Immigration Enforcement, the Supply of Home Care Workers, 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 home care workers, like home health and personal care aides, to provide this care. Since nearly one-third of home care workers are immigrants, it is critical to understand how escalating US immigration enforcement impacts the supply of home care. Relying on economic theory, we first propose a conceptual model of the impact of immigration enforcement on the home care market. Then, we use data from the American Community Survey and the Health & Retirement Study to test the model's predictions. We exploit temporal and geographic variation in the rollout of a federal enforcement policy, Secure Communities, 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 Secure Communities reduces the overall size of the home care workforce by 7.5%, with 70% of this effect driven by a reduction in the number of immigrant workers. Next, we test for negative externalities of this workforce reduction by examining receipt of home-based care among older adults with care needs. Overall, we find that older adults needing assistance are 2.9 percentage points less likely to receive any help at home, a 5% relative reduction. However, consistent with our model's predictions, these effects are concentrated among older adults with Medicaid coverage, who are 10.5% less likely to receive any help, and 23.2% less likely to receive formal (i.e., non-family) home care, following the introduction of Secure Communities.

Keywords: Long-term care, Immigration, Medicaid, Health economics, Labor economics, Secure Communities, Immigration Enforcement, Immigration and Customs Enforcement (ICE), Home care, Home health aide, Personal care aide, Health & Retirement Study, American Community Survey

JEL Classification: I00, I11, J01, J14, J61