Inside State Initiatives Boosting Immigrant Labor in Nursing Homes Amid Trump’s Deportation Threats

States and local associations haven’t given up on using policy changes to immigration as a major tool to combat the staffing crisis in nursing homes, despite the Trump administration launching the largest mass deportation operation in U.S. history. Immigrant workers in nursing homes all across the U.S. have proven to be a strong solution to the staffing crisis.

In the face of the federal minimum staffing mandate and continuing staffing shortages, states like Minnesota have made good use of grant funding to have immigrants and refugees work in nursing homes. Providers like Minnesota-based Monarch Healthcare Management have deployed the funds to support direct care workers.

Meanwhile, Massachusetts is working on a proposal to bring work-approved immigrants that are living in shelters to work in facilities. And, Wisconsin’s refugee workforce program – launched more than two years ago – placed refugees in nursing homes to work in dietary and housekeeping with remarkable retention rates.

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Minnesota received $28 million in grant funding from the state legislature between 2023 and 2024 for workforce development, targeting new Americans and their children already living in the country for the long-term care profession.

Nicole Mattson, vice president of strategic initiatives, Care Providers of Minnesota, told Skilled Nursing News that the group received $350,000 for the first round, and its staffing partner the International Institute was awarded close to $950,000.

LeadingAge Minnesota, another grantee, received $1 million, said Anna Mowry, director of workforce solutions for the state chapter. The association leads one of the largest nursing assistant training programs in Minnesota, using funding to translate pieces of its curriculum into three other languages and allow prospective certified nurse aides (CNAs) to test for the position in these languages through the state Department of Health.

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“Our nursing assistant training trains around 2,000 nursing assistants a year,” said Mowry. “There’s definitely the potential to really be expanded and offer out those translated materials to even more nursing assistants in Minnesota who have the desire to become a nursing assistant.”

This is part one of Skilled Nursing News’ workforce and immigration series. Part two will delve into initiatives in Wisconsin and Massachusetts.

Initiatives recognize wide-ranging staffing issues

There’s the possibility of additional grants once all of the $28 million is allocated, while only $12 million of the $28 million has been promised with this round of funding.

Funding was appropriated through the state Department of Human Services rather than the workforce state agency, something Mattson said was unique for such an initiative.

“It really speaks to the fact that workforce issues touch every level of government. I think lawmakers were looking for innovative solutions to those problems, and this is one that hones in on a specific talent pool,” said Mattson.

Dan Strittmater, vice president of innovation and bench strength for Monarch, told SNN that his organization received $1.2 million from this funding. Monarch is a large provider in the state, operating 45 nursing homes and 17 assisted living communities.

Funding can be used for any nursing home position, from culinary to administrators, he said.

“You might have a large number of folks who are new Americans at more entry level positions, or hourly positions,” said Strittmater. “Why wouldn’t you want representation at leadership positions … administrators, department and director positions, regional positions?”

Models for the national stage

Care Providers was one of 24 grantees in the state to receive a portion of the funding over a two-year period, with a plan to partner with community-based organization International Institute, which does training for immigrants and refugees in the state. The goal is to connect 150 individuals with long-term care opportunities and foster their career growth.

“This isn’t just a one way door where individuals are coming to us, getting placed and then it’s done. It really is about developing those relationships for the longer term,” said Mattson. “We’re charged with creating the environment such that we’ve got employers who are going to be employers of choice, of choice for new Americans and their children for the long term.”

Mattson hopes the program, among other initiatives in the state, have the potential to be national models for immigration and staffing initiatives among nursing homes.

“We’re really seeking to create workplaces of choice,” said Mattson. “The talent pools have shrunk and we’re all vying for the same finite talent. Employers should look at individuals differently, help them get to where they need to go.”

In other words, learning and working through barriers can happen concurrently with employment, and workers might not be “completely polished” upon onboarding. Immigrants working with Care Providers must be born outside of the U.S., or have a parent born outside of the country.

