Q. My mom has had the same home health aide for 5 years. My mom’s needs are great at this time, so her aide, Sylvia, bathes her, dresses her, feeds her, and takes her to the grocery store. We couldn’t ask for a better home health aide or person than Sylvia.
Sylvia fled here from Haiti after the January 2010 earthquake. She is one of about 59,000 Haitians living in the U.S. under Temporary Protected Status, a program that gave Haitians, El Salvadorans, Nicaraguans and others permission to work and live here after natural disasters devastated their countries. She works two low-wage jobs as a home health aide.
Finding Sylvia wasn’t easy, as there is a shortage of nursing aides like her that are affordable, good at what they do, and so caring. Now, we fear she will be deported next year? What do you suggest we do then? Is there anything being done about the shortage of skilled home health care workers, and is that even being taken into account by the president? Thanks in advance for your help!
A. As you mentioned, many Haitians came to this country in 2010 under Temporary Protected Status (TPS), after a devastating earthquake hit their country.
TPS is granted to nationals of certain countries that have been hit by natural disasters or political turmoil. Although it’s supposed to be temporary, TPS can be renewed, over and over again, to the dismay of some conservatives who want to limit immigration.
A TPS recipient can live here for 15 or 20 years, raising a family, buying a home, and paying taxes. This may end next year, as the Trump administration decided to end TPS for Haitians, giving them until July 22, 2019 to leave the country or face deportation.
Currently, as many as 300,000 immigrants in the U.S. are bracing for the possible end of TPS. And, many of those who are here work in health care, often in demanding, low-wage jobs as nursing assistants or home health aides.
Home Health Aides in the United States
Home health aides log long, physically demanding hours taking care of people who cannot care for themselves and helping families who need extra hands to care for loved ones. They bathe and feed ailing clients, check vitals, monitor medications, and change bedpans and bedsheets. These jobs offer low wages and are certainly not glamorous, and for these reasons are hard to fill, given the physically and emotionally challenging duties.
While many home health aides complete on-the-job training and hold professional certificates, the positions often require only a high school degree and no previous work experience, making them a good entry point into the U.S. labor force for immigrants and refugees.
What the End of TPS Would Mean
When the White House unveiled its plan to cut off immigration plans such as TPS, it issued a threat to a crucial pipeline of workers–home health care aides—as follows:
- Senior population is rising: Analysts expect 1.1 million of these jobs to come online by 2026 as America’s population of seniors rises to 71.5 million by 2030.
- Immigrants assume nearly a quarter of these positions: One in five DACA recipients is employed in health care, and many TPS holders—especially among the 50,000 Haitians who received TPS after the earthquake—work in home health care. With immigrants assuming 24% of the nation’s home health aide positions, where will we find the new workers to meet the demand?
- The U.S. immigration system is increasingly hostile to the foreign-born talent needed to fill the gaps. The end to DACA (Deferred Action for Childhood Arrivals), which occurred on March 5, coupled with the Trump administration’s cancellation of many TPS programs, could hit health care hard.
- “Low-skilled” workers will prove difficult to replace if the pipeline of immigrants suddenly slows. The median wage for personal care attendants and home health aides is $10.66 per hour, and $12.78 per hour for CNAs (Certified Nurse Aides). Improved pay and benefits should be top of employers’ to-do lists but may prove futile in attracting US-born workers, as these are positions that US-born workers typically shy away from.
Moving forward, many would-be home health aides will not meet the lofty criteria of the points-based immigration systems being championed by the White House. The federal government’s immigration crackdown threatens to push out current work-authorized immigrants and limit the channels for new workers to enter the country to replace them.
Can We Rely on Family Members to Step-In?
More than two-thirds of Americans believe they will be able to rely on their families to meet their long-term care needs. According to an AARP study, however, if you are a baby boomer, even though you may be supporting your own elderly parents, the chances of someone being there for you are significantly diminished.
The study, “The Aging of the Baby Boom and the Growing Care Gap,” determined that two decades from now, there will be far fewer caregivers available and more need for them. In fact, the ratio of potential caregivers to boomers needing care will sink from 7.2 to 1 in 2010 to 2.9 to 1 by 2050, according to the study.
The problem, as researchers have defined it, stems from a combination of factors, including the large number of baby boomers and the fact that boomers had relatively fewer children than earlier generations. Women in particular will be affected, because they typically live longer, but men have been catching up, the report said. The high rate of divorce among baby boomers, and the fact that one in three is unmarried, exacerbates the problem, combined with rising levels of obesity even as longevity increases (people who are obese are much more difficult to care for, as they often require two people to be lifted or transferred from a bed to a chair and back).
To make up for this and the lack of immigrants to help, the country needs policies that will provide for better support for caregivers and more affordable options for home care, the report said.
Worried About Needing Nursing Home Care?
Given the trends described in the AARP report regarding family members as caregivers and the Trump administration’s plans for immigration reform, it is now more important than ever to plan for your future and for your loved ones. Do you have a loved one who is in a nursing home or nearing the need for nursing home care? Or are you simply needing to plan ahead for the likelihood that nursing home care will be needed in the future? Life Care Planning and Medicaid Asset Protection is the process of protecting your assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home.
Nursing home care in our area costs between $10,000 – $14,000 a month. To protect your family’s hard earned assets from these catastrophic costs, there is no time like the present to begin Medicaid Asset Protection Planning. Please call us to make an appointment for an initial consultation:
Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797
About Evan H Farr, CELA, CAP
