Immigration cuts could deepen U.S. eldercare shortage

In 2030, more Americans will die than are born. The Congressional Budget Office puts the crossover that year, the same year the youngest baby boomer turns 65. After that, every additional person in this country arrives from somewhere else. Population growth stops being something we produce and becomes something we admit.

We’re admitting fewer. Net immigration ran near 410,000 last year. The CBO baseline underneath every federal revenue forecast you’ve read assumes it climbs back toward 1.2 million a year by the mid-2030s. Right now, it isn’t climbing, and the politics say it won’t. Hold immigration where it sits today, and the country reaches 2036 with roughly 3 million fewer workers than every one of those forecasts assumes.

Immigrants arrive already working age and go to work at higher rates than people born here, which means a change in immigration policy shows up in the labor force almost immediately. Nothing else does. A sudden national enthusiasm for having babies would not produce a single additional worker until the 2040s. Raising the retirement age buys a few years from people whose bodies are already deciding the question for them. Immigration is the only lever that moves the American workforce inside a decade, and we are in the middle of pulling it the wrong way.

So, we’re running an experiment with a 10-year delay. The politics happen now. The bill arrives when the boomers need help getting out of bed.

I’ve sat with people in hospice. The person in the room at the end is rarely the one you’d guess. It isn’t the son who lives 40 minutes away and calls on Sundays. It’s an aide who knows how your mother takes her coffee, which side she likes to lie on, and what her face does right before the pain gets bad. She is doing the most intimate work in American life for about what a warehouse pays. There is no version of the next decade where we need fewer of her.

We’re going to need enormously more. Thirteen million more Americans turn 65 in the 10 years ahead. Healthcare and eldercare account for roughly two out of every five new jobs the Bureau of Labor Statistics expects the entire country to add.

Then there’s the number nobody quotes, and it’s the one that should keep you up.

Home health and personal care agencies need to fill 765,800 openings a year.

Not over the decade. Every year. The work is physically punishing, emotionally heavier, and paid like it’s neither, so people leave and the same jobs come open again. Immigrants already do about a quarter of that work. Take a meaningful share of them out of the pipeline and the shortage arrives immediately.

And a care shortage doesn’t stay a care shortage. When the aide isn’t available, the daughter does the work. She’s usually in her late 40s, in the best earning years she will ever have, and she cuts her hours, turns down the promotion or quits. A caregiving shortage manufactures a second labor shortage on top of the first, this one made of men and women who were supposed to be running things by now.

None of this arrives as a headline. There’s no morning where the country announces it’s out of people. It shows up as a facility with 12 beds it can’t staff, an agency that stops taking clients, a memory care waitlist that runs longer than the disease gives you, a hospital paying triple for travel nurses and moving the cost to your bill.

We already have names for all of that. The nursing shortage. The staffing crisis in long-term care. The cost of aging in America. We treat each one as its own problem with its own fix, and the fixes keep failing, because they aren’t separate problems. They’re one shortage of people, surfacing in the work where people can’t be substituted.

Which makes the immigration argument we’re actually having strange to sit through. It runs almost entirely backward, over who came and how they got here and whether they should have. The part that decides the next 10 years barely comes up, because nobody files it under immigration at all.

Immigrants aren’t a cost this country is deciding whether to carry. They’re already holding up the part of the economy every one of us eventually needs and none of us can outsource, and every projection we have says we’ll need more of them before this decade is out, not fewer.

So, the question worth arguing over isn’t whether America can afford immigration. It’s whether America can staff itself without it, in the specific rooms where our parents will spend their last years.

The woman who will sit with your mother at the end is alive right now. She’s in her 20s, and she’s probably not in this country yet.

We’re deciding this year whether she ever gets here.

Jaime Raul Zepeda is the Executive Vice President and Principal Consultant at Best Companies Group. Best Companies Group is a leading employee experience and workplace research firm. Since 2004, Best Companies Group has helped over 10,000 organizations understand and improve their workplace and their employee’s effectiveness. If you want to learn more about how Best Companies Group can help your organization improve your employee’s effectiveness, you can reach Jaime at [email protected].