Introduction
America has a long history of immigrants arriving from all corners of the world and settling in communities across the country. As a result of recent executive actions and discussions among policymakers, immigration has re-emerged as a topic of national importance. Too often, discussions of immigration policy leave out older adults. Older immigrants are vital to our communities. Despite facing significant barriers, they are strong pillars of support in multi-generational families and celebrated as leaders with wisdom and expertise in our communities. Immigrants also play a key role in the long-term care sector. This document identifies several connections between older adults and immigration and highlights how policymakers and advocates who care about aging should also care about immigrants in our communities.
Older Immigrants Are Vital to Our Communities
There are more than 8.5 million older immigrants (65 years and older) in the U.S., making up about 14.4% of the general older adult population.[1] Older immigrants come from a variety of countries and ethnic backgrounds; speak hundreds of languages; and arrived here through a number of immigration pathways, including through asylum or refuge; employment or education-based options; or family unification processes, which allow immediate relatives of U.S. citizens or lawful permanent residents (LPR) to immigrate to the U.S. They live in cities, smaller towns, rural areas, and in all parts of the country, including the Midwest and South.[2]
Some older immigrants immigrated to the U.S. as younger individuals. Many of them either hold LPR status or have become naturalized citizens. Immigrants who have aged in the U.S. face many of the same challenges that their non-immigrant peers face, but also experience some unique challenges with economic security and discrimination.
Others immigrated to the U.S. at an older age—a population that has seen a significant increase in recent years[3]–often as part of family reunification policies. These older immigrants play critical roles in multi-generational homes, such as contributing to the household or providing unpaid childcare, yet they face significant inequities in terms of poverty and accessing social supports.
Older Immigrants Experience Significant Barriers and Difficulty Making Ends Meet
Older immigrants experience many barriers to aging with dignity. While they experience significant levels of poverty, especially among immigrant women and immigrants of color, many government benefits programs exclude immigrants from coverage, leaving their needs unaddressed.[4] Restrictions on access to public benefits, like the five-year bar, which prohibits immigrants from accessing federal means-tested public benefits for five years after they have secured a qualified immigrant status, make older immigrants more economically vulnerable. This insecurity is exacerbated by a lack of language access—for those older immigrants with limited English proficiency (LEP)—and other policies, like the rollback of sanctuary policies. Poverty, particularly in old age, negatively impacts one’s physical and mental health, leading to depression, as older immigrants are more likely to report loneliness than their non-immigrant peers. Older immigrants are also less likely to have health insurance, meaning that many struggle to cover health care costs.[5] These circumstances force some older immigrants to continue working to pay for basic needs.[6] Policies can help address these needs and reduce the barriers that older immigrants face. For example, states that have expanded Medicaid coverage to older adults regardless of immigration status help close the coverage gap and give all older adults access to timely and affordable care.[7]
Immigrants Play a Key Role in the Long-Term Care Infrastructure
Immigrants play a critical role in the long-term care infrastructure by providing essential care to older adults and people with disabilities. At least 27% of direct care workers are immigrants.[8] By comparison, 17% of the total US labor force is comprised of immigrants. Almost one in three home care workers are immigrants, while over one in four are residential care aides. Proportions vary significantly across states. For example, less than 1 percent of certified nursing assistants (CNAs) are foreign-born in West Virginia, compared to more than 70 percent in Hawaii.[9] Immigrants tend to work longer in long-term care jobs than non-immigrants.[10] Given the significant role immigrants play, restrictive immigration policies, including mass deportation campaigns, have the potential to dramatically reduce the long-term care workforce at a time when the sector faces a shortage of workers.[11]
Immigrants not only constitute a significant proportion of the direct care workforce, they also bring many skills and improve the care that older adults and people with disabilities receive as a result. Researchers have also found that nursing homes in regions with more immigrant CNAs were associated with more direct care staff hours per resident day and better-quality performance. Although immigrants in the direct care workforce are often hired for underpaid, entry-level positions and forced to work their way up after arriving in the U.S., they are more likely to speak multiple languages, have additional certificates, years of experience, and have licenses to practice in more states than their U.S. born counterparts.[12]
Recent Executive Actions Harm Older Immigrants and Direct Care Workers
Recent executive actions and rhetoric from the Administration have already had an impact on older adults by creating a chilling effect in many immigrant communities, including among older immigrants and their families who are afraid to access services and programs due to potential immigration-related consequences. The chilling effect also impacts the direct care workforce. Some media reports include accounts of direct care workers deciding to stay at home or leave their jobs because family members and other loved ones were detained by immigration enforcement.[13] For more information on policies impacting older immigrants, see our resource, Threats to Older Immigrants in Health Care, Economic Security, Housing and Elder Rights.
