President Donald Trump's immigration crackdown is beginning to strain the long-term care workforce, raising concerns about how the effects could ripple across the nation's senior population.
Providers that operate nursing homes and home care agencies say they have lost staff members as the Trump administration has moved to end deportation protections for hundreds of thousands of migrants with temporary legal status. Republican critics of those programs say that they have allowed migrants to stay longer than intended and that ending them "restores integrity" in the country's immigration system.
But the long-term care industry already faces persistent challenges in recruiting workers. Providers say the reduction in staff could threaten the quality of services they are able to offer to the nation's senior population. Some said they would have to raise wages to attract more workers to fill positions, and they were set to pass on cost increases to people receiving care.
The issue underscores the critical role that foreign-born workers play in the long-term care industry. Immigrants make up about 28% of the workforce directly providing that care, according to an analysis of Census Bureau data from KFF, a health policy research group. In comparison, foreign-born workers account for about 19% of the entire U.S. civilian labor force.
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Katie Smith Sloan, president of LeadingAge, an association representing nonprofit aging services providers, said the Trump administration's immigration policies were already starting to disrupt facilities across the country as providers moved to terminate some caregivers in recent weeks. She said some employees had stopped showing up at work out of fear for themselves and their families.
The biggest impact so far has stemmed from the Trump administration's decision to end various programs that grant migrants temporary legal status, which authorizes them to live and work in the United States. In late May, the Supreme Court allowed the Trump administration, for now, to end a humanitarian program that gave temporary residency to more than 500,000 people from Cuba, Haiti, Nicaragua and Venezuela.
The administration has also tried to end a program for Haitians who have been living in the United States under Temporary Protected Status, which is intended to help migrants who cannot return to their countries because of unsafe conditions.
Before he left office, President Joe Biden had extended those protections through next February. Although the Trump administration moved to end those protections by September, a federal judge recently blocked the administration from doing so. Tricia McLaughlin, a spokesperson for the Homeland Security Department, said the administration expected "a higher court to vindicate us in this."
Smith Sloan said the effects across the long-term care industry could become more pronounced as the administration ramps up efforts to restrict migrants from entering the United States. If there are fewer immigrants to fill positions, that could lead to nursing homes and assisted-living facilities shutting down wings or closing their doors entirely, she said. Cuts to Medicaid, which were included in the domestic policy bill that Republicans recently passed, could further strain providers, she added.
"The services just won't be available for people when they need them because we won't be able to staff them," she said.
Smith Sloan said the Trump administration's efforts to limit refugee admissions, for instance, has made it more difficult for some providers to fill job openings.
White House officials said Trump would ensure that sectors "have the workforce they need to be successful."
"There is no shortage of American minds and hands to grow our labor force, and President Trump's agenda to create jobs for American workers represents this administration's commitment to capitalizing on that untapped potential while delivering on our mandate to enforce our immigration laws," said Abigail Jackson, a White House spokesperson.
The administration's attempt to clamp down on immigration comes at a time when the industry faces another challenge: the growing number of seniors. The U.S. population age 65 and older has been increasing at a rapid clip, meaning the long-term care industry will need more workers in the coming years to keep up.
"Barring some major change in fertility rates, we're going to need immigrants to continue to supply the workforce that the country needs for aging care," said Julia Gelatt, associate director of the U.S. immigration policy program at the Migration Policy Institute.
Lower staffing levels at nursing homes, assisted-living facilities and home care agencies could have substantial effects on the health of seniors, potentially leading to lower quality of care and life, said David Grabowski, a health care policy professor at Harvard Medical School.
For instance, a lack of caregivers could create unsafe conditions by increasing the risk that someone falls or becomes dehydrated, he said. Staffing shortages could also lead to lower quality of care if there are fewer workers to ensure that residents are engaged or living a meaningful life, he added.
Some proponents of tighter immigration laws said that providers should focus on hiring U.S.-born workers or immigrants with legal status already in the country. Steven Camarota, research director at the Center for Immigration Studies, a think tank that favors restricting immigration, said providers should increase wages and benefits to attract workers.
"It's the kind of job that we need people to do, but it's better if it pays more, and it'll attract more Americans," Camarota said.
