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Immigrants Key To Looming Health Aide Shortage

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In the shadow of the Capitol on a recent sunny morning, about 50 home care workers from around the country gather to lobby their legislators for basic labor rights. Most are native-born Americans, but about a quarter are documented immigrants from Africa, Latin America, India and the Caribbean.

Elizabeth Castillo is one of them. Born in central Mexico, she's now a U.S. citizen. She's been working with an agency for 30 years in El Paso, Texas, and she says she currently makes $7.75 an hour. Castillo says she's here because she wants people to know that caring for the elderly is an important job. "I'm a social worker, a psychologist," she says in Spanish. "I wear so many hats on this job. I wish we were valued because we provide much more than companionship."

Currently, about 2.5 million home health aides care for the elderly, and 23 percent are foreign born. As the boomers retire and choose to age at home, many see documented immigrants as offering one of the best hopes to prevent a labor shortage in the home care industry.

Growing Demand

"I think that the immigrant workers bring with them outstanding work attitude, but they also bring with them customs of how care is given at home in their home countries," says Dowell Myers, a demographer at the University of Southern California and author of Immigrants and Boomers: Forging a New Social Contract for the Future of America.

Myers argues that the two groups need each other. As more boomers age at home, they will need aides to care for them.

"We are starting to wonder: Where are the workers going to come from who are going to take care of the baby boom elderly?" he says.

According to the Bureau of Labor Statistics, employment for home health aides is expected to grow by 69 percent by 2020, much faster than the average for all jobs. Myers says the country should be thinking about issuing work visas for aides.

Most aides make around minimum wage — often less than crossing guards and janitors. They don't get paid vacation or sick days. And almost half of them receive food stamps or other public benefits.

"We have about 65,000 caregivers now, and we're going to have to double that number in the next five to seven years," says Paul Hogan, head of Home Instead, one of the largest home-care agencies nationwide. About a quarter of Home Instead's current employees are documented immigrants. And Hogan says legal immigrants are vital for his industry to grow.

Michael Elsas, president of Cooperative Home Care, agrees. The size of his agency has quadrupled in the past 10 years. "This is a wonderful entry-level position, and we shouldn't be ashamed of that," Elsas says.

But to attract more workers, says Elsas, salaries need to be higher.

"We value the fact that people come and pick up our garbage every single morning. How do i know that?"asks Elsas. "Because we pay those people more than we pay the worker that takes care of our elderly population"

Many in the industry, including Elsas, agree that unless assumptions of who does this work changes, the profession will lack respect. "Some of the most perceptive people that I've ever met are home care workers," says Elsas. "Not only are they caring, they're excellent at negotiation, they're excellent at problem-solving. They're people who know how to compromise and still get what they need to get."

Like many agencies, Cooperative Home Care runs training in English and Spanish, graduating about 500 aides a year. But demographer Myers worries the country isn't prepared for the thousands of boomers that will retire every year. "This is a very big challenge because the clock is ticking, and this is really the calm before the storm right here," he says.

We know how many boomers will need home care, and, says Myers, it's in everyone's best interest to invest in that workforce, including legal immigrants.

Copyright 2012 National Public Radio. To see more, visit


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