When Will the U.S. Start Competing for Immigrants? Sooner Than You Think

Is the nation about to see the magnetic poles of this conversation reverse?

It may seem unlikely in the short term, given Donald Trump’s return to the White House. Immigration formed a major talking point in his campaign, and he wasn’t focused on the positives, saying illegal immigration is “poisoning the blood of our country,” phrasing almost identical to language Hitler used about Jews.

Since taking office, Trump has issued a slew of immigration-related executive orders, including declaring a national emergency at the U.S.-Mexico border, suspending refugee resettlement and attempting to end birthright citizenship. In December, Trump’s orbit publicly erupted in a “civil war” over legal immigration and support of the decades-old H-1B visa program. Last week, both the U.S. House and Senate passed the Laken Riley Act with bipartisan support. The bill would allow the Department of Homeland Security to detain and even deport undocumented immigrants if they are accused—not yet convicted—of certain crimes like burglary, theft, larceny or shoplifting.

In other words, it’s not likely the government is about to reform immigration policy or open the floodgates to a new wave of workers anytime soon.

And yet math may trump campaign rhetoric. Baby Boomers are leaving the workforce in droves, and the generations following them are smaller. At the same time, these retirees are entering a phase of life where they will soon need more assistance and medical care, while senior facilities already struggle to meet the needs of the population.

Under this pressure, will we start to argue about the best ways to attract more legal immigrants? It’s already happening, especially in senior care.

“In the decades to come, migration is likely to be driven largely by the needs of destination countries, which will compete for a shrinking pool of qualified workers,” a 2023 report by the World Bank concluded.

Workforce shortages raise a complex blend of questions about wage levels, the education system and worker training, not to mention the exploitation of undocumented migrants to fill low-wage roles. But a declining number of native-born workers is another important factor. 

Tara Watson, an economist for the Brookings Institute who researches immigration, says she expects the conversation to change in the next five to 10 years. “We have an aging population. We have declining fertility. We have millions of people who are going to be entering the years where they need care, and we clearly do not have the workforce for that.”

The evidence is overwhelming, says Watson: Immigration is good for the economy as a whole. It can have limited negative impacts, for example in particular sectors where people without high school degrees might get lower wages.

However, few economists see Trump’s immigration policy as positive for the economy at large, according to Watson. “There’s just not a case to be made there.”

Though it might not sound logical to some, the idea that immigration is a boon to the economy—taken as a whole—is well accepted by economists. “We almost don’t talk about it anymore, because it just seems really obvious,” says Watson.

Farming and beach tourism

Delaware doesn’t show up in the national conversation much, except when it’s the preferred habitat of a U.S. president or when climate reporters reach for a way to describe a really large iceberg. But the state’s struggles with workforce, and its dependence on migrant labor—legal and otherwise—reflect the nation at large.

Growing up on a farm near Georgetown, the Sussex County seat, Ruth Briggs King was familiar with migrant workers. Her father grew grain, raised hogs and laying hens, and sold vegetables from a produce market.

“There would be (migrant) workers in the area that would come and ask if they could pick the peppers, pick the watermelons,” she says. The help was welcome, especially for crops like watermelons that can’t be harvested mechanically.

Today, some of Briggs King’s family members have shifted to raising chickens, like many other farmers. Chickens are by far Delaware’s most important agricultural product, although produce farming still has a major presence.

The farming industry here draws heavily on migrant workers, some permanent and others on temporary work visas. Many are Hispanic, but southern Delaware has also seen a quickly growing Haitian population, as evidenced along its highways with billboards in English, Spanish and Haitian Creole.

Delaware’s sparse square mileage is divided from north to south into three counties, with much of its rural land downstate in Kent and Sussex counties. Unlike many rural areas, southern Delaware is growing quickly, with longtime residents irked by housing developments encroaching on farms. And because many of these newcomers are retirees, attracted by low property taxes and the nearby beaches, the area faces the challenges of an aging population.

For more than a decade, Briggs King represented the Georgetown area where she grew up in the Delaware House of Representatives. She’s kept a close eye on the local business scene and is well aware of the ongoing need for migrant labor.

“From that traditional thinking that it’s just primarily ag workers, I think it’s really expanded into a lot of different labor markets,” Briggs King says, pointing to hospitality and tourism at the beaches. (Many beach businesses rely on Eastern European workers during the busy summer season.)

