Ep 08: Will Immigrants Rescue the Home Care Sector?

For generations, immigrants have contributed significantly to this country, including our health and long-term care sectors. Unfortunately, our divisive political climate prevents a constructive conversation about the potential of immigrant workers to support people with long-term care needs.

In the eighth episode of A Question of Care™, Robert Espinoza speaks with Ai-jen Poo, President at the National Domestic Workers Alliance and Executive Director at Caring Across Generations. They speak to the experiences of immigrant home care workers, why immigration is a contentious issue, and the future of caregiving.

Robert Espinoza: How did the wealthiest country in the world get to a point where it can't support the health and long-term care needs of more than 54 million older adults? Welcome to A Question of Care™, a podcast that explores the many answers to this question through different viewpoints and topics. I'm your host, Robert Espinoza, a national expert and frequent speaker on aging, long-term care, and the workforce.

On this episode, we'll shed light on the vital role immigrants play in the home care workforce, and we’ll delve into some of the challenges they bravely navigate. Our guide on this topic is well known for her work advocating for the rights and dignity of domestic workers and immigrant care workers. We are honored to welcome Ai-jen Poo to the podcast.

Ai-jen Poo: My name is Ai-jen Poo, and I'm the president of the National Domestic Workers Alliance and Director of Caring Across Generations.

Robert Espinoza: Apart from her significant expertise in the field, Ai-jen has a profound personal connection to home care workers and immigrants, which fuels her commitment to the cause.

Ai-jen Poo: I come from an immigrant family. And my grandmother, before she passed away a couple of years ago, was cared for by a series of immigrant home care workers who enabled her to stay at home and really live a pretty full life, even as she became more frail and needed more assistance. And she was able to live independently at home and then in my mom's care until the very end. And we were really proud of that. And I don't think we could have managed to keep her at home, where she wanted to be and live to the end, without the support of many immigrant care workers. So, I feel very personally indebted to immigrant care workers. a

And then I also, at the National Domestic Workers Alliance, have organized alongside immigrant care workers for almost 25 years—first in New York City and then nationally, across the country. And I have just seen so many immigrant women who have come to this country with an aspiration for giving their families and their children a better life and found themselves in the care economy, working as home care workers, direct care workers, childcare, and early educators. And [they] have found their calling doing this work and have become an indispensable part of millions of families across the country. And I know that work means the world to them, and I think it means a lot to the families they support. So, yeah, immigrants are a huge part of our care economy.

Robert Espinoza: Ai-jen, can you give our listeners an overview of the immigrant workforce in the home care worker field? What are some of their experiences? What are some of the issues that you've seen?

Ai-jen Poo: Well, home care work is a unique occupation in our economy because if you think about it, you could go into any neighborhood or community and not know which homes are also workplaces, [or] which homes have a home care worker working there. There's no list, registry, or place where all those relationships get organized or documented.

And then when you're in the home, it's you and your client or the person that you're supporting and maybe, a family caregiver that you're dealing with—but it's a very intimate relationship and a very interdependent one.

Oftentimes, the home care worker is the one who knows when or if medication's been taken and whether moods have shifted. They're on the frontlines of the health and well-being of the people in their care. Oftentimes, doctors, nurses, and other members of the health team or family members know way less than the home care worker in terms of how a person is doing.

And so we're talking about people who are in the most intimate aspects of their clients' lives and also quite invisible in our broader society and in a very difficult negotiation. Oftentimes, you're either negotiating with a relative or an agency, and you have very little bargaining power, so to speak, in that oftentimes, if you raise an issue or have a concern about the job you're in, you could just be let go. And you really have no job security.

And what happens for immigrant workers is you layer on top of that the insecurity of immigration status and the fears associated with that. So, if you're already concerned about losing your job, if you raise an issue or ask for a paid sick day, imagine also doing that from a position of being an immigrant. And potentially, if you're out of status, the fear of being reported and deported and separated from your family.

And, you know, the domestic work context from home care to childcare to house cleaning—work in the home is the part of the workforce that has the highest concentration of undocumented workers of any part of our workforce. So, there are a lot of immigrant women doing this work and providing an indispensable role and contribution to so many families and individuals' lives but lack any security for their own life and their own family.

And it's a constant negotiation. It affects every part of your life, including getting to and from work, getting on the bus, getting on public transportation. You know, you live in fear of being deported and separated from your families. And so trying to care for somebody else's family and your own amidst that set of insecurities and fears is incredibly challenging.

Robert Espinoza: Ai-jen, is there a personal story you've heard that really captures the complexity of living and working in this country as an immigrant home care worker?