Conclusion
Older immigrants are vital to our families and communities. Unfortunately, they are often neglected in discussions about immigration policy. The connections between older adults and immigration are critical to consider in policy discussions, and policies should support older immigrants, ensuring their needs are met and recognizing their invaluable roles and contributions.
Endnotes
Migration Policy Institute, State Immigration Data Profiles, available at https://www.migrationpolicy.org/data/state-profiles/state/demographics/US. ↑
American Immigration Council, How the United States Immigration System Works (2024), available at https://www.americanimmigrationcouncil.org/research/how-united-states-immigration-system-works; Population Reference Bureau, Elderly Immigrants in the United States, 29 Today’s Research on Aging 2 (2013), available at https://www.prb.org/wp-content/uploads/2020/11/TRA29-2013-elderly-us-immigrants.pdf. ↑
Migration Policy Institute, Frequently Requested Statistics on Immigrants and Immigration in the United States (March 14, 2023), available at https://www.migrationpolicy.org/sites/default/files/publications/frs-print-2023.pdf. ↑
Nobuko Mizoguchi et al., American Community Survey Reports, The Older Foreign-Born Population in the United States: 2012-2016 20 (2019), available at https://www.census.gov/content/dam/Census/library/publications/2019/acs/acs-42.pdf. ↑
Maren M. Hawkins et al., BMC Public Health, Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature (2022), available at https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13042-x. ↑
Nobuko Mizoguchi et al., American Community Survey Reports, The Older Foreign-Born Population in the United States: 2012-2016 (2019), available at https://www.census.gov/content/dam/Census/library/publications/2019/acs/acs-42.pdf; Population Reference Bureau, Elderly Immigrants in the United States, 29 Today’s Research on Aging 3 (2013), available at https://www.prb.org/wp-content/uploads/2020/11/TRA29-2013-elderly-us-immigrants.pdf; Arloc Sherman et al., Ctr. On Budget & Policy Priorities, Immigrants Contribute Greatly to U.S. Economy, Despite Administration’s ”Public Charge” Rule Rationale (2019), available at https://www.cbpp.org/research/immigrants-contribute-greatly-to-us-economy-despite-administrations-public-charge-rule/ (noting that the fact that most immigrants are employed but still require public benefits, meaning they are paid lower wages). ↑
Akash Pillai et al., Kaiser Family Foundation, State Health Coverage for Immigrants and Implications for Health Coverage and Care (May 1, 2024), available at https://www.kff.org/racial-equity-and-health-policy/issue-brief/state-health-coverage-for-immigrants-and-implications-for-health-coverage-and-care/. ↑
Robert Espinoza, Linda Stepick, Jessica King, Jake McDonald, Amby Robins, and Kezia Scales, PHI, Bridging the Gap: Enhancing Support for Immigrant Direct Care Workers (2023), available at https://www.phinational.org/resource/bridging-the-gap-enhancing-support-for-immigrant-direct-care-workers/. ↑
David C. Grabowski and Hakyung Jun, HealthAffairs, Nursing Home Staff: Share of Immigrant Certified Nursing Assistants Grew As US-Born Staff Numbers Fell, 2010-21 (January 2024), available at https://www.healthaffairs.org/doi/10.1377/hlthaff.2023.00881. ↑
Thomas Rapp and Jonathan Sicsic, Social Science & Medicine, The contribution of the immigrant population to the U.S. long-term care workforce (October 2020), available at https://www.sciencedirect.com/science/article/abs/pii/S0277953620305244. ↑
Id. ↑
Roy A Thompson et al., Journal of Nursing Regulation, Examining Human Capital Among Foreign- and U.S- Educated Nurses in Long Term Care (July 2023), available at https://nursing.missouri.edu/immigrant-nurses-in-long-term-care-facilities-often-have-more-human-capital-compared-to-american-born-nurses-sson-researcher-finds/. ↑
Rebecca Davis O’Brien and Miriam Jordan, The New York Times, A Chill Sets In For Undocumented Workers, and Those Who Hire Them (March 9, 2025), available at https://www.nytimes.com/2025/03/09/business/economy/immigrant-workers-deportation-fears.html. ↑
