If you only focused on Donald Trump’s vile rhetoric and phony fear-mongering about “undocumented immigrants,” you might easily forget the vital role that they have performed in keeping American society—and American families—afloat.
No, it’s not just mopping the floors in the back of the McDonald’s. Or cutting our grass, tending our gardens, cleaning our houses, and babysitting our kids. Those are all important, critical jobs that immigrants do at high rates, and jobs that most white Americans wouldn’t dream of seeing their own children do for the rest of their lives. But research indicates that there’s even more important work which immigrants disproportionately perform across the nation, and usually at dirt-low wages.
Immigrants take care of our parents and grandparents, those same grandmas and grandpas who are now surviving well into their late 80s and 90s. The ones who have outlived the usefulness of a meager Social Security check and the ones who, every week it seems, have a new, debilitating health problem to deal with that Medicare, by golly, just doesn’t cover.
As of 2017, immigrants accounted for more than 18% of U.S. healthcare workers, researchers report in the journal Health Affairs. In nursing homes, nearly one in four workers who directly care for patients are immigrants, as are nearly one in three housekeeping and maintenance workers.
“We rely heavily on immigrants to care for the elderly and disabled, particularly in their everyday care,” said the study’s lead author, Dr. Leah Zallman, an assistant professor of medicine at the Harvard Medical School and director of research for the Institute for Community Health at the Cambridge Health Alliance. “Therefore, any policies trying to reduce immigration are likely to make what is already a workforce shortage worse.”
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Nearly one in three immigrants is employed in a long-term healthcare setting, caring for the grandparents (or great-grandparents) of American citizens. Among the undocumented immigrant population (the “illegals” who Donald Trump so eagerly demonizes), the figure is 43%. Immigrant workers involved in home and nursing care are more likely to have four-year degrees than their American-born counterparts; additionally, they’re more likely to be Hispanic, non-Hispanic Asian, or non-Hispanic Black.
But even with millions of immigrants working long hours (often at night) providing in-home and facility care, the aging of the U.S. population is entering crisis territory, most acutely in terms of long-term treatment. By 2050, the population of elderly Americans is expected to double—even as the U.S. birthrate is falling.
Currently, Zallman said, “there are not enough people willing to do these jobs and we are going to need a lot more people in the future. This is an industry that needs people round the clock. And immigrants disproportionately take the night shifts. They are really filling the gaps.”
The real-life consequences of this shortfall in elder-health care workers—and specifically what can happen to the children of these elderly folks who are suddenly left without recourse—are playing themselves out right now in Maine, which is suffering through a massive shortage of such laborers. It's a slow-moving human crisis, aggravated by the relentless growth of the retired population as much as a severe scarcity of people willing and available to do the work needed to keep our oldest people vital and comfortable throughout the last years of their lives.
With one-fifth of its population over age 65, Maine is the “oldest” state, so it is viewed as a harbinger of what is absolutely going to occur in the rest of the country. By 2026, Maine is expected to be joined by as many as 15 additional so-called “super-aged” states.
Jeff Stein, writing for the Washington Post, profiled the Flahertys, a Maine family forced to cope with the lack of workers able to care for their 82-year-old matriarch.
Flaherty’s mother, Caroline, has for two years qualified for in-home care paid for by the state’s Medicaid program. But the agency could not find someone to hire amid a severe shortage of workers that has crippled facilities for seniors across the state.
With private help now bid up to $50 an hour, Janet and her two sisters have been forced to do what millions of families in a rapidly aging America have done: take up second, unpaid jobs caring full time for their mother.
“We do not know what to do. We do not know where to go. We are in such dire need of help,” said Flaherty, an insurance saleswoman.
The Flahertys undoubtedly did not expect to be spending their mid-50s desperately trying to find time to care for their own mother. They likely wanted to focus on their own impending retirements and their kids’ educations. But Medicaid or no Medicaid, the state simply could not find anyone to perform the services.
The disconnect between Maine’s aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade, demographic experts say. And that’s especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show.
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Perhaps the Flahertys, and others like them, might have to put their mother in a nursing home? Sorry, but no. With few exceptions, Medicare does not provide for long-term care. More to the point, as Stein explains, there simply are not enough healthcare workers available to staff Maine’s nursing homes, either.
Maine’s largest long-term-care provider, North Country Associates, has been forced to temporarily close admissions in each of its 26 nursing homes because of staffing shortages, sometimes for as long as several months, in an unprecedented change from a few years ago.
Bruce Chernof, an advocate for long-term care issues, explained that this is just the beginning of an inevitable crisis.
“Left unaddressed, this will be catastrophic. We as a country have not wrapped our heads around what it’s going to take to pay for long-term care,” Chernof said.
Bottom line: There aren’t enough workers to care for Americans as they age out of the ability to care for themselves. Workers cannot be found because younger people either a) do not want to do this type of stressful, difficult work for the pay offered, or b) cannot realistically accommodate the hours or schedules required to do it. Either way, the dire situation facing our elderly (and by implication, their families) is unlikely to improve in an environment where the governing principle in the U.S. (at least under this Republican administration) is how much the federal government can cut social services, rather than increase them.
Concurrently, the policies of Donald Trump, and those who support him, are specifically designed with the end goal of eliminating (or disincentivizing) an entire class of people from performing work that they have proved themselves willing and able to undertake: caring for the nation’s elderly. Which begs the question: Who, exactly, are Trump’s voters going to turn to when there’s no care available for their own parents, or themselves?
The consequences of Trump’s perverse, misguided immigration policy are actually highlighted by the experience of another country that is undergoing the same demographic shifts and trying to care for its aging residents. Japan is facing the exact same problem: a lack of workers able and willing to care for its rapidly increasing elderly population. But rather than curbing immigration in response, famously xenophobic Japan has done the exact opposite. In 2018 the country relaxed restrictions on immigration and instead issued several hundred thousand five-year visas to immigrants, solely for the purpose of taking care of the younger generations’ parents and grandparents.
Apparently, Japan cares more about its elderly than we do in the United States.