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aging-nursing home

Geezers who are more, well, strategic than I am have already finalized their wills, drafted their healthcare directives, and long ago began investing in their long-term-care insurance plans. I’m more of a take-every-day-as-it-comes kind of guy, which can frustrate My Lovely Wife, whose well-intentioned attempts to begin a conversation about nursing-home scenarios I promptly derail by stubbornly declaring that I’m never moving again.

I like to assume, given the limitless zeal with which American business chases a buck, that there will always be home healthcare services available to lend a hand when I reach the point where I’m too decrepit to handle stuff myself. Recent events, however, have raised some doubts about this.

When the Trump Administration last week announced that it was ending the popular Deferred Action for Childhood Arrivals (DACA) program unless Congress rescued it with legislation in the next six months, some 700,000 immigrants were thrown into limbo. The move elicited a predictable uproar among a wide swath of folks sympathetic to the plight of these young “dreamers,” but few recognized the effect this would have on older Americans.

As Noam Scheiber and Rachel Abrams note in the New York Times, about one in five DACA beneficiaries currently work in the healthcare and education sectors. Deporting them, or driving them into hiding, would mean losing “tens of thousands of workers from in-demand job categories like home health aide and nursing assistant,” they write.

This at a time of ever-increasing demand for these services — especially in rural areas. Scheiber and Abrams cite government projections showing that “the economy will need to add hundreds of thousands of workers in these fields over the next five to 10 years simply to keep up with escalating demand, caused primarily by a rapidly aging population,”

And it could have a destabilizing effect throughout the entire home-healthcare industry, upon which some 5 million elderly Americans depend. More than a quarter of all home health aides are immigrants. And, as Robert Espinoza, vice-president for policy at the advocacy group PHI, explains, when you threaten a large segment of this workforce with deportation, the quality of service is bound to suffer. “If you are seeing family members, children, neighbors being deported, threatened, and so on, the ability to be present on the job is undermined.”

This won’t simply affect the quality of care elderly Americans will receive; it may drive thousands of them out of their homes and into long-term care facilities, where the cost of care is significantly higher.

Hard-line anti-immigration folks often argue that immigrants are stealing American jobs, but as Michelle Chen points out in a recent essay in Mic, life as a home healthcare worker comes with some serious challenges.

“Both immigrant and non-immigrant workers face high risk of injury and exploitative working conditions,” Chen writes. “With median incomes of about $15,600 (and even less for the sector as a whole), roughly 20 percent of immigrant home-care workers live in households below the poverty line. Over a quarter of their households survive on federal nutrition assistance programs; a third are themselves Medicaid recipients.”

The upshot, of course, is that Trump’s continued tough line on immigration will have unintended consequences on another already vulnerable population, Chen notes. “The people who will really have it tough are the grandmothers whose caregivers may soon vanish from their lives, and with them, the one critical human bond that keeps them connected to their communities.”

I’m encouraged by the pushback the White House received after last week’s announcement and hope Congress will come together to offer some assurances to dreamers — and the elderly Americans who depend on them for their in-home care. If all goes well on the legislative front, there’s a good chance I may never have to move again after all.

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