Trump’s immigration crackdown hits senior care workforce

WASHINGTON, D.C. — 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 can offer 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.

Many direct support workers in Minnesota are immigrants and refugees from African countries, including Liberia, the Democratic Republic of the Congo, Ethiopia and Somalia, industry members said. The future pipeline of workers into the profession is “extremely threatened” by federal policies that would slow immigration from such countries, said Tom Gillespie, president and CEO of Living Well Disability Services.

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.

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.

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.

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.

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.”