Joe Conaway is another longtime leader in Sussex County where he’s been everything from a school principal to a town council member and county administrator. In lieu of retirement he heads up a coalition of business leaders promoting economic growth in Sussex County. The labor shortage is a frequent topic of discussion.

“Across the street, they’re having a new roof put on a house, and most of the laborers were Hispanic,” he says, referring to what has become a trend on local construction sites. “So they’re playing a role, a major role, in solving some of the problems.”

Both Conaway and Briggs King point to other persistent problems that contribute to workforce struggles in the area, including young people leaving for better opportunities elsewhere, a housing shortage that leads to high cost of living, and a need for more job training. These are familiar refrains in other parts of the country as well, along with calls for better vocational training.

But in what may be a preview of the future, in some circles the conversation has long since shifted to a focus on recruiting immigrants and expanding their numbers.

The urgent situation in senior care

Midwestern states tend to be far less interested in chickens than Delaware, but they share major concerns, including trying to care for an aging population with a shrinking workforce.

According to analysis by the Long-Term Care Imperative, the state of Minnesota had around 17,000 open long-term care positions. That figure represents about 20% of the industry’s total workforce in the state. A 2023 report by Presbyterian Homes and Services, in partnership with Lightcast, found that immigrants make up over a fifth of health care workers in the state and represent a significantly higher percentage of workforce participation than native born workers.

Rob Lahammer, vice president of engagement and advocacy for Presbyterian Homes and Services, a nonprofit that runs more than 60 senior communities in Minnesota and Wisconsin, cites another startling statistic: Senior facilities in rural areas can face as much as 100% turnover each year. He’s spoken to colleagues who have seen some jobs turn over two to three times a year—this in a state that has seen unemployment at its lowest rate in nearly half a century.

“It’s a very, very significant problem,” he says, one that’s even more pronounced for their rural facilities.

While he’s seen staffing challenges throughout his 40 years in the industry, Lahammer says, “It clearly is a much bigger issue the last handful of years.” 

Pamela Guthman, a retired public health nurse and professor of public population health nursing at the University of Wisconsin-Eau Claire, has seen similar trends in neighboring Wisconsin:

We have an aging population. We have an aging workforce … It’s not that people don’t want to work. We don’t have the numbers of people to do the work that needs to be done. And when you don’t allow for pathways for immigrants to have … education to provide a workforce, and you yourself as a population are not providing a younger workforce either, it’s going to be pretty hard to fill those gaps.

In addition to the demographic math, Guthman and Lahammer note the difficulty of long-term care work. While it’s very rewarding, Lahammer says, wages tend to be low and staff can’t work remotely.

“The labor market is competitive,” Nicole Howell, director of workforce public policy for LeadingAge, an association representing nonprofit senior care providers, tells Barn Raiser in an email. Her member nursing homes “are competing not only with others in health care (including more deep-pocketed hospitals) but also with retailers, restaurants and others who may have more wage flexibility.” She notes that Medicaid reimbursement rates are often too low to cover the cost of care.

Senior care providers are trying their best to hire locally, Howell says. “We would welcome anyone into our sector, and we continue to explore expanded pathways, reaching into high schools and middle schools and individuals who have been out of the job market.”

The crunch could get even worse. The Centers for Medicare and Medicaid Services recently released new minimum staffing requirements for nursing homes—requirements that Donald Trump has promised to rescind. If they stand, LeadingAge estimated the industry would have to hire another 27,000 full-time registered nurses and nearly 80,000 more full-time nurse aides in the first year.

Despite exceptions carved out for rural areas, Lahammer says, the new rules could still be a significant issue.

Senior care organizations are looking to migrant labor for help, and many foreign nationals are eager to answer the call.

But immigration is limited by rigid quotas that have not changed in decades despite evolving needs, Jenna Kellerman, director of workforce strategy and development for LeadingAge, writes in an email.

Organizations don’t just need nurses, she says, but staff across a wide range of jobs like in dining and housekeeping. The system, though, favors those with bachelor’s degrees.

