April 26, 2025

Executive Summary
The U.S. healthcare and long-term care systems are at a critical juncture. As immigration enforcement intensifies under the Trump administration’s renewed policies, the nation faces a deepening shortage in its caregiving workforce, many of whom are immigrants. These workers make up a significant portion of home health aides, nursing assistants, and personal care workers. Their potential removal from the workforce threatens the continuity of care for millions of aging and disabled Americans.

This looming crisis also presents an opportunity: strategic investment in assistive technology, particularly in personal robotics and automated care solutions, can help bridge the caregiving gap, increase independence for people with disabilities, and reduce long-term strain on an already fragile system.

Background: The Care Economy’s Dependency on Immigrants

• 1 in 4 direct care workers is an immigrant, with thousands holding Temporary Protected Status (TPS) or lacking legal status.
• In states like Massachusetts, immigrant caregivers are essential to nursing home operations and in-home care services.
• Deportations or the expiration of TPS could displace tens of thousands of essential workers, particularly in underserved communities.

The caregiving sector was already on shaky ground. According to the U.S. Bureau of Labor Statistics, the country will need to fill 9.3 million direct care job openings by 2031. Without targeted intervention, this shortage will accelerate, disproportionately impacting seniors, veterans, and people with disabilities.

Consequences of a Shrinking Care Workforce

• Delayed or inadequate care in home settings and nursing homes.
• Increased hospitalization rates due to lack of monitoring and support.
• Rising costs for families and healthcare systems as labor becomes scarce.
• Burnout among remaining staff, leading to further turnover and quality-of-care issues.

A Path Forward: Investing in Assistive Technologies
To mitigate the impact of workforce reductions, the U.S. must embrace innovation through:

• Personal Care Robots: Devices that assist with hygiene, mobility, medication reminders, and companionship.
• Remote Monitoring and Smart Home Systems: Using AI to detect falls, track vitals, and support in-home safety.
• Voice-Activated Assistance Devices: Enabling greater autonomy for individuals with physical or cognitive limitations.

Global Evidence: How Robotics Improve Care Outcomes
Countries facing similar labor shortages have already integrated robotics into elder and disability care—with promising results:

• Japan has deployed over 30,000 care robots, including robotic lifts, walking aids, and social robots. A 2022 government report showed that facilities using robots reported a 20–30% reduction in caregiver burden and increased job satisfaction.
• In South Korea, the Hyodol companion robot has been shown to reduce loneliness and improve medication adherence among seniors. A 2023 pilot across 12 nursing homes showed a 25% decrease in emergency room visits over 6 months.
• Denmark has incorporated assistive tech into state-funded elder care. The introduction of robotic bath aids and lifting devices has led to a 40% drop in musculoskeletal injuries among staff and improved client satisfaction scores.

These examples prove that robotic solutions can supplement human care and improve outcomes with the right policy and funding framework.

Policy Recommendations

1. Protect the Existing Immigrant Care Workforce
   • Extend TPS protections and create a pathway to permanent residency for caregivers.
   • Include care workers in “essential worker” designations with immigration protections.
2. Launch a National Assistive Tech Initiative
   • Create matching grant programs to subsidize robotic care technologies in homes and facilities.
   • Fund research partnerships between nonprofits, universities, and startups focused on disability innovation.
3. Expand Medicaid & Medicare Reimbursement for Tech-Enabled Care
   
   • Recognize robotic assistance and smart devices as reimbursable tools to support independent living and reduce hospitalization.

Conclusion
The caregiving crisis is not just a workforce issue—it is a civil rights issue. Ensuring access to quality, dignified care for people with disabilities and older adults must be a national priority. As we face labor shortages exacerbated by immigration crackdowns, we must pursue dual solutions: protect the human workforce we have and invest boldly in technologies that expand independence and care capacity for those who need it most.