Some experts said it was challenging, however, for providers to recruit Americans who could work a less strenuous job and receive a comparable wage in industries such as food service or retail. Direct care workers earned a median hourly wage of $16.72 in 2023, according to PHI, a research and advocacy organization focused on long-term care for seniors and people with disabilities.
"They don't want the job," said Rachel Blumberg, president and CEO of the Toby and Leon Cooperman Sinai Residences in Boca Raton, Florida. "That's why we're so reliant on immigrants."
Blumberg said she had to terminate 10 workers from Cuba and Haiti last month after the Trump administration ended the humanitarian parole program that had given them temporary residency. She said she expected to terminate an additional 28 workers from Haiti in the coming weeks. Collectively, those 38 staff members represent about 9% of her workforce.
Blumberg said her facility had raised wages for those roles by an average of 10% in order to fill the positions, and it planned to pass on some of those cost increases to residents.
Colin O'Leary, executive director of the Laurel Ridge Rehabilitation and Skilled Care Center in Boston, said it was preparing to lose as much as 10% of its workforce in the coming months, in large part because many of the facility's certified nursing assistants are Haitians with Temporary Protected Status.
"I'm not confident that I can fill those positions," O'Leary said.
He said the facility would have to raise wages to attract more caregivers, but finding the funds to offer higher wages would be challenging. It could resort to cutting funding for certain activities or deferring maintenance costs, meaning that older beds might not be replaced as often, he said.
If the center cannot find enough workers to fill positions, more staff members would have to work overtime, O'Leary said. That could result in higher expenses and further strain employees, affecting the level of care the facility is able to provide, he said.
Immigrants also play an outsize role in the home care industry, making up about 32% of that workforce, according to KFF.
John Sneath, CEO of Tribute Home Care, an agency that largely operates in Massachusetts, said he had to terminate nine caregivers after the Trump administration ended the program that gave temporary legal status to migrants from Cuba, Haiti, Nicaragua and Venezuela. He said he expected to lose six more workers from Haiti in the coming months.
Sneath said the loss of those workers had been upsetting for the agency's clients, many of whom have built strong relationships with their caregivers.
"It compounds all of the other things one has to think about as they're getting old," Sneath. "It's hard enough to invite somebody into your home to get care. And once you have these relationships, it's very hard to see them end."
Providers that operate nursing homes and home care agencies say they have lost staff members as the Trump administration has moved to end deportation protections for hundreds of thousands of migrants with temporary legal status. Republican critics of those programs say that they have allowed migrants to stay longer than intended and that ending them "restores integrity" in the country's immigration system.
But the long-term care industry already faces persistent challenges in recruiting workers. Providers say the reduction in staff could threaten the quality of services they are able to offer to the nation's senior population. Some said they would have to raise wages to attract more workers to fill positions, and they were set to pass on cost increases to people receiving care.
The issue underscores the critical role that foreign-born workers play in the long-term care industry. Immigrants make up about 28% of the workforce directly providing that care, according to an analysis of Census Bureau data from KFF, a health policy research group. In comparison, foreign-born workers account for about 19% of the entire U.S. civilian labor force.
(Join our ETNRI WhatsApp channel for all the latest updates)
Katie Smith Sloan, president of LeadingAge, an association representing nonprofit aging services providers, said the Trump administration's immigration policies were already starting to disrupt facilities across the country as providers moved to terminate some caregivers in recent weeks. She said some employees had stopped showing up at work out of fear for themselves and their families.
The biggest impact so far has stemmed from the Trump administration's decision to end various programs that grant migrants temporary legal status, which authorizes them to live and work in the United States. In late May, the Supreme Court allowed the Trump administration, for now, to end a humanitarian program that gave temporary residency to more than 500,000 people from Cuba, Haiti, Nicaragua and Venezuela.
The administration has also tried to end a program for Haitians who have been living in the United States under Temporary Protected Status, which is intended to help migrants who cannot return to their countries because of unsafe conditions.
Before he left office, President Joe Biden had extended those protections through next February. Although the Trump administration moved to end those protections by September, a federal judge recently blocked the administration from doing so. Tricia McLaughlin, a spokesperson for the Homeland Security Department, said the administration expected "a higher court to vindicate us in this."
