Immigration Enforcement, the Home Care Workforce, and Access to Long-Term Care: Evidence from Secure Communities

Abstract

Most Americans who turn 65 will eventually need long-term care, with those who remain at home relying on help from unpaid informal caregivers or paid home care workers. Since nearly one-third of home care workers are immigrants, it is critical to understand how escalating immigration enforcement in recent decades has impacted this workforce. To examine this question, we exploit geographic variation in the rollout of a federal enforcement policy, Secure Communities (SC), between 2008-2013. We first propose a two-market model for home care, with home care agencies supplying care to both Medicaid-insured and private-pay patients, and we predict that home care agencies will respond to a SC-induced increase in labor costs by restricting supply to Medicaid enrollees. Then, we use data from the American Community Survey and the Health & Retirement Study to examine the effect of SC on home care workers’ labor market outcomes and older adults’ home care utilization. We find that SC led to a 7.5% reduction in the number of home care workers per capita, with 70% of the effect driven by reductions in the supply of foreign-born workers.