May 7, 2025  – Long-term care providers and industry leaders are sounding the alarm on recent federal immigration policies they say could severely harm the elder care system. In an urgent appeal to the Department of Health and Human Services (HHS), advocates are asking the agency to reconsider decisions that would strip work authorization from thousands of foreign-born workers—many of whom hold Temporary Protected Status (TPS) or humanitarian parole.

“Your agency’s decisions … have created immediate uncertainty and concern for employers and workers alike,” said LeadingAge CEO Katie Sloan in a statement