A recent report by the Center for Migration Studies presents detailed demographic and socioeconomic estimates with a narrowing focus on New York City’s low-earning immigrant healthcare workforce.
The City’s healthcare system relies on the contributions of its healthcare workforce. The report assess the 520,100 healthcare workers who conduct check-ups, treat diseases and injuries, and provide in-home care for over eight million New Yorkers.
The healthcare sector is one of the City’s fastest-growing, especially in typically low-paying and highly precarious Healthcare Support occupations, the number of which has increased 49 percent from 2010 to 2022.
New York’s healthcare workforce is especially reliant on immigrants; 57 percent of the City’s healthcare workforce is foreign-born. Immigrant healthcare workers are typically older than both native-born healthcare workers and workers in other occupations, and are overwhelmingly women. Over half are parents of young children or otherwise responsible for raising children under the age of 18.
Immigrant healthcare workers experience greater housing precarity, with higher shares reporting both overcrowding and burdensome rent. They are also more likely to be occupations categorized as Healthcare Support roles, which have median hourly earnings $25 below those of Healthcare Practitioner & Technical occupations (the category that includes physicians, surgeons, and registered nurses).
Of note, the financially better-off Practitioner & Technical occupations are also heavily reliant on immigrant workers; 43 percent of those employed in such roles are foreign-born.
Overall, 39 percent of New York City’s healthcare workforce are low-earning immigrants, totaling 203,500 workers. The majority of these workers provide direct care to New Yorkers in their homes, primarily as Home Health and Personal Care Aides, though Nursing Assistants also account for a significant share.
Home Health and Personal Care Aides report median hourly earnings of $16, which is $12 below a living wage for the New York City metropolitan area. Over half of workers in these occupations work part-time hours, with reasons for doing so including both employer-set limitations and fear of losing access to needed benefits.
Of particular importance is access to Medicaid, which provides health coverage to over half of the City’s Home Health and Personal Care Aides. (In other words, the state government subsidizes the low wages of Home Health and Personal Care Aides by providing health coverage through Medicaid).
Included in this recent analysis is a comparison with a similar population in Los Angeles County, California, which despite a similar sized population and share of immigrant workers presents a very different healthcare ecosystem.
It concludes with recommendations for better supporting low-earning immigrant healthcare workers, including mechanisms to raise wages, enforce labor laws, modernize access to benefits, make administrative information accessible for speakers of all languages, encourage the development of affordable housing, and enable access to affordable childcare.
Key Findings: Healthcare Workers
Healthcare workers were the largest occupational category in New York City. There were more than half a million (520,100) workers, accounting for 12 percent of the City’s workforce.
Workers in Healthcare Support occupations were one of the fastest growing occupations, increasing by 49 percent between 2010 and 2020. Median earnings for this group were $26,100, half the median income for all workers in the City ($52,100).
Two-thirds of those in Healthcare Support occupations are immigrants (67 percent), the largest share of any occupational subgroup.
Home Health and Personal Care Aides account for the largest share of all healthcare occupations: 202,400 workers or 39 percent of the healthcare workforce. Median hourly earnings for this group are $16–the lowest of all healthcare occupations.
Healthcare workers are predominantly women (77 percent compared to 45 percent for all other workers) and much older than the general workforce. Their median age was 45 years, six years older than all other workers.
Healthcare workers are more likely to be women who are the sole breadwinners for their families. They are more likely to live in a female-headed household with no spouse present (25 percent compared to 15 percent for all other workers), and are also more likely to have at least one child in the household (48 percent) than non-healthcare workers (36 percent).
Key finding: Immigrant Healthcare Workers
The majority of healthcare workers are foreign-born (57 percent), compared to 42 percent for all other workers.
Healthcare occupations across the earnings spectrum are filled with immigrant workers; 44 percent of Physicians are foreign-born, as are 50 percent of Registered Nurses, 65 percent of Nursing Assistants, and 73 percent of Home Health and Personal Care Aides.
Healthcare workers, both native- and foreign-born, have high rates of health insurance (96 percent). However, immigrant workers have higher rates of Medicaid usage, with 36 percent compared to 24 percent for native-born workers.
Immigrant healthcare workers are even more likely to be female and older; 81 percent were women compared to 72 percent of native-born healthcare workers. Foreign-born healthcare workers’ median age was 49 years compared to 36 years for the native-born.
More than half have at least one child under the age of 18, indicating greater household responsibilities for foreign-born workers.
Compared to native-born healthcare workers, immigrant healthcare workers are almost twice as likely to live in overcrowded housing (20 percent compared to 11 percent).
Within the foreign-born population, undocumented immigrants are underrepresented among healthcare workers compared to all other workers at 9 percent compared to 16 percent.
Key Finding: Low-Earning Immigrant Healthcare Workers
Of the 520,100 healthcare workers, 62 percent were defined as having low earnings (322,000). Immigrants comprised the majority of this group: 203,500, or 63 percent of low-earning healthcare workers and 39 percent of all New York City healthcare workers.
The overwhelming majority of Home Health and Personal Care Aides–91 percent–were classified as low earners. A similar occupation, Nursing Assistants, also has 83 percent of workers classified as low earners.
Compared to low-earning immigrant workers Citywide, comparatively higher shares of low-earning immigrant healthcare workers reside in the Bronx, and comparatively lower shares live in Queens.
The top countries of birth for low-earning healthcare workers are the Dominican Republic, China, Jamaica, Guyana, Ghana, Haiti, and Bangladesh. Together, these countries account for 60 percent of the low-earning immigrant workforce.
Notably missing from the top sending countries are immigrants from Mexico. Citywide, Mexican immigrants account for approximately one-third of the foreign-born population, which makes their omission from top countries of birth notable.
The hourly median wage for healthcare workers in the support occupations was far below what is considered a living wage: $17 compared to $28.
You can read the entire report here.
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