The population is rapidly aging, unemployment is high, and millions of illegal workers in the U.S. are waiting to see how Congress will act on immigration reform.

At the intersection of those three very different topics is the question of who will continue to care for aging Americans. A new report says that immigrants, including many illegal workers, are staving off a labor shortage in this field, but those on the other side of the debate have a different view.

As of 2010, the most recent year for available data, there were 3.4 million U.S. direct care workers, according to the Paraprofessional Healthcare Institute. Direct care workers include personal care attendants, nursing assistants, and other similar positions. That number is expected to increase to 4.3 million by 2018, driven in large part by at-home workers and personal care workers, which are both expected to grow by around 50 percent, according to a report from the Institute for Women’s Policy Research. The report, which focuses on women in the direct care workforce, finds that immigrants make up 28 percent of all in-home healthcare workers, and that more than 20 percent of all immigrants employed in direct care are illegal.

The report concludes immigrants are solving a labor shortage, filling jobs that would otherwise go unfilled, a problem that will only get worse as the number of people needing care, whether elderly or disabled, grows.

“In the face of this labor shortage, a growing immigrant population in the United States has stepped up to fill a substantial portion of care work jobs,” the authors write.

Because of the projected future need of care workers, IWPR’s report puts forth four proposals that would help to keep immigrant care workers in the country, including providing a path to legalization for undocumented care workers, and implementing a provisional visa system that could help workers to transition to permanent visa status.

The goal is to keep those workers in the country and make their lives better, says one of the report’s authors. Median weekly pay for all female in-home care workers is $308, compared with $560 for all U.S. female workers, and illegal immigrant workers are particularly vulnerable to exploitation (such as lower pay) and abuse, according to the report.

“The wages for a range of reasons are kept low, and we do consider that a problem,” says Jane Henrici, study director at IWPR. “We’re concerned for the workers’ sake that they be able to subsist on those salaries.”

However, opponents of this type of reform say it’s not just about the workers, it’s about the jobs and the American workforce.

“The reason we are relying increasingly on foreign healthcare workers is not because Americans don’t want to do these jobs; it’s that wages and working conditions don’t meet the expectation of American workers.” says Ira Mehlman, media director at the Federation for American Immigration Reform, a group that advocates heavier border security and generally tighter immigration policies.

He says the arguments parallel those about immigrant workers in other occupations, such as agricultural labor, where illegal immigrants are employed.

“We’ve created a lot of self-fulfilling prophecies, where we offer poor wages and poor working conditions, Americans don’t take the jobs, and the employer turns around and says, ‘We need all of these foreign workers to do the jobs,'” says Mehlman.

Henrici and Mehlman agree that illegal workers are often paid unjustifiably low wages. And while Mehlman might argue for Americans taking these in-home care jobs, and Henrici argues for legal status for workers, the outcome for people needing that care would be the same: a higher price. Mehlman claims that native-born or naturalized workers would likely require higher wages, while Henrici says that visas tend to increase workers’ wage opportunities.