Ai-jen Poo: Yes. So, we have a member who has become a very strong leader in our movement, worked as a home care worker in Florida, and still does. She's an immigrant from the Caribbean, and she faced sexual assault and harassment from a client that she cared for and was afraid to report it or to say anything. And [she] was trapped in a situation that was incredibly abusive and traumatic as a result of that. And I think it's partly because she was concerned about her economic security. But first and foremost, as an immigrant, I'm not sure about whether she would be safe if she reported it. So, she was caught between two scenarios, both of which she felt unsafe inside.

Robert Espinoza: You mentioned the issue of undocumented immigrants and additional challenges that they face. According to estimates from the Pew Research Center, there are more than 10 million undocumented immigrants in this country. And I've noticed in my own work, there is no issue we discuss on social media that gets as much vitriolic reaction as immigration. And it seems to be aimed almost entirely at undocumented immigrants.

Why do you think so many people have negative attitudes about undocumented immigrants?

Ai-jen Poo: Well, people have negative attitudes right now because there are real pain points that working Americans are facing. The cost of living continues to rise, and wages are not rising to keep up with that. So, there are a lot of people who are struggling in this country. Actually, 60 percent of the workforce earns less than $50,000 per year. And when you start to add up the cost of housing, food, transportation, and childcare, you start to realize that it's just not enough to make ends meet for a lot of people. Let alone pay for something like care, which is why we have been so passionately organizing to try to expand access to care and to raise wages for the care workforce.

And when people are struggling economically, it creates a ripe ground for pointing fingers when you try to make meaning of why things are so hard. The truth is nobody deserves to struggle as hard as so many people are struggling in our country. And when you ask yourself, why are things this way? There will be people on Fox News who will point fingers at immigrants.

And the truth is that when we blame, usually there are two scenarios. You blame yourself, or you blame somebody else, and they're usually of a different race or different immigration status because of the way that our country has… because of the long legacy of racism that's so deep in the lifeblood of our culture. And we're pitted against each other when, in reality, none of us are benefiting from the status quo. And the other part of the reality is that immigrants are completely interdependent with all of us and completely embedded inside our economy, every single community. They are our neighbors, and it turns out they are also our caregivers. And there's no point in denying that. It's just our reality. In fact, there's a lot in our self-interest to embrace that. 

In fact, when we think about the fact that we have 10,000 people aging into retirement per day and people living longer than ever, actually care in America is an all-hands-on-deck situation. There is no way we will care for the growing aging population in the United States of America without a strong contingent of immigrant workers who are supported to do this work.

And so, whatever we may be hearing from Tucker Carlson in our living rooms at night, the reality is we are going to be dependent on immigrants to take care of us. And the best thing we can do for ourselves and for them is to embrace that fact and support it.

Robert Espinoza: Early on in his presidency, President Biden recognized this potential of drawing on undocumented immigrants to fill jobs in long-term care as home care workers, nursing assistants, and much more. He proposed the U. S. Citizenship Act of 2021, which would have provided lawful prospective immigrant status to approximately 11 million undocumented immigrants, including essential workers such as direct care workers.

In your opinion, why hasn't this act become law?

Ai-jen Poo: Because there is a growing Far Right wing—a White nationalist, white supremacist grassroots movement in this country that has captured the media narrative about immigration in this country and has also captured a huge contingent of elected officials who are therefore afraid of facing our reality, which is as we've just said, completely interdependent with immigrants. 

And so there's just a ton of toxicity around this issue that really shouldn't be, and that is deeply rooted in fear and hatred and is also deeply divorced from our actual history and reality.

Historically, immigration has been good for our country in many ways and has enabled history to move forward. And that is exactly what they're afraid of in this instance. They want to take us backward. And so that is a great concern. 

And I also think that on the other end, there is a growing movement of caring people in this country who recognize that America is the democracy it is because of immigration and are going to continue to fight for it.

The President of the United States continues to try to take steps to make life better for immigrants despite the political hostage-taking on this issue from the Far Right. He recently announced that he was going to extend access to health care to "dreamers" and DACA recipients, and I think that's really, really important.

And we're just going to have to keep making progress where we can. My organization is very interested in creating a pathway to work authorization and citizenship for the immigrants who do care work as part of the solution to how we're going to care for our growing aging population and the families who need care.

Robert Espinoza: It seems that at the same time as these issues are being discussed politically, there are many U.S. based industry groups in long-term care that are also primarily interested in recruiting workers from other countries. They're asking for the legal ability to recruit foreign-born workers abroad to fill jobs here in the U.S. as home care workers or as nursing assistants.

But a few of these proposals make the visa temporary and don't include protections that would prevent a worker from really being at the mercy of their employer. What are your thoughts on a guest visa program in long-term care?

