Direct care workers provide care directly to frail elders and people with long-term illnesses or disabilities. They include hospital, nursing home, home health and personal care aides. These workers often become trusted conﬁdants and allies of family members and friends of those who need care. Hospital and nursing home aides work in nursing homes, hospitals and other assisted living facilities, helping residents with activities of daily life. Personal care and home health aides work in community-based settings and in private homes, providing companionship and assisting with activities such as bathing, dressing, toileting, meal preparation, eating, shopping and housework. Home health aides also assist patients with medication and monitoring vital signs. About one-fourth of all U.S. direct care workers are foreign-born. This policy brief examines the role of immigrant workers in the growing care economy, addressing important questions about who is caring for our country’s elderly, sick and disabled and about the conditions under which they work.