LeadingAge is advocating that the Trump administration dedicate the same level of energy to expanding legal immigration that it’s putting into enforcement, Howell says, to help meet the needs of employers. “There’s a variety of sectors who are raising this issue, and chiefly agriculture and construction gets a lot of attention around this. But we would also say healthcare and aging services are close behind those two.”

‘The numbers are too low’

Whether the topic is immigration—legal or otherwise—worrying about it is a venerable American tradition.

Conaway’s family has been in southern Delaware a very long time. But before that, his ancestors lived in Ireland.

“There were a lot of folks that thought, my God, it was the end of the world, the Irish are here,” Conaway says.

Immigrants are already fulfilling a crucial role, says David Grabowski, a professor of Health Care Policy at Harvard Medical School who has researched the impact of migrant workers in senior care. “I think there’s a lot of folks that kind of have their head in the sand on this issue,” he says. “I don’t think you could operate long-term care in this country without it.”

“The limits that we have, the numbers are too low,” the Brookings Institution’s Watson says. “The last time we revised those numbers was in 1990 and our economy was half its current size.”

Despite labor shortages, the main driver of conversation when it comes to immigration is the border and the short-term costs of sheltering migrants. Watson says, when people “have to find someone to take care of their mom, and they can’t find anyone, and there aren’t enough workers at their kids’ daycare center, and all these things are hitting at the same time, I think that will start to change the conversation.”

It’s hard for people without an education or a family connection to move to rural Delaware, Watson says.

“People say, ‘Well, they should have waited in line.’ There literally is no line for a good chunk of the world’s population,” Watson says, maintaining that allowing more legal pathways could not only reduce border pressure but help the economy.

At Presbyterian Homes and Services, Lahammer isn’t wading into the debate on unauthorized immigration, but he has been reaching out to lawmakers to sound the alarm about the need for higher legal migration levels, joining advocacy from groups like LeadingAge.

He’s seen good legislation stall. Lawmakers from different political sides know about the workforce issues and agree that something should be done, Lahammer says. “It’s just they’ve not been able to agree on making things happen.”

“I don’t think policymakers view this as a priority right now, and if anything, it feels like things [are] going the wrong direction,” Grabowski says.

Watson doesn’t think it’s likely, or even possible, for Trump to implement mass deportations on the scale he’s suggested.

“He’s thrown around numbers like 20 million people, and there aren’t even 20 million deportable people,” she says. Beyond that, the logistics are daunting, with the need to hire more enforcement and find the transportation to move millions of people out of the country.

That’s not to mention the impacts on the economy. Reuters reports that nearly half of the approximately 2 million farm workers in the U.S. don’t have legal status, which has made the agriculture industry uneasy about what changes might be coming. Estimates by the Peterson Institute for International Economics are that deporting 8.3 million undocumented immigrants would reduce GDP by 7.4% and reduce employment by 7% by 2028.

Still, Watson thinks Trump knows the economy needs immigrant labor—he’s used it himself—and that much of his stance is political posturing to seem tough on immigration.

We’ll find out soon. But legal immigration isn’t expected to get any easier either. Some expect the termination of temporary protected status designations for people from countries like Haiti, Cuba and Venezuela, for example, and a general tightening of the system to slow things down.

In his first term, Trump’s approach “was just putting a lot of sand in the gears,” Watson says. “So just adding more bureaucracy, more paperwork, making it seem less hospitable, so maybe people were a little bit less eager to come.” She expects similar effects this time around.

The timing isn’t ideal for industries like senior care where leadership is hoping for a greater influx of immigrants.

“This is an industry that needs lots of additional workers, and immigration pathways,” Grabowski says. “If we see a shift here away from new immigration, we’re already at a shortfall, and that’ll be an even bigger shortfall.”

Howell agrees. “Foreign born workers, particularly foreign-born nurses, are incredibly valuable, and there are lots of countries around the world that are trying to recruit them.”

Navigating through the immigration process that can take two to three years even after a job offer, she says. “And so we’re concerned that those individuals may choose to take their talents to other countries.”

The U.S. will need nearly 8 million new caregivers over the next decade, Kellerman says, but there is no visa specifically for these workers. “We are in desperate need of nurses, but we are also in desperate need of caregivers.”

“They could clearly fix our industry and just put out a caregiver visa,” Lahammer says.

A model for change

Across the developed world, from China and Japan to Europe, birth rates have declined and nations face the vexing dilemma of how to follow a model of ever-growing economies without ever-growing populations.

