Home Care Already Runs $80,080 a Year, and a Supreme Court Decision May Shrink the Pool of Aides

Some paid caregivers have lost permission to work in the U.S. Here are the questions to ask your agency before your family feels the shortage.

The Supreme Court ruled 6-3 that the Trump administration may end Temporary Protected Status for roughly 350,000 Haitians.

A federal judge later confirmed that her order blocking the move was no longer in effect. Haiti’s TPS, along with the work permits attached to it, ended at the end of July.

Among those affected are home health aides, nursing assistants, and other paid caregivers. Agencies that rely on those workers are already weighing what losing them could mean for families that purchase care.

No study has yet measured the full impact. What is clear, though, is how much paid care depends on immigrant labor and how much families already pay for the hours they can secure.

Three in 10 caregivers are immigrants

In 2024, the U.S. had 2.3 million direct care workers, and 3 in 10 were immigrants, according to KFF’s analysis of Census Bureau data. That compares with 18% of all adult workers.

The dependence is even greater in home care. Immigrants account for 33% of home care workers, including 14% who are noncitizens, and home care makes up 66% of all direct care jobs.

Not every immigrant aide has Temporary Protected Status. American Immigration Council figures, as reported by Home Health Care News, estimate that as many as 58,000 U.S. health aides were born in Haiti, about 2% of all health aides.

What providers expect

A senior living provider and LeadingAge Southeast told the Supreme Court in a brief that ending the status would strain already understaffed facilities and interrupt caregiver relationships that are especially important in memory care.

After the ruling, Mollie Gurian, a vice president at LeadingAge, a nonprofit group representing aging-services providers, told Home Health Care News that agencies short on aides may have to turn away new referrals or reduce visits for existing clients. She said that could also leave hospitals unable to arrange home care at discharge, and she expects New York City to be hit particularly hard.

Seth Sternberg, chief executive of the home care company Honor, said changing caregivers can be especially difficult for people living with dementia. These are forecasts from the industry, not measured outcomes.

What home care costs now

CareScout’s 2025 Cost of Care Survey put the national median price for a non-medical caregiver at $35 an hour, up 3% from the previous year. At 44 hours a week, that totals $80,080 a year. Assisted living averaged $6,200 a month, while a semi-private nursing home room cost $315 a day, or $114,975 a year.

Those figures reflect 2025 conditions and do not automatically rise just because there is a labor shortage. Still, the math of a gap is straightforward: every 10 hours a week a family covers on its own instead of buying care comes to about $18,200 a year at the median rate, paid in time rather than cash.

Questions to ask your agency now

Families that work with an agency can ask whether the aide assigned to a loved one is employed by the agency, how quickly a replacement could be sent, and how much notice is given before visits are changed or ended. It is also wise to get those answers in writing, along with the agency’s cancellation policy.

Families that fill in the gaps themselves often discover that the hours pile up quickly, a pattern sometimes called caregiver creep. You may be able to pay a sibling who steps in, but you should also find out how that could affect a parent’s Medicaid eligibility.