to mentally steel herself, and then off to the first of several clients who rely on her for essential care. For more than ten hours, she navigates a landscape of human need, providing not just assistance but also companionship and comfort.

Julia’s tasks are varied and demanding. She cooks nutritious meals, meticulously cleans living spaces, and handles sensitive medical procedures like replacing catheter bags. She bathes and dresses her clients, carefully monitors their blood pressure, and ensures they adhere to complex medication schedules. Her day, however, doesn’t neatly fit within the confines of her paid hours. After officially ending her shift with a disabled Iraq War veteran at 4:30 p.m., she makes a crucial detour, returning to the home of her first client, a vulnerable 92-year-old woman grappling with dementia and living alone. There, she prepares and serves her dinner, ensuring the elderly woman has a nourishing meal and a friendly face before the night descends.

For this demanding work, Julia earns $18.50 an hour. A sum that provides no health care benefits, leaving her vulnerable to the financial strain of illness or injury. Despite the long hours, the physical and emotional demands, and the lack of comprehensive benefits, Julia finds fulfillment in her work. She derives genuine satisfaction from providing care and comfort to those who need it most.

However, a shadow of uncertainty hangs over her life, fueled by political anxieties. President Donald Trump’s stance on immigration, particularly his plans for mass deportations, casts a long and menacing shadow over Julia’s future. She fears that the crackdown could abruptly end her ability to continue providing care for her clients, a prospect that deeply troubles her.

“Not all immigrants who come here cause harm. Most are here to contribute,” Julia told USA TODAY in Spanish, her words carrying a profound sense of disappointment and injustice. “It’s sad and disheartening to see how immigrants are being treated.”

To protect herself from potential targeting, Julia requested anonymity, a decision respected by USA TODAY, who confirmed her identity and agreed to refer to her as "Julia." Her story is not unique. She represents a vast population of immigrants living in the United States without a clear and secure path to citizenship.

Julia arrived in the U.S. 23 years ago from El Salvador, seeking refuge as a Temporary Protected Status (TPS) holder after a devastating earthquake ravaged her home country. This temporary status, once a lifeline, now feels increasingly fragile as the Trump administration targets individuals with similar legal but precarious immigration statuses. This focus, she fears, could have devastating consequences for the caregiver industry, an industry overwhelmingly reliant on foreign-born workers.

The Trump administration’s actions have included ending the extension of Temporary Protected Status for hundreds of thousands of Haitian and Venezuelan immigrants. The president even signed an executive order aimed at revoking birthright citizenship for children of immigrants without legal authorization, a move that was subsequently blocked by a U.S. appeals court. These actions, combined with announcements of "the largest massive deportation operation in history," have instilled fear and uncertainty within immigrant communities across the nation.

Julia is just one of countless immigrants, both with legal status and without, who form the backbone of the U.S. caregiver industry. These workers play a crucial role in addressing the ever-growing need for care, driven by the aging Baby Boomer population.

In 2020, the U.S. Census Bureau reported that 55.8 million Americans were 65 years or older. A study published in the National Library of Medicine projects this number will surge to nearly 70 million by 2030. This demographic shift will inevitably lead to an increased demand for various forms of care.

A National Center for Health Workforce Analysis study estimates significant increases in the demand for home health aides (35%), personal care aides (38%), and nursing assistants (41%) between 2022 and 2037. These statistics highlight the critical role caregivers will play in the coming years.

April Verrett, president of the Service Employees International Union (SEIU), representing over one million long-term care workers in the U.S. and Canada, warns that without the contributions of immigrants, the already high cost of caring for seniors, children, and people with disabilities will skyrocket.

Donna Norton, Executive Vice President for MomsRising, a family advocacy nonprofit, echoes this sentiment, stating that "Trump’s immigration policies could make a bad situation dramatically worse." She emphasizes the crucial role immigrants play in the community and care infrastructure.

While immigrants constitute only 17% of the total American labor force, they represent a significantly larger proportion of the caregiving sector. According to a 2024 report from Leading Age, an organization representing nonprofit aging services providers, immigrants make up 31% of the home care workforce, 21% of the residential care aide and nursing assistant workforce, and 30% of the nursing home housekeeping and maintenance workforce.

Although a smaller percentage of these workers are believed to be undocumented, their contribution is nonetheless significant. Nan Wu, Director of Research at the American Immigration Council, estimates that 4.2% of nursing assistants and 6.4% of home health aides across the country are undocumented, based on Census data.

Even without mass deportations, Brookings Economic Studies program director Ben Harris suggests that increased border enforcement, higher rates of immigrants leaving the country, and policy changes that restrict paths to legal residency for asylum seekers could have a "cooling effect" on the number of migrants available to work in tight labor markets.