However, in its 2023 report, the World Bank notes that while many countries are shrinking, others, especially in Africa, have a surplus of young workers. Enter migration.

Presbyterian Homes and Services has been tapping into these available workers. For years, the nonprofit has run a program to bring trained nurses and CNAs from the Philippines. Lahammer says it’s been extraordinarily successful. To date, more than 500 of these workers have moved here along with family members. All told, he estimates that nearly a third of their workforce is foreign born.

This tracks with stats from LeadingAge, which says that in some states foreign-born workers in the long-term care sector make up more than 40% of the workforce.

The Philippines has been an ideal partner for Presbyterian Homes and Services because of the way it strategically trains an excess of workers—including nurses —with the express intention that they go overseas and send back money they earn. It’s a mutual benefit, as they fill a staffing void in the U.S. while their wages make a big difference back home.

Lahammer says Kenya is starting to experiment with a similar system, and his organization is interested in working with that country as well.

Culturally, these nurses can be a good fit, Lahammer notes, as they often come from societies where care for elders is an important value.

“I personally just have seen and known the amount of love and attention both our RNs [from] the Philippines and the people from around the world have done for us and for our people. It is awe inspiring,” Lahammer says.

His organization is not the only one leaning on this resource. LeadingAge even offers a guide on hiring refugees.

Missed opportunities

While organizations like Presbyterian Homes and Services are focusing on legal migration, the United States’ existing system has also created a shadow unauthorized workforce that fills niches in a variety of industries.

Watson calls the border pressure not the result of a policy choice, but “more of the absence of a policy choice … there is a lot of demand for workers to come, and people are finding a way to come.”

It’s not efficient, she argues. The long and dangerous illegal routes migrants take leave them without a lot of resources when they arrive. “We are not making the best use of the talent pool that could be here,” she says.

Much has been made of cities struggling to handle waves of migrants bused there from the border. Watson says she doesn’t want to sugarcoat these challenges, but suggests the impacts are short-term.

The benefits and costs are also mismatched—the federal government reaps advantages in the long term, while city and state governments, which must balance their budgets, are on the hook for the short-term care of these migrants. Watson suggests the federal government could send resources to help balance these costs.

As the system sits stagnant, some other countries appear to have a head start on the U.S. when it comes to attracting migrant workers.

We have nothing like Canada’s fast track program for permanent residency, Grabowski, the professor at Harvard says. “I could imagine a lot of folks going to Canada [over] the U.S. because of that problem.” 

“We’ll start thinking, why did we let Canada develop this really nice set of policies for immigrants, and a lot of our [temporary] visa holders decided to move there instead of staying here and contributing to our economy?” Watson says.

If the narrative does flip on immigration, we may even see hot takes on social media about how we’re taking advantage of countries like Mexico (which also has an aging population). If Sussex County, Delaware, is distressed to see its young people leaving, maybe other regions are too.

Grabowski raises this concern of addressing brain drain and making sure the system is a win-win. “That’s really, really challenging.”

Another downside is that once workers battle through the immigration maze, they can face new obstacles.

“We should also make sure that we are not taking advantage of these people, and that we are good employers and find them good benefits and find them reasonable housing if we can,” Lahammer says. His organization has worked to provide its migrant workers with resources like initial housing help, coaching, and connections in the community.

Delaware has been very receptive to migrant workers in general, Briggs King says, but “migrant workers can be vulnerable to people taking advantage of them,” whether that’s because of a lack of understanding of finances or not having good health care access. “What we really need is a pathway to citizenship.”

Guthman, too, notes the way migrant workers can be exploited in sectors like farming. “I don’t know that we see quite as much of that in healthcare, but there’s no doubt that there’s some level of it as well.”

The World Bank Development Report puts it succinctly: “Migration is neither universally good nor universally bad. It is complicated and necessary, and it needs to be better managed.”

Andrew SharpMore by this author →

Born and raised in southern Delaware, Andrew graduated from The Ohio State University in 2008 with a bachelor’s in journalism and a minor in Spanish. He lived in Ohio for a number of years and then moved with his wife to Sussex County, Delaware, with two sons, two dogs and two cats, on an acre of ground that is running out of spots to plant new trees.