When politicians use their favorite buzzword of the day “affordability,” they likely are talking about housing, insurance or beef. But they also should be thinking about the costs of personal care for older adults and younger people with disabilities, which is becoming less affordable than ever.
As the Trump Administration’s immigration policies become more restrictive, shortages of care aides, as well as nurses and physicians, may be getting worse. The result: The cost of care is rising far beyond the ability of most families to pay. And adult children, often lower-income women, are being forced to leave their own jobs to care for parents.
Low Pay, High Costs
According to the Bureau of Labor Statistics, the average hourly pay of a personal care aide last year was $16.78, up by almost one-third from $12.71 in 2019. And it very likely will be even higher in 2025.
But that is only part of the story: The actual cost to families for aides hired though an agency is twice that. The Genworth/CareScout cost of care survey reports the cost of an aide rose from $23/hour in 2019 to $34/hour in 2025. And in many communities, the cost of is $40 an hour or more. Genworth/CareScout found the annual cost of home care aides for a typical family approached $78,000 last year.
The main reason costs are rising is the supply of aides is falling. More than 300,000 left the workforce during the pandemic. Many never returned. Other aides are aging out, finding the work too physically challenging as they reach their 50s. And about one-third of home care workers are immigrants. Many now face deportation themselves or fear for family members.
Rising Demand For Care
Yet demand for care continues to grow. The health care data firm WellSky reports that patients are being discharged from the hospital with more chronic and complex conditions. For example, firms it surveyed report a 51% increase in clients with pulmonary disease since 2019, a 45% increase in drug use, and a 30% increase in moderate kidney disease.
And it found that while referrals to skilled nursing facilities were relatively stable over the past year, referrals for home health were up 4.6%.
At the same time, getting and keeping care workers is increasingly difficult. Personal care firms told Wellsky their staff turnover rate hit a staggering 126 percent. In other words, on average, every single care worker (and more) on staff on January 1 was gone by December 31.
And unlike coffee prices, these staffing shortages and resulting cost increases often are a matter of life and death. A frail older adult living alone can literally die without the support of an aide. Without family or paid aides, people with chronic disease or disabilities inevitably will have more falls, more malnutrition, more emergency department visits, more hospital stays, and, yes, more premature deaths.
Trump’s Immigration Curbs
Yet, Trump is making a long-standing trend worse. In part due to his restrictive immigration policies, care worker shortages are growing and costs are rising rapidly.
The administration claims that 600,000 migrants have been deported this year and nearly 2 million have left the US voluntarily. Though others say these numbers are wildly inflated, deportations are high.
About 1.3 million immigrants who were in the US legally under a program called Temporary Protective Status have been, or now are subject to, being deported. Many, from countries such as Haiti, have been employed as care workers. And home care agencies and senior living providers in places such as Florida report losing large numbers of workers.
Beyond that, Trump has threated to review existing “green card” work permits for all immigrants from 19 countries, though it is unclear how he will follow through.
Even those here with proper documentation feel threatened by random highly publicized immigration raids on workplaces. Home care agency owners tell me that staff are afraid to come to work, even if they are in the US legally.
On top of all that, Trump has created massive confusion among immigrants who potentially are subject to what is known as the public charge rule. New guidance would give immigration officers wide discretion to decide whether an immigrant is likely to receive some public assistance. If so, the migrant could be deported or barred from getting help from programs such as Medicaid or food stamps (SNAP) even if they otherwise are in the US legally.
Who Will Do The Work?
The great paradox of direct care workers: Even though the cost of home care is rising rapidly, many aides make so little money that they normally would be entitled to this assistance. Because many work only part time, the median pay for home care workers was about $26,000 in 2024, roughly the poverty rate for a family of three.
And it just isn’t immigration. Looming cuts to Medicaid and proposed reductions in federal Medicare payments to home health agencies will further increase costs of care for millions of families.
The government expects families will need another 800,000 care workers over the next decade, a growth rate of 17 percent. That’s more than five times the rate of job growth in the economy at large. The question is: Who will do this difficult and low-paying work, if immigrants no longer can?
Read the full article here
