President Trump’s plans to overhaul immigration could reduce the ranks of workers who care for elderly and disabled people at home and in long-term care facilities as California and the country grapple with the needs of an aging population, healthcare experts and immigrant advocates say.

Trump has pledged to carry out the biggest deportation effort in U.S. history. On his first day in office he signed executive orders to suspend refugee admissions for months, require asylum seekers to stay in Mexico as their cases were adjudicated, and roll back humanitarian programs that had granted temporary legal status and work authorization to more than 1.5 million people.

That could have consequences for tens of millions of older Americans who may end up requiring long-term care. California estimates that by 2030, a quarter of the state’s population will be at least 60 years old. Across the U.S., the demand for home health aides, nursing assistants and personal care aides in long-term care has been projected to rise between 35% and 41% from 2022 to 2037, according to the National Center for Health Workforce Analysis.

“Long-term care providers and nursing homes in particular have really struggled, for decades, to recruit staff,” said David C. Grabowski, professor of health care policy at Harvard Medical School. “The jobs are challenging. They typically aren’t well-paid.”

The problem was only magnified with the strain of the pandemic, he said. Now, “at a time where it seems fewer and fewer of us want to work in long-term care, the need has never been greater.”

Immigrants make up 28% of the workers who care directly for people in nursing homes and other forms of long-term care, according to a national analysis by the independent research group KFF. In California nursing homes, more than half of certified nursing assistants — direct care workers who feed, bathe and dress residents — were born in other countries, according to a study published last year in Health Affairs.

A smaller percentage are believed to be in the country without legal authorization: The American Immigration Council, a left-leaning nonprofit that advocates for immigrants, estimates that 4.2% of nursing assistants and 6.4% of home health aides nationally are undocumented, based on its analysis of Census Bureau data.

Those numbers may seem modest, but in the face of the demand for such workers, “when you remove that percentage of the workforce, it becomes a huge problem,” said Steven Hubbard, a senior data scientist at the American Immigration Council.

Although Americans are more widely in support of deporting people convicted of violent crimes, a significant share of adults surveyed — 43% — support deporting all immigrants living in the U.S. illegally, according to a recent poll by the Associated Press-NORC Center for Public Affairs Research.

California Assemblymember Carl DeMaio (R-San Diego) rejected the idea that the changes in immigration policy anticipated under the Trump administration would harm the caregiving sector, saying that “a secure border is not mutually exclusive with a vibrant workforce.”

“People who want an open border are trying to demonize or distort the public policy discussion here by cherry-picking one element and not seeing the full spectrum of savings that we would achieve,” DeMaio said.

Groups that want to reduce immigration have also argued that restricting the flow of immigrants would put upward pressure on wages, benefiting American workers who might then take caregiving jobs.

Others questioned that idea: Wages for such care have remained low despite existing shortages of caregivers, which were worsened by an exodus of employees amid the COVID-19 emergency, said Priya Chidambaram, a senior policy manager with KFF’s Program on Medicaid and the Uninsured. If wages haven’t surged so far, “it’s hard to imagine why that would be true if we continue to cut down on the available long-term care workforce.”

Caregivers could also be affected by rollbacks to Temporary Protected Status or future changes to the Deferred Action for Childhood Arrivals program, both of which shield certain immigrants from deportation, experts said.

“Even legal immigrants could really be affected just by slowdowns in procedural processing that allows them to continue to function within our legal market,” said Cecilia Esterline, a senior immigration policy analyst with the Niskanen Center in Washington, D.C.

In Los Angeles, an immigrant woman works each day tending to the needs of her elderly client — bathing her, changing her diapers and brushing her teeth. She prepares meals, cleans the bathroom and kitchen and changes the bed sheets. She helps the woman go out and walk and assists with daily exercises.

“These people need love, understanding, someone to take care of them,” the Honduran immigrant said in Spanish. The 67-year-old worker asked not to be named because of concerns about her immigration status, fearing that with Trump in the White House, she could be at risk of losing her protection from deportation.

The woman said that decades ago, she entered the U.S. without authorization after escaping an abusive spouse. She later obtained Temporary Protected Status, which allows her to legally work in the country. The program, which must be regularly renewed, expires for Hondurans like her in months. Under Trump, the caregiver fears she and other immigrants could lose their jobs with a government program for home care.

“And the clients will be by themselves,” she said, “with no one to take care of them.”

Advocates have pointed to an analysis published in the Oxford Bulletin of Economics and Statistics, which found that an immigration enforcement program carried out between 2008 and 2014 led to reduced hours of direct care for nursing home residents.

Experts said that a crackdown on immigration could also reverberate in indirect ways, such as driving away immigrant workers who share homes with family members at risk of deportation.

“We don’t know to what extent any of the policies that come into place are going to slow the flow of legal immigration,” either by making it harder to immigrate to the U.S. or simply dissuading people from coming, said Joanne Spetz, director of UC San Francisco’s Health Workforce Research Center on Long-Term Care.

If immigration enforcement slows the flow of workers, “not only is it going to worsen the caregiver shortage we have throughout the United States, but it could potentially make caregiving services more expensive and could further strain public assistance programs,” said Meghan Rose, general counsel and chief government affairs officer for LeadingAge California, which represents nonprofit providers of senior living and care.

Industry groups have called to ease the way for immigrant caregivers. “Streamlining legal pathways for passionate people to come to our country and serve our seniors is an important part of how our sector will answer the growing demand for long-term care,” said Clif Porter, president and CEO of the American Health Care Assn. and the National Center for Assisted Living, which represent long-term care facilities.

With a Trump presidency, “the bigger threat to this industry is not the enforcement mechanisms,” said Laura Collins, director of the George W. Bush Institute-SMU Economic Growth Initiative. She said she was “far more concerned about the lack of a plan to bring in workers.”

Research by Grabowski found “negligible impacts on wages” when there was an influx of immigrant workers at nursing homes in an area. In a working paper published by the National Bureau of Economic Research, Grabowski and other researchers found that when immigration rose, so did the number of hours of caregiving for nursing home residents, along with other indicators of improved care.

Beyond nursing homes and other residential facilities, “the home care industry is hugely dependent on immigrants,” said Diana Silver, a professor who studies public health policy at New York University. “These are all minimum-wage jobs with relatively minimal skill, but they’re providing an incredibly necessary skill.”

One analysis from PHI, a national organization that works to improve jobs for such workers, found that in home care, roughly a third of caregivers were immigrants. Its president and chief executive, Jodi Sturgeon, said that doesn’t include the “gray market” in which workers are hired and paid directly by families, a harder-to-track workforce that is more likely to be at risk of deportation.

If they are driven away, “people like you and I will have to make decisions about leaving the workforce or decreasing our time in order to care for our family members,” Sturgeon said.

SEIU 2015 President Arnulfo De La Cruz, whose union represents California workers in home care, skilled nursing facilities and assisted living, said California and the country are in the middle of “a care crisis,” with far more seniors and disabled people wanting home care than can be attended by existing workers.

In recent years, millions of hours authorized under a California program for home care have gone unfilled each month, the union said, underscoring the lack of needed providers.

Around the U.S., “there are folks who haven’t been able to get support getting fed or dressed or out of bed — or even having to sleep in their wheelchairs because there’s no one available to hire and support them,” said Stacy Kono, executive director of Hand in Hand, a national network of employers of domestic workers including home attendants. “It’s really life-and-death kind of consequences.”

Times staff writers Andrea Castillo and Karen Kaplan contributed to this report.