The current administration’s immigration policies are threatening a cornerstone of America’s nursing home workforce, as well as the care and safety of vulnerable residents. Immigrant health care workers—including those whose protected status has been revoked, refugees, and others—are leaving their jobs as aides and other direct care roles in nursing homes amid policy changes that have stripped away protections and created a climate of fear.
In April 2025, KFF reported that immigrants comprise 28% of the direct care workforce for long-term care services, including 30% of aides. This represents over 820,000 immigrants–including over 500,000 naturalized citizens and over 300,000 noncitizen immigrants—who provide essential daily care to nursing home residents across the country. PHI estimates that more than one in four direct care workers are immigrants.
Research demonstrates that immigrant direct care staff have been essential to maintaining nursing home operations, particularly during crisis periods. During the COVID-19 pandemic, nursing facilities with higher concentrations of immigrant direct care staff experienced lower declines in staffing levels, maintained more consistent nurse aide hours, and showed reduced staff turnover compared to facilities with fewer immigrant workers. Reliance on immigrant staff members was twice as high in rural parts of the country. These workers demonstrated exceptional commitment during the healthcare system’s most challenging period, yet they are now being systematically excluded from the workforce they helped sustain.
The administration’s immigration policies have created an untenable situation. In January 2025 the administration rescinded a 2021 Biden policy that protected health care facilities from Immigration and Customs Enforcement raids. This reversal has caused widespread fear not only among workers who have lost their protected immigration status, but also among immigrants with green cards and naturalized citizens who may now avoid their workplaces due to concern about enforcement actions. Despite working during the pandemic, immigrant direct care workers are now leaving the nursing home workforce, as reported by both the Associated Press and The New York Times. The loss of a major component of nursing home staff means that the crisis-level understaffing of nursing homes will only worsen.
The departure of experienced immigrant health care workers exacerbates existing staffing difficulties in nursing homes and directly compromises the quality of care and safety for residents who depend on consistent, skilled assistance with daily activities, medication management, health monitoring, and more. The loss of culturally diverse staff also eliminates important language and cultural competencies that serve diverse nursing home residents who may have limited English proficiency.
Researchers on staffing and immigration recognize the key role of immigrant workers in the nursing home workforce: “Enhancing legal protections and benefits for immigrant CNAs will foster a more sustainable workforce in the long-term and improve resident care in both routine and crisis settings.” The U.S. is moving in the wrong direction.
Resources
Priya Chidambaram and Drishti Pillai, “What Role Do Immigrants Play in The Direct Long-Term Care Workforce?” KFF (Apr. 2, 2025).
PHI, Immigration and the Direct Care Workforce(Mar. 31, 2025).
U.S. Immigration and Customs Enforcement, “DHS Directive Enforcement Actions in or Near Protected Areas (Jan. 20, 2025)”
U.S. Department of Homeland Security, “Guidelines for Enforcement Actions in or Near Protected Areas” (Oct. 27, 2021)
Jordan Rau, “Nursing homes face 2 threats: Trump’s Medicaid cuts and his immigration crackdown,” NPR (Jun. 26, 2025)
Matt Sedensky, “Nursing homes struggle with Trump’s immigration crackdown,” AP (Jul. 14, 2025).
Madeleine Ngo, “Trump’s Immigration Crackdown Hits Senior Care Workforce,” The New York Times (Jul. 18, 2025).
Hankyung Jun, et al, “Immigrant Staff in Nursing Homes: Mitigating Staffing Shortages During the COVID-19 Pandemic,” Medical Care Research and Review (Jun. 29, 2025) (abstract, full article available from Center for Medicare Advocacy, on request)