Ai-jen Poo: You know, I am a proponent of any guest work visa programs having equal protections and rights to workers who are here in the United States because I worry about these programs being used to downgrade the quality of jobs in these industries where we already have a hard time retaining and recruiting workers.

In fact, we lose some of our best, most committed caregivers to fast food, retail, and other industries because the wages are better. No offense to fast food and retail, which are also really important, dignified jobs, but we really need people to stay in care, especially those who want to. And I worry that the imposition of a guest worker policy that doesn't have very strong worker protections and rights and wages—that isn't about quality jobs—will then drive down the quality of work in a sector where we actually need to drive it way, way up.

And there's this whole conversation that started during COVID, where everybody was talking about labor shortages in the care economy. We kept saying, "There's not a labor shortage. There is a shortage of good jobs that you can actually sustain yourself on." And I still believe that to be true. And I'm open.

If we want to bring people from other countries to do this work, I think [we need] two things. One is we've got to make sure that those jobs are equally protected, the workers have rights, and that there's real equity between those workers and the workers who are currently here in those jobs. And I also think that we should first offer a pathway to work authorization and citizenship for the immigrants who are already here, many of whom are already doing this work. But they're doing it under the radar. And really recruit from that base of workers first. And maybe even before any of that, we should make these jobs better so that we can retain the workers that we currently have in the workforce instead of dealing with the unbelievable rates of turnover that we currently see.

Robert Espinoza: Ai-jen, a lot of the work that you do through Caring Across Generations is focused on our culture and on the public narrative around care work. If you had the ability to create an ideal public narrative on immigration and on immigrants in direct care, what would that narrative be?

Ai-jen Poo: It would be that we are all part of one caring majority in this country that is focused on making sure that the people that we love—that we can all live, work, and age with dignity in this country. And immigrants are a part of that care squad that's going to care for us in the future, along with so many of us. And the care squad has to take care of each other. First and foremost, caring for the caregivers, immigrant and non-immigrant, has to be a part of our story going forward.

Robert Espinoza: Let me ask you one last question. What is the most pressing need that should be addressed right now for immigrants, in your opinion?

Ai-jen Poo: We should make sure that immigrants have the ability to get on a pathway to becoming citizens here. And they are already functioning as full citizens in so many ways. And so many of us have friends and neighbors who are immigrants and know this—that we would not be who we are without their participation, contributions, and friendships. And so, we should have a pathway to citizenship for the 10 million.

And we should embrace the role that immigrants can play in a strong care infrastructure and care economy of the future... I mean, what could be more important than nurturing the human potential of our children or ensuring the dignity and agency of our loved ones with disabilities and our older adults who cared for us and raised us?

It's a really important task, and we don't want to shortchange it. We want to have the best people doing this work. And that will include lots of immigrants. That's what I think.

Robert Espinoza: I also have a deeply personal connection to immigration. My mother, Aurora, immigrated to the U.S. from Mexico in the 1960s, and she met my father, Robert, who was on leave from the war in Vietnam. They met on a bus heading to San Diego from Los Angeles, fell in love, and exchanged contact information. They married a few years later and remained so for fifty years until my mother's abrupt death in December 2020.

When I hear others describe their immigrant upbringings, I recognize their experiences—learning two languages, navigating the culture back home with the traditions in the U.S., and that persistent feeling that you belong in two worlds.

I remember the gratefulness in my mother's spirit, coupled with the sadness of migration—that sense that she never stopped missing her life and her loved ones thousands of miles away. Unlike many immigrants, she didn't flee a collapsed state or violence or even extreme poverty. Instead, she had this nomadic orientation that compelled her to live somewhere else. She said to herself, "My story doesn't end here."

Do you recognize that feeling? Have you ever left home or a life searching for a new horizon? Have you ever been forced to flee an untenable, even dangerous, situation? Have you ever scanned a map and said, there, right there, is where I want to live?

In this sense, we might all be immigrants at our core. So, why do we punish only those who meet certain criteria?

And in the context of care, what does this mean for millions of people who are struggling to find workers to support them when we know that immigrants, documented and undocumented, could perform those jobs and address this gap? Perhaps we have already built a border wall in the caregiving system that prevents immigrants from working in direct care, but it's those of us on the inside who need their support that are the ones in danger.

Thank you to my guest, Ai-jen Poo, and to you, our listeners. If you enjoyed this episode of A Question of Care, please share it on your social channels and stay tuned for future episodes. This podcast was produced by me, Robert Espinoza, in partnership with Modry Media. Please make sure to rate and review the podcast wherever you're listening.

This transcript has been slightly edited from the original episodes to improve readability and accessibility—while preserving the guest's authentic voice and conversational style.