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

Abstract

Most Americans will need long-term care at some point in their lifetimes, with many relying on assistance from home health and personal care aides. Since nearly one-third of these workers are foreign-born, it is critical to understand how immigration enforcement impacts their labor supply. We first propose a conceptual model of the impact of immigration enforcement on the market for home-based long-term care. Then, using data from the American Community Survey, we examine the effect of enforcement on the number of home care workers in a local area. We exploit temporal and geographic variation in the rollout of a federal enforcement policy, Secure Communities (SC), between 2008-2013, estimating difference-in-differences and event study models with time and location fixed effects to isolate the effect of the policy. We find that SC reduced the overall size of the workforce by 8.9%, with 70% of the effect driven by foreign-born workers. Then, using data from the Health & Retirement Study, we find large, negative externalities on older adults who need help at home. Consistent with our model’s predictions, these effects are concentrated among older adults on Medicaid, who experience a 20% reduction in receipt of formal home care post-SC.