As the Trump administration ramps up deportations of immigrants in the United States, a new analysis estimates that noncitizens in 2024 made up nearly 5% of the country’s healthcare workforce, with a high number of them working in nursing homes and home care agencies.
The study, published in JAMA, estimates that undocumented noncitizens comprised 1.8% of all 20.1 million healthcare workers in the country, including 3.8% of those in home care, 3.9% of nursing aides/assistants, and 8.9% of housekeepers and janitors.
“It’s clear that if the Trump administration succeeds in its stated goal of shrinking the immigrant population, severe shortages of healthcare personnel are likely,” co-author Steffie Woolhandler, MD, MPH, of Hunter College, City University of New York, New York City, told Medscape Medical News.
The consequences could be severe in medical fields with high numbers of immigrant workers, Woolhandler said. Immigrants without documentation are at higher risk for deportation.
“When nursing homes or home care agencies can’t recruit nursing aides and assistants to care for patients, they have to refuse to admit new patients,” Woolhandler said. Then “hospitals and emergency rooms have difficulty discharging frail patients and are unable to admit new patients.”
A think tank that advocates against immigration called the study’s conclusions “inappropriately apocalyptic.”
Mass Deportations Were on the Trump Agenda
During his most recent presidential campaign, Trump promised mass deportations that would remove millions of people from the United States. The Trump administration has revoked the right of hundreds of thousands of Venezuelan and Haitian refugees to live in the country under temporary protected status, which has been challenged in court.
Meanwhile, the Deferred Action for Childhood Arrivals program, which has allowed 538,000 noncitizen young adults who came to the United States as children to stay in the country and work, is in legal jeopardy. No new applications are being accepted.
Although some studies have examined noncitizens working in healthcare, there has been little research into the size of the undocumented immigrant workforce, Woolhandler said.
New Study Extrapolates From National Survey Data
For the new study, researchers led by Lenore S. Azaroff, MD, ScD, of Edward M. Kennedy Community Health Center, Worcester, Massachusetts, examined data from the 2024 Current Population Survey (CPS), a survey of the noninstitutionalized US population conducted by the US Census Bureau and US Bureau of Labor Statistics.
The voluntary survey encompassed 144,265 participants, including 8587 healthcare workers. The study authors extrapolated weighted data to the 20.1 million people who work in healthcare, assuming that noncitizen workers were undocumented if they didn’t meet certain criteria such as receiving Medicaid or Medicare benefits.
The new study estimates these percentages of noncitizen immigrants in healthcare fields and occupations:
• Outpatient care: 2.2% documented and 1.6% undocumented
• Hospital: 3.2% and 1.0%
• Nursing home: 4.6% and 2.7%
• Home care: 7.0% and 3.8%
• Physicians: 6.1% and zero
• Registered nurses: 4.3% and zero
• Health technologists/technicians: 3.1% and 0.3%
“We suspect that we have somewhat underestimated the number of undocumented people working in healthcare,” Woolhandler said. “However, the overall estimate of undocumented persons identifiable in the CPS is similar to official government estimates of the number of undocumented residents in the country, providing some reassurance that our estimates are reasonable.”
Immigration Critic Rebuts Study Conclusions
Jessica M. Vaughan, director of policy studies at the Center for Immigration Studies, which is influential in conservative circles but describes itself as nonpartisan, questioned the study findings in an interview with Medscape Medical News.
“The conclusions drawn by the researchers are inappropriately apocalyptic,” said Vaughan, whose organization supports limits on immigration and is a member of the advisory board of Project 2025, a right-wing initiative to remake the federal government. According to The Atlantic, the group has also “incubated” the anti-immigration policies of top White House adviser Stephen Miller.
Even if undocumented immigrants make up 2% of the healthcare force, “that doesn’t strike me as significant,” Vaughan said. “There’s no reason to believe that healthcare employers will not be able to find replacements.”
She added that the healthcare employers shouldn’t be hiring undocumented workers in the first place.
What Other Impacts Could Mass Deportations Have?
Vaughan also noted that healthcare spending on immigrants without authorization could decline if fewer of them are in the country.
But Woolhandler highlighted a 2022 study that found that immigrants, particularly undocumented immigrants, may subsidize the US healthcare system. Noncitizen immigrants are known to use much less healthcare than native-born Americans, Woolhandler said.
“Immigrants tend to be younger and healthier than native-born Americans and may be reluctant to seek routine medical care,” she said. “So while mass deportations may slightly reduce the total number of patients seeking care, the effects on healthcare staffing are likely to be much larger.”
Impact Potentially Higher for Home Healthcare
Bianca K. Frogner, PhD, professor and director of the Center for Health Workforce Studies at the University of Washington, Seattle, told Medscape Medical News that the study findings should be interpreted cautiously.
“The CPS does not collect information on whether immigrants are documented or not, so these are estimates that the authors produced based on many assumptions,” she said.
Frogner added that she’s surprised to see that high numbers of undocumented immigrants are believed to be working as nursing assistants, IT workers, and janitors. “Typically, employers would check their documents when they are employed.”
But it’s not surprising that home health workers are often undocumented, she said.
“We have had a concerted effort in this country to allow people to age at home rather than in nursing homes, in part because that is what people want and in part because keeping people in the hospital and nursing homes is expensive,” she said. But “it has been very difficult to retain workers in the home health space given how poorly paid these jobs are along with being hard work and requiring good interpersonal skills. Deportations may make it harder to fill these roles.”
Murray Devine, a spokesman for PHI, which advocates for workers in senior care and disability services, told Medscape Medical News that mass deportations won’t just affect those who must leave.
“Countless more immigrant workers — mainly direct care workers and other healthcare support staff — are likely to leave the healthcare workforce due to fear for themselves or their family members,” he said. “We will see immediate impacts on care access and outcomes for older adults and people with disabilities, chronic conditions, and serious illness that rely on these workers and the services they provide.”
No study funding was reported, and the authors had no disclosures. Vaughan and Devine had no disclosures. Frogner disclosed funding to examine the role of immigrants in the health workforce from the Health Resources and Services Administration.