Aside from its curriculum translations, LeadingAge Minnesota allocated $50,000 of its grant for direct services, including supporting new Americans with child care, transportation – really anything that could pose a barrier to working and living in the state.

“We’ll be forming an advisory group of new Americans within our field already to say, ‘What do you really wish you had? What resources?’ We anticipate some of those needs are going to be things like child care, transportation, housing, and that’s where we’re hoping the Supportive Services Fund will come into play,” said Mowry.

This same fund will also aid in covering legal fees related to work authorizations, said Mowry. Both Mowry and Mattson said President Trump’s executive orders on immigration won’t have a direct impact on their staffing projects.

“We can’t use the dollars to support direct hiring abroad, but there are different statuses of people who are here. We’re making sure that they have the proper work authorizations to be able to work in our field,” she said.

The association will also push out a statewide campaign, showcasing caregivers and how new Americans could benefit from such positions.

Care Providers has hired a community outreach and workforce navigator, who has lived experience as an immigrant and has experience with job placement, Mattson said. This position will help connect with the community, meeting job seekers and telling them the story of what it means to work in long-term care.

The community outreach coordinator and workforce navigator role is also about helping operators break through barriers or issues they might have in hiring new American talent, she said.

“We want to be that problem solver … if there’s occupational English courses that are needed, we’ve got some of that money built into the grant. If there are other barriers to employment, we’ve got a little bit of money for that,” said Mattson. “Mostly the focus is on developing the relationships and then progressing that person. I strongly believe that this isn’t just about getting people into an entry-level job.”

Mattson hopes the initiative aids in growing people into a profession and cultivating those relationships as a valued talent pool into the future. That means figuring out where people want to go next while also giving them community-based resources to help support them.

University interns, wraparound services

Monarch used its funding starting last October to hire interns from the University of Minnesota, and shifted one of its recruiting directors to become the Director of new Americans Workforce, who is Hmong-American and bilingual, said Strittmater.

University interns are from Somalia, East Africa, among other nationalities. With the grant, these interns already at Monarch facilities were kept on and others were hired, basically a scholarship for the students, he said.

“We’ve tried to pay out some different scholarships. We have a lot of money in wraparound services, like helping somebody pay for groceries,” said Strittmater.

Minnesota’s state demographer has said it has been the least diverse state but is diversifying at a faster rate than any other state in the country, Strittmater said. Monarch has a big presence in the Twin Cities, which is very diverse, among other cities. Individuals either immigrate directly to these cities or emigrate from other states. These locations have universities that get a large number of foreign students, coming over on an F-1 visa which allows international students to study full time in the country.

In addition to the University of Minnesota, Monarch has a collaboration with Cristo Rey Jesuit High School, where 10 students do internships at Monarch facilities; 80% to 90% at Cristo are new Americans, he said.

In terms of wraparound services, through the grant, Strittmater said Monarch pays subcontractor Wellshare International which provides case workers along with other wraparound services.

“We’ve literally used the grant to write a check to some private individual who’s giving somebody else a ride. We bought groceries for someone who might be attending class, and try to bridge that gap to really get people to a point where they’re certified, they’re working,” said Strittmater.

Daycare support and fellowships for people looking to advance their careers are also on the table, he said.

Changing what we can

States like Minnesota and Massachusetts are facing a federal administration which already sent out a flurry of executive orders for mass immigrant deportation. With so much in flux, Mattson said it’s important to focus on the fact that there are new Americans here right now who are making a significant contribution to the nursing home profession.

“This is about ensuring that we are intentional about those connections, and that we’re really standing something up that can be used in the long term,” said Mattson. “This isn’t just new Americans, this is new Americans and their children, which I think is also pretty wise to look at from the broadest lens possible.”

Mowry said it’s critical to highlight the need we have in the sector, and how immigrants and refugees are really a part of that workforce.

“We want to keep lifting up the good work of our immigrant and refugee communities. Keeping that positive dialog on the contributions that they for several years have been making for our workforce and specifically caring for our seniors here in Minnesota,” said Mowry.

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