Michelle Garcia relies on a wheelchair and has long turned to immigrant workers she finds through an informal network to help her with bathing and light housework. But in recent months, she has sometimes gone two to three-week stretches without any help.
She began struggling to find care this year, as news spread of federal agents arresting immigrants in Chicago. One fearful woman who had worked for Garcia at her Chicago home called one day to say that U.S. Immigration and Customs Enforcement agents were on her block.
“I told her, ‘You don’t have to come. Do what’s best for you,’” says Garcia, 48, who has cerebral palsy.
Losing the help has meant that Garcia, who even sleeps in her motorized wheelchair, has gone weeks without a shower. She needs someone to help her move to a shower chair to safely bathe. She lives with and cares for her husband, who has a spinal cord injury and is bedridden, and the workers she hires also help with his hygiene. Around her home, she cleans what she can and has relied on take-out meals.
It’s also made her professional life more difficult.
“How am I going to feel comfortable, if I haven’t showered in two, three weeks, to be out and about?” says Garcia, who works as a manager of organizing for Access Living, a disability rights group.
Immigrants make up a disproportionate share of home health care aides. In the Chicago metro area, 65% of the 24,000 people who worked for home care agencies in 2024 were not citizens, according to a WBEZ/Sun-Times analysis of U.S. Census data. Six months into President Donald Trump’s crackdown on immigration, it’s not yet clear how deeply these workers have been hit by his efforts. But there are signs in Chicago that the changes in immigration policy could be affecting aides, caregivers and the people who rely on them.
“If we’re talking about the entire universe of people who are being threatened — who are getting their visas revoked, who are being told they can’t enter the United States, … who are told if they leave the United States, they may not be able to get back in — if you think of all of them, then you’re talking about … every part of the health care workforce,” says Dr. Steffie Woolhandler, a health policy professor at Hunter College in New York City. “We rely very heavily on foreign-trained health workers in the United States.”
A system built around immigrants
More than 1 million people who were born outside the U.S. work in health care in America, according to 2024 U.S. Census data in a study in the Journal of the American Medical Association. Overall, immigrants make up about 17% of all health care workers, which includes hospitals and outpatient facilities as well as nursing homes and caregivers who work in private homes.
The study authors warn that scaled-up deportations and immigration restrictions could shrink the health care workforce, exacerbating existing shortages.
“If there’s no nursing home beds available, if there’s no home care agency that can send somebody over to keep an eye on them, you can’t send them home” from the hospital, says Woolhandler, an author of the JAMA research letter. “So, you end up with a backup in the hospitals and emergency rooms where they can’t accept new patients. They can’t see new people and they’re turning folks away.”
Nearly 940,000 immigrants who aren’t naturalized citizens — including those with and without legal status — work in formal health care settings. Another 128,000 immigrants work in nonformal health care settings, often in people’s homes or in residential facilities as aides, the JAMA analysis found. At least 10% of all staff in home care agencies and informal settings are not citizens.
That makes the staff and patients who depend on nursing homes and care at home particularly vulnerable to Trump’s immigration actions.
“Deportations could especially compromise long-term care, where immigrants play a large role,” the researchers wrote.
Some experts worry the Trump administration policies restricting immigration could cause a shortage of workers available to care for people in their homes and in nursing facilities, which would prevent hospitals from discharging patients.
Ashlee Rezin/Sun-Times file
This comes as the demand for aides and home care workers is only expected to increase as the senior population continues to grow. Immigrants will be needed to fill the gap, says Julia Gelatt of the Washington, D.C.-based Migration Policy Institute.
“Even if the number of U.S.-born people who want to work in those jobs were to greatly expand, it still might not be sufficient to fill all of the roles,” Gelatt says.
Garcia, who has private health insurance, has long tapped into Chicago’s large immigrant population to find help. She doesn’t qualify for Medicaid and has to pay out of pocket for home health services.
“My husband and I like to work with folks who we know need the money, and they would greatly appreciate it and would also reciprocate in doing the work that we need,” she says.
‘This is not a bed of roses’
In Chicago, a naturalized U.S. citizen named Frances cares for seniors in their homes and at facilities. She also oversees a small team of mostly immigrants doing home health care as a second job. She asked that her full name not be published to protect her business and her workers.
“We do … the dirty work,” she says. “We have to clean the poop, we have to clean the bathroom, do the laundry, do the dishes. … Some patient[s] really totally cannot do it.”
Months into Trump’s second term, she’s down to about one-third of the workers she had a year ago. The decline — from 30 to 9 workers — could be because people have less to spend on home health care, but Frances also thinks Trump’s immigration policies are playing a role.
At least three immigrants she worked with have left for their native countries, she says. One woman in particular was worried about getting caught in an ICE raid.
“They realize this is not a bed of roses, so [they would] rather go back to the Philippines,” Frances says.
Four other home care agencies told WBEZ/Chicago Sun-Times that their immigrant workers, even those who are U.S. permanent residents, are afraid to travel, especially when reports surface of ICE arrests in certain neighborhoods. One company said about half its workers are immigrants, and that they worry for the future of their workforce. Agencies in the suburbs reported fewer concerns, but none of the agencies wanted to be named to protect their businesses and employees.
Frances says she’s tried hiring Americans in the past, but they often don’t want to do the gritty part of their work. In the past few months, two different families didn’t pay her after using her home care services. They refused after asking for her Social Security number.
“I said, ‘That’s my privacy,’” Frances says. “If you need the company name, you can check the background.”
Michelle Garcia in 2024 in the Northwest Side condo she shares with her husband.
Peyton Reich/For the Sun-Times
Making it work — for now
Garcia recently managed to hire a worker to help with personal hygiene and tidying up her condo, but she isn’t sure she’ll be able to find another one anytime soon.
During the COVID-19 pandemic, she also saw a dip in home health care workers. The market had rebounded, with workers coming as frequently as three times per week for a few hours each time. Then, in January, Garcia noticed a slowdown of available workers. And she knows the fears are valid as she receives reports of ICE sightings in her Northwest Side neighborhood.
“I would hate for anybody to get deported or incarcerated because they came to support me,” Garcia says.
For now, Garcia uses wipes to give herself a sponge bath until a worker can help her get ready for the day. She makes herself sandwiches, and her neighbors sometimes stop by to take out her trash.
Although she would like more help, she’s committed to living in her own home, especially so she can be with her husband.
“In a facility, it wouldn’t be as easy to be together. We want to be together, obviously,” she says. “Even though we might be struggling right now, we’re still taking care of each other as much as we can and with the support of friends and family and other folks.”
Elvia Malagón is a health reporter for the Sun-Times
Contributing: Alden Loury, WBEZ data projects editor