All across the U.S., from California to Massachusetts and Wisconsin and Minnesota, especially in states with large rural communities, experts are worried that President Donald Trump’s executive orders on immigration, along with his pledge to lead the largest deportation effort in history, will compound the worker shortage the nursing home sector currently faces.
President Trump’s plans could worsen the staffing crisis in long-term care facilities as the sector has barely begun to see positive change, health care experts and immigrant advocates told the Los Angeles Times.
Immigrants make up a significant portion of the long-term care workforce. In California, for example, over half of certified nursing assistants (CNAs) are foreign-born, while nationally, about 28% of the direct care workers are immigrants, a KFF analysis estimates. And even though, the American Immigration Council estimates that only a small percentage of these workers are undocumented, with 4.2% of nursing assistants and 6.4% of home health aides nationally being undocumented, given the large demand for workers in long-term care facilities, the deportation orders are very concerning.
“[W]hen you remove that percentage of the workforce, it becomes a huge problem,” said Steven Hubbard, a senior data scientist at the American Immigration Council.
Trump’s executive orders, particularly targeting the Temporary Protected Status (TPS) program, have raised concerns about the future of these workers. These EOs will suspend refugee admissions for months, and require asylum seekers to stay in Mexico as their cases were adjudicated, and cut programs that had granted temporary legal status and work authorization to more than 1.5 million people.
Moreover, the demand for home health aides, nursing assistants and personal care aides in long-term care is expected to rise by up to 41% from 2022 to 2037, based on data from the National Center for Health Workforce Analysis, the LA Times story notes.
“Long-term care providers and nursing homes in particular have really struggled, for decades, to recruit staff,” David C. Grabowski, professor of health care policy at Harvard Medical School, told the LA Times. “The jobs are challenging. They typically aren’t well-paid … [and] at a time where it seems fewer and fewer of us want to work in long-term care, the need has never been greater.”
Grabowski’s research found that immigrant workers help improve patient care, particularly in nursing homes, where consistency is vital. Immigrants often stay longer in these challenging, low-paying jobs, unlike U.S.-born workers.
Trump’s EO on immigration could also put pressure on providers to increase wages.
Meanwhile, in nursing homes in Massachusetts, where about 40% of front-line staff are immigrants, and fill crucial roles as nursing assistants, licensed nurses, and in housekeeping and dining services, the dismantling of the TPS program through Trump’s EO, will cause disruptions to care and worsen bottlenecks at hospitals.
The TPS provides work permits and deportation protection to immigrants who are experiencing crises in their native countries, with an estimated 5,000 TPS recipients work in nursing homes in Massachusetts, according to a story in the Boston Globe.
Industry leaders warn that eliminating TPS or work authorization would worsen the state’s ongoing staffing crisis, which already has many nursing homes unable to accept new patients due to labor shortages. Tara Gregorio, president of Massachusetts Senior Care, told the Globe that repealing TPS would exacerbate these challenges, putting vulnerable residents at risk.
Moreover, severe staffing shortages have led to hospital capacity issues in Massachusetts, with over 2,000 patients unable to access necessary post-hospital care due to nursing home vacancies.
Companies featured in this article:
American Immigration Council, KFF, National Bureau of Economic Research, National Center for Health Workforce Analysis