Smith Sloan said the effects across the long-term care industry could become more pronounced as the administration ramps up efforts to restrict migrants from entering the United States. If there are fewer immigrants to fill positions, that could lead to nursing homes and assisted-living facilities shutting down wings or closing their doors entirely, she said. Cuts to Medicaid, which were included in the domestic policy bill that Republicans recently passed, could further strain providers, she added.
"The services just won't be available for people when they need them because we won't be able to staff them," she said.
Smith Sloan said the Trump administration's efforts to limit refugee admissions, for instance, has made it more difficult for some providers to fill job openings.
White House officials said Trump would ensure that sectors "have the workforce they need to be successful."
"There is no shortage of American minds and hands to grow our labor force, and President Trump's agenda to create jobs for American workers represents this administration's commitment to capitalizing on that untapped potential while delivering on our mandate to enforce our immigration laws," said Abigail Jackson, a White House spokesperson.
The administration's attempt to clamp down on immigration comes at a time when the industry faces another challenge: the growing number of seniors. The U.S. population age 65 and older has been increasing at a rapid clip, meaning the long-term care industry will need more workers in the coming years to keep up.
"Barring some major change in fertility rates, we're going to need immigrants to continue to supply the workforce that the country needs for aging care," said Julia Gelatt, associate director of the U.S. immigration policy program at the Migration Policy Institute.
Lower staffing levels at nursing homes, assisted-living facilities and home care agencies could have substantial effects on the health of seniors, potentially leading to lower quality of care and life, said David Grabowski, a health care policy professor at Harvard Medical School.
For instance, a lack of caregivers could create unsafe conditions by increasing the risk that someone falls or becomes dehydrated, he said. Staffing shortages could also lead to lower quality of care if there are fewer workers to ensure that residents are engaged or living a meaningful life, he added.
Some proponents of tighter immigration laws said that providers should focus on hiring U.S.-born workers or immigrants with legal status already in the country. Steven Camarota, research director at the Center for Immigration Studies, a think tank that favors restricting immigration, said providers should increase wages and benefits to attract workers.
"It's the kind of job that we need people to do, but it's better if it pays more, and it'll attract more Americans," Camarota said.
Some experts said it was challenging, however, for providers to recruit Americans who could work a less strenuous job and receive a comparable wage in industries such as food service or retail. Direct care workers earned a median hourly wage of $16.72 in 2023, according to PHI, a research and advocacy organization focused on long-term care for seniors and people with disabilities.
"They don't want the job," said Rachel Blumberg, president and CEO of the Toby and Leon Cooperman Sinai Residences in Boca Raton, Florida. "That's why we're so reliant on immigrants."
Blumberg said she had to terminate 10 workers from Cuba and Haiti last month after the Trump administration ended the humanitarian parole program that had given them temporary residency. She said she expected to terminate an additional 28 workers from Haiti in the coming weeks. Collectively, those 38 staff members represent about 9% of her workforce.
Blumberg said her facility had raised wages for those roles by an average of 10% in order to fill the positions, and it planned to pass on some of those cost increases to residents.
Colin O'Leary, executive director of the Laurel Ridge Rehabilitation and Skilled Care Center in Boston, said it was preparing to lose as much as 10% of its workforce in the coming months, in large part because many of the facility's certified nursing assistants are Haitians with Temporary Protected Status.
"I'm not confident that I can fill those positions," O'Leary said.
He said the facility would have to raise wages to attract more caregivers, but finding the funds to offer higher wages would be challenging. It could resort to cutting funding for certain activities or deferring maintenance costs, meaning that older beds might not be replaced as often, he said.
If the center cannot find enough workers to fill positions, more staff members would have to work overtime, O'Leary said. That could result in higher expenses and further strain employees, affecting the level of care the facility is able to provide, he said.
Immigrants also play an outsize role in the home care industry, making up about 32% of that workforce, according to KFF.
John Sneath, CEO of Tribute Home Care, an agency that largely operates in Massachusetts, said he had to terminate nine caregivers after the Trump administration ended the program that gave temporary legal status to migrants from Cuba, Haiti, Nicaragua and Venezuela. He said he expected to lose six more workers from Haiti in the coming months.
Sneath said the loss of those workers had been upsetting for the agency's clients, many of whom have built strong relationships with their caregivers.
"It compounds all of the other things one has to think about as they're getting old," Sneath. "It's hard enough to invite somebody into your home to get care. And once you have these relationships, it's very hard to see them end."
