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I would ask you to consider, for instance, those working in our boiling hot fields picking our crops today or those working in our slaughterhouses. They are almost always immigrants. They take on jobs that are not only difficult, but jobs that don't pay well.
Their language skills vary.
Traditionally, working in nursing homes, and with the elderly and disabled, who are sometimes cranky, sometimes incontinent, sometime inappropriate, and almost always "heavy-lifting" is a tough job.
Worse, and again, it doesn't pay well!
So there you have it. Them's the facts, as they say. If you were to think about it I know you would have yourself come to this conclusion.
We who need the care of these folks are lucky to have them, and while I understand that as we age it is more difficult for us to "understand" ANY language, it's what's required.
I had a conversation with the agency that I didn't care who they send me but my very elderly Aunt with hearing loss and advancing dementia needed to be able to understand the person they send. The next person they sent was stellar and we enjoyed her for 6 years.