Caregiver John Boakye added paprika, garlic and onion to a bag of raw chicken that he was prepping for dinner for a Dallas family to grill up later. 

Cooking is one of the many tasks Boakye takes on to help Jean Fuller, 89, and her husband, Dale, 91, manage their home and their health. “I take him through exercises and stuff,” he said. “And I [help] with the wife too.” 

Boakye, who emigrated from Ghana around eight years ago, earns $15 an hour. It helps pay the rent on a house where he lives with his wife and another family from his home country. 

He and two other caregivers help the Fuller family manage life. Jean has a brain condition. 

“What it takes away is short-term memory loss. If you were to meet my wife today, she would have no recollection of having met you the next day,” Dale said. 

Dale said that for the first year or so after his wife’s diagnosis in 2019, they managed on their own. But eventually they needed help with activities like taking medication, bathing and laundry. 

He gets to spend more time with his children, grandchildren and great-grandchildren because of the assistance he gets for his wife. 

“The caregiver becomes sort of a second brain for her, since hers doesn’t work so well,” he said.

The at-home help from Cambridge Caregivers costs around $16,000 a month. Dale said they’re lucky it’s covered by long-term care insurance, which most people don’t have. All three of the Fullers’ helpers are immigrants from Africa. 

“Eighty percent of our staff are foreign born. Most of them, 90%, are African,” said Cambridge Caregivers CEO Adam Lampert, who employs roughly 300 people. “Americans don’t want to do this job.” 

About a third of home health and personal care aides in the U.S. are foreign born, according to the American Immigration Council analysis of American Community Survey data. Around 100,000 are from African countries. 

“Our labor force is generally more skilled than is required by that type of job,” said economist Pia Orrenius of the Dallas Federal Reserve. “Our kids are growing up with more education than ever before. They’re not aspiring to those types of jobs.” 

But someone still has to do this work, and it won’t be artificial intelligence. These are physically and emotionally demanding jobs. 

As the U.S. population ages, Massachusetts Institute of Technology economist Jonathan Gruber said it’s a looming labor problem. Recent census data shows that there are just five states where more than 1 in 5 people is 65 or older. In 2050, Gruber estimates, 43 states will be in the same boat.

“America is going to be Florida,” he said. “We have no plan for credibly meeting that massive change in the long-term care needs of our population.”  

It may be unrealistic in this political environment, but he said one obvious solution is increasing legal immigration. 

“There’s a natural trade to be made, which is to let people who would like to come live in America and be happy to work for the low wages we pay our care providers to come and provide the care we need,” Gruber said.   

And without immigration reform, it’ll be baby boomers, their kids and taxpayers who will pay for the labor shortage. Adam Lampert said the pandemic is an example of what can happen when there’s a shock to the labor market. 

“Prices went up almost 30% — when I say ‘prices,’ I mean the wages that we had to pay went up — and we turned around and charged that to our client,” Lampert said. 

The pandemic labor shortage boosted immigrants’ wages because there weren’t enough other workers to compete for those caregiver roles. 

Lampert worries about a similar effect under a policy of mass deportation. He said his employees are working legally, but that’s not true everywhere.

“There are these undocumented workers in the invisible part of the market. They’re working privately for people,” Lampert said. 

A large part of the caregiving labor force works informally and even the threat of mass deportation, he said, could cause workers to stay home, removing a chunk of that workforce. 

“That is the definition of the labor shortage,” he said. 

And a run on caregivers would make these services more costly at a time when the ranks of people who need care are growing.