Surrounded by flowering house plants and White Socks, an orange cat with white paws, care worker Irma Luz López, known as Malu, cooled off from the Las Vegas heat as she reminisced and giggled on the couch with her former client, Diane Wohlman. They recounted getting to know one another, going out to dinner, and exploring the city.
“She was always bringing me little treats,” Wohlman said.
Wohlman loved when Malu braided her hair, and she shared one of her favorite memories, gifting López a purple dress from her closet for a formal work event.
“She always surprised me, too,” López said.
López cared for Wohlman, a former convention worker, while she built her strength back after a stroke. For more than two years, she helped overnight, ensuring Wohlman woke up at 5:30 a.m. to catch a bus for her physical therapy appointments. López assisted with cooking, showering, and lifting household items. That was before Wohlman lost coverage due to an insurance change.
“If it hadn’t been for Malu, I don’t know, she allowed me to stay in my home,” Wohlman said.
López had always cared for people. Looking for a better life, she immigrated to Las Vegas more than three decades ago with her two children from Los Mochis, Sinaloa, Mexico. There, she owned two pharmacies with her ex-husband. She said giving people hope is what’s most important to her.
“In Mexican culture, now Mexican-American, in our culture, it’s always pamper whoever is ill in the family, we pamper until they heal, or the elderly,” López said.
Home care industry strained by immigration restrictions
Immigrants, like López, make up 33% of this U.S. workforce, according to the national nonprofit PHI, which advocates for improving these jobs. Jake McDonald, senior policy advocacy specialist, said that number is likely higher, as some undocumented immigrants may not be counted. He said immigrants are more likely to stay in the long-term care workforce than their U.S.-born counterparts. This could be due to limited employment opportunities caused by financial, educational, or language barriers.
“Oftentimes, immigrants are also coming from cultures where there’s a greater onus put on caregiving,” McDonald said. “They have a really big effect on some key issues: care stability, continuity, and also quality; all really important to people having good health outcomes.”
There are other benefits too — they can serve diverse, culturally sensitive needs, including Spanish-speaking communities in Nevada.
“When you look at factors like their experience in caregiving, their multilingual ability, and their higher licenses and certifications in other countries that don’t transfer over here, you’re getting folks who are providing really good quality care that’s also kind of adaptable to the diversity of the people receiving care,” McDonald said.
But this workforce is in jeopardy. The Trump administration’s drastic immigration enforcement has removed workers — primarily those with Temporary Protected Status — from their jobs. This has also been compounded by ramped-up deportations, suspended visas, and higher processing fees.
U.S. citizens aren’t rushing to fill the gaps. Nevada, one of the fastest-aging states, will need an additional nearly 10,800 personal care aides for people 65 and older by 2040, according to the nonpartisan Kenny Guinn Center for Policy Priorities.
Jeanne Batalova, a senior policy analyst at the Migration Policy Institute, said the immigration policy changes restrict future workers from entering the country and make it more difficult for immigrants to remain employed, as confusion among employers causes hesitation.
“Instead of working illegally in someone’s home, they could have worked through an agency, which meant better conditions for them, as well as better oversight to the client,” Batalova said. “I see this as a paradox; the demographics would call for one set of responses, and yet the immigration policies are focused exclusively on restricting access without offering an alternative.”
Other countries are seeking solutions. For example, Canada has a pilot program that provides caregivers a pathway to permanent residence, but it is currently on hold while the country clears a backlog of thousands of applications.
A bilingual cat bonds two strangers together
López, a legal resident, wasn’t worried about her future in the country, but she understood how others may feel.
“My daughter said, ‘Mom, I’m worried for you with this administration,’ and I say, ‘Don’t worry.’ What I want people to know about me is just that I’m here to serve,” López said.
Before López entered Wohlman’s life and became more of a close friend rather than a care worker, Wohlman had harsher views of immigrants. The experience changed her perspective.
“I was just very staunch about it, but now I understand,” Wohlman said. “She’s been here many years; she may not be a citizen, but she’s an American to me.”
For Wohlman, having an immigrant care worker meant sharing food, language, and culture. López ordered a bucket of chicken at KFC, and Wohlman tried flan for the first time, and, most importantly, her bilingual cat, White Socks, which Wohlman received from López, and his “casita,” or cat tree.
This story was published with the assistance of the Journalism & Women Symposium Health Journalism Fellowship, supported by The Commonwealth Fund.