These factors, combined with an existing worker shortage and high turnover rate within the caregiving industry, could rapidly impact both the cost and quality of care in the U.S. Harris points out that nursing and residential care facilities lost 400,000 workers during the pandemic. Studies have also shown that increased immigration is linked to higher nursing home staffing levels and improved patient outcomes.

“When some people are cheering these really aggressive anti-immigration policies, they may not be thinking that they mean a higher chance that their parent or grandparent might have a problematic fall,” Harris told USA TODAY, highlighting the often-unseen consequences of immigration policies. “This is not an obvious connection, but it’s established by the research.”

One study highlighted by Harris found that the increasing cost of care in the U.S. is partly fueled by nursing home staffing shortages, leading to a greater reliance on temporary workers from staffing agencies, who charge hourly rates 50% to 60% higher than what is paid to directly employed nurses.

“If there are not folks here to take care of our loved ones, that means folks are going to have to choose: Do I go to work? Do I stay home with my aging parents?” Verrett said, emphasizing the difficult choices families will face. “Families are going to have to make real tough choices at a time where it’s already so hard for families to make ends meet.”

Julia worries that without her and with ongoing threats to government health care programs, her clients would be left without the care they desperately need. “Even though these two individuals have extended family, they are alone,” Julia said.

In her limited time off, Julia and other homecare workers she knows provide care to those in the community who cannot afford or do not qualify for their services. Julia believes that without workers like her, some people would be “left to die.”

Despite her dedication, Julia is forced to consider a backup plan in case she loses her legal status. Although her U.S. homecare license would not be transferable to El Salvador, she worked as a nurse there before moving to the U.S. and believes she could potentially return to that profession. However, the thought of leaving her daughter, a U.S. citizen, is profoundly painful.

Jaz Vergara, a nursing assistant and DACA recipient, who has treated patients with COVID-19, cancer, and those affected by wildfires, also lives under the constant threat of deportation as the program shielding her from deportation remains under legal challenge.

“They know where I live, where I work. They know everything. I’m an easy target,” Vergara said, emphasizing that she and other immigrants are “trying to contribute. We’re not looking for the high paying jobs or something that we didn’t earn.”

Vergara’s parents brought her to the U.S. from Mexico when she was six years old. She follows her lawyers’ advice and maintains sufficient savings in case she loses her legal status and is deported. She has even researched whether her U.S. nursing assistant certification would be transferable to Canada, but she doesn’t want to leave the country she’s called home for 20 years.

After decades of living in the U.S., both Vergara and Julia feel that returning to their home countries would require completely starting over.

Recognizing the urgency of the situation, House lawmakers reintroduced a bill on Feb. 26 that would create a legal pathway to citizenship for DACA recipients and a pathway to Lawful Permanent Resident status for current TPS holders.

“Imagine building a life here only to be told to leave for a country you don’t even remember, much less sometimes even speak the language,” Rep. Sylvia Garcia, D-Texas, who reintroduced the bill, said on the House floor. “Congress must act.”

The American Dream and Promise Act of 2025 has been co-sponsored by 202 members of Congress, including Florida Rep. Maria Elvira Salazar, the only Republican to sign on.

“I’m constantly engaging my colleagues in Congress to push forward with practical immigration reform,” Salazar said. “We need to be honest about how immigration affects American citizens, our job market, our economy, our national security, and our national character.”

Salazar believes that a balance must be struck between deporting those who “truly don’t deserve to be here,” such as violent criminals and gang members, and “giving dignity” to those who work hard, pay taxes, and contribute to the U.S. economy.

“This has always been a challenging topic, but I believe now is the moment,” Salazar told USA TODAY. “Take some time in both Miami and across the country and you’ll see that the appetite to fix these problems is very real among the American people.”

However, even with the bill’s 202 co-sponsors, it still faces significant hurdles. It needs to advance through the House Judiciary and Education and Workforce Committees before surviving votes in the Republican-controlled House and Senate and ultimately reaching President Trump’s desk. The president could then veto the bill, send it back to Congress for revisions, or sign it into law.

When USA TODAY asked if Trump would sign the bill into law, White House spokesman Kush Desai responded, “President Trump was given a resounding mandate from the American people to enforce our immigration laws and put Americans first. The Trump administration is committed to delivering on that mandate.” He added that Trump was focused on mandating healthcare price transparency through a February executive order.

Rep. Jim Jordan, (R-Ohio), who chairs the Judiciary Committee, and Rep. Tim Walberg, (R-Michigan), who chairs the Education and Workforce Committee, did not respond to USA TODAY’s request for comment, highlighting the lack of clarity surrounding the bill’s future.

Lawmakers have been trying to codify a path to lawful permanent resident status for DACA recipients and TPS holders since 2017. An earlier version of the American Dream and Promise Act and other legislation aimed at protecting healthcare and essential immigrant workers failed to get a vote in the last Congress, demonstrating the persistent challenges in achieving meaningful immigration reform.