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NCD Letter to Congress and the President Regarding Immigration Policy Discussions Wednesday, February 14, 2018
 
 Employment
  
    

    
    Health Care
  
    

    
    Long Term Services & Support
 February 14, 2018 President Donald J. Trump
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500 The Honorable Mitch McConnell
Majority Leader
U.S. Senate
317 Russell Senate Office Building
Washington, DC 20510 The Honorable Charles Schumer
Minority Leader
U.S. Senate
322 Hart Senate Office Building
Washington, DC 20510 The Honorable Paul Ryan
Speaker of the House
United States House of Representatives
H-232, The Capitol
Washington, DC 20515 The Honorable Nancy Pelosi
Democratic Leader
H-204, The Capitol
United States House of Representatives
Washington, DC 20515 Dear President Trump, Majority Leader McConnell, Minority Leader Schumer, Speaker Ryan, and Leader Pelosi: I write on behalf of the National Council on Disability (NCD) – an independent federal agency charged with advising the President, Congress, and other federal agencies on policy matters affecting the lives of people with disabilities – to offer policy insights for your consideration as you begin debate on immigration legislation this week, as these debates will likely have implications for the quality of life of many Americans with disabilities. Throughout discussions on immigration reform to date, there has been a consistent focus on increasing the nation’s emphasis on the country’s high-skilled labor pool. However, it is important to maintain a level view of the nation’s needs across sectors; to consider a profile of each in-demand sector’s current employment; and to weigh the effect of proposed immigration reforms in each instance. In 2010, NCD released a report titled, *Workforce Infrastructure in Support of People with Disabilities: Matching Human Resources to Service Needs*,[[1]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftn1) in which we shined a spotlight on the significantly increasing reliance on the disability services infrastructure, including health and social service programs, and the corresponding projected shortfall in the workforce of this infrastructure to meet the needs of America’s aging and disability communities. In the report, NCD highlighted Bureau of Labor Statistics (BLS) projections that certain occupations will require at least a 15 percent rate of growth over ten years to respond to increases in demand, and topping out that list at 48.7 percent anticipated growth in 10 years was the role of home health aide. That figure has only tempered slightly in the 8 years since the report was written and is now projected at 41 percent growth between 2016 and 2026.[[2]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftn2) The 2016 BLS profile of this critical job shows that as of 2016, these individuals – absolutely critical in helping the elderly and people with disabilities perform activities of daily living that maintain their independence – were paid a median hourly rate of $10.87/hr or median annual salary $22,600 per year,[[3]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftn3) which was well below the poverty level for a family of four in 2016. NCD has for many years heard from our stakeholders, including direct care providers, that attracting and retaining these critical workers is extremely difficult given the low pay and the physical demands of the job. The high turnover rates often result in a lack of consistency and ultimately, compromises the care of individuals. Furthermore, the high turnover rates also lead to increased workloads for the workers who remain, further exacerbating the risk of compromising both quality of care and increasing the already high turnover**. According to U.S. Census Bureau data, nearly one-fourth of the over three million direct care workers are immigrants, and mostly women.**[[4]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftn4) While the majority are legal immigrants, anecdotally, it is clear that there is an appreciable percentage of these immigrant direct care workers who are undocumented. It is also worth noting that some undocumented immigrants are caregivers for U.S. citizens with disabilities (their children or immediate family members), and without the care they are providing, federal, state, and local systems may be further strained. As the direct care workforce shortage increases, so also do the downsides to the American economy and society, which are increasingly engaged competitively on a global basis. As we emphasized in our *Workforce Infrastructure* report, people with disabilities occupy a strategic place in America’s ability to compete. Either their skills and ambitions will be developed into a resource for our society, or they will remain on the margins, battling for shrinking resources. Oftentimes, the difference in the ultimate outcomes comes down to the provision of assistance in daily living activities to equip people with disabilities with what is needed to pursue and maintain education, employment, and fuller participation in society. Given the extremely well-documented growth in demand for direct care workers that far surpasses current supply, as well as the documentation of the challenges this profession experiences with high turnover, NCD strongly encourages you to consider policies that would provide employment-based legal pathways for both currently undocumented immigrants who serve in these roles now, as well as for new immigrants to the U.S. who would commit to working in this highly in-demand service profession. We urge you to consider ways that the U.S. might service the needs of not only the high-skilled job market, but also the lower-skilled long-term care industry through immigration policy. We also encourage you to pursue immigration policies that give due consideration to immigrants who have children with disabilities and relatives with disabilities who are U.S. citizens. Finally, we strongly encourage you to contemplate any potential negative or exacerbating effect that any immigration proposal may have on addressing the practical and healthcare needs of many Americans with disabilities. We would be pleased to discuss these topics with you or your staff at further length and remain at your assistance as advisors on the intersections of your important immigration discussions with the needs of countless Americans with disabilities. Please contact Anne Sommers, Director of Legislative Affairs and Outreach, to discuss this matter further, at asommers@ncd.gov or (202) 272-0106. Respectfully,  Clyde E. Terry
Chairperson   [[1]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftnref1) National Council on Disability, *Workforce Infrastructure in Support of People with Disabilities: Matching Human Resources to Service Needs* (2010), available at: https://ncd.gov/publications/2010/Jan202010. [[2]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftnref2) Bureau of Labor Statistics, Occupational Outlook Handbook, “Home Health Aides and Personal Care Aides” (2016), available at: https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm. [[3]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftnref3) Bureau of Labor Statistics, Occupational Employee Statistics, “Occupational Employment and Wages, May 2016, 31-1011 Home Health Aides,” available at: https://www.bls.gov/oes/current/oes311011.htm. [[4]](https://ncd.gov/publications/2018/ncd-letter-immigration-policy-discussions#_ftnref4) U.S. Census Bureau, American Community Survey (ACS), 2015 1-year Public Use Microdata Sample (PUMS), available at: https://www.census.gov/programs-surveys/acs/data/pums.html.


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