Minnesota lacks caregivers. What could Trump’s policies mean for a workforce that relies on immigrants?

Growing up in Ethiopia, Kulud Hassan Faisal would assist her grandparents with little tasks, grabbing them water or helping cook. She knew from a young age that she wanted to be a nurse.

“I want to help people,” said the 27-year-old St. Paul resident, who next month will take the test to become a certified nursing assistant and is interested in working with older adults.

She will join a direct support workforce that relies heavily on immigrants and refugees to serve Minnesotans who need assistance, including people with disabilities, the chronically ill and seniors. It’s a workforce that is already failing to meet a growing demand.

President Donald Trump’s crackdown on immigrants and refugees has some members of the caregiving industry, and those who rely on it, on high alert. Direct support workers, who serve vulnerable individuals, generally need valid immigration paperwork to meet background check requirements, experts in the field said, but they added that’s not always the case for workers' family members, who could be swept up in mass deportations.

They are also worried about the president’s suspension of refugee resettlement, which is being challenged in court.

Hassan Faisal moved to the U.S. last year to join her parents, who are refugees, and fears Trump’s policies will keep her sister in Ethiopia from reuniting with their family.

Many direct support workers in Minnesota are immigrants and refugees from African countries, including Liberia, the Democratic Republic of the Congo, Ethiopia and Somalia, industry members said. The future pipeline of workers into the profession is “extremely threatened” by federal policies that would slow immigration from such countries, said Tom Gillespie, president and CEO of Living Well Disability Services.

The Mendota Heights-based nonprofit serves more than 300 people with disabilities across the metro area, and Gillespie estimates more than half of their frontline workers are from other counties.

“Tens of thousands of Minnesotans … literally do not get out of bed, do not leave the house, do not eat a meal, any of that, without a caregiver’s intervention,” Gillespie said. “It takes a caregiver to open up the world for people that we serve, and without those caregivers, the world stays far too small for people with disabilities.”

Home care workers help Nikki Villavicencio live daily life, from eating to showering to laundry and bathroom trips.

“I literally can’t even count on both hands and feet … how many people I have had who are immigrants as home workers,” she said, estimating immigrants have made up roughly 40% of her workers over the years.

Even if the people she works with aren’t directly affected by deportations, fears and potential impacts on their families can have a ripple effect, said Villavicencio, a Maplewood City Council member who has arthrogryposis, which limits her mobility.

“It affects the whole system of home care,” she said. “When my [personal care assistant’s] life is being threatened or is disrupted … that directly affects my care.”

Roughly one in four of Minnesota’s nursing, psychiatric, home health and personal care aides are foreign-born, according to census data.

“Direct care — whether it’s in a group home or a nursing home or even a hospital in some ways — has always depended on immigrant labor,” said John Estrem, CEO of Hammer & NER, which serves people with intellectual and other disabilities. “For many, it becomes something that they can step into relatively easily and it’s something for many immigrant communities that fits with their values. Honestly, generally speaking, [in] many other countries the value of caring for people is a lot higher than it is in America.”

Estrem’s Wayzata-based nonprofit houses about 360 people and also does supportive services for people with disabilities. Like other providers, he said he would like to hire far more staff to provide direct care but there’s not enough workers to meet the demand.

There are about 17,000 long-term care job openings in Minnesota, said Nicole Mattson with Care Providers of Minnesota, which represents nursing homes, assisted living facilities, home care and hospice organizations. She said those industries rely on foreign-born workers and they have been doing targeted recruitment in immigrant communities.

Hospitals also face a persistent workforce shortage that threatens patients' access to care, the Minnesota Hospital Association said in a statement.

“Our focus in working with federal policymakers has been — and will continue to be — on strengthening our ability to legally access skilled health care professionals and advancing solutions that expand workforce pipelines," the organization said.

Home health workers and personal care aides hold Minnesota’s most in-demand jobs, according to the Department of Employment and Economic Development.

People in those roles have described the work as rewarding, but also low-paid and sometimes physically and emotionally demanding.

Adolphus Kesseh’s love of the job has kept him in the field for almost three decades. Born prematurely in Liberia, he was expected to have health problems.

“It could have been me” who needed services, said Kesseh, a program manager at a Living Well Disability Services group home in Inver Grove Heights. Several of their recent hires came to the U.S. as refugees, like he did, he said.

He worries Trump’s orders will make hiring challenges worse, and the people they care for could suffer the consequences. He has worked 16 to 18 hour days in the past to fill staffing gaps.

“I feel that anxiety,” he said. “That there will come a time we won’t be able to find people to cover the shifts here.”

A lot of people won’t do direct support work, and the industry has high turnover, but employers have found immigrant workers are reliable, willing to learn and take on long hours, said Joseph Macbeth, president and CEO of the National Alliance for Direct Support Professionals. In urban areas across the country, he said, immigrants make up the majority of direct support professionals who help kids and adults with disabilities.

He hasn’t heard about any raids of direct support service providers nationally, but the alliance is watching closely and trying to ensure that employers and supervisors know workers' rights and understand protections for people with I-9 forms, which verify an employee’s identity and work authorization.

About half of the people in the International Institute of Minnesota’s workforce programs are refugees, said JP Holwerda, who leads workforce development there. Those workers, many of whom go into health care careers like certified nursing assistant jobs, are well-vetted and have work authorizations, he said. They also have no home to return to.

Trump’s halt on the flow of refugees could have long-term effects, he said.

“Minnesota’s health care system would not have enough qualified workers without the skilled and compassionate immigrant medical professionals filling those critical roles in hospitals and nursing homes across the state,” Holwerda said. “We’ve got a decreasing population without immigrants. If we dry up the pipeline into the state … who is going to care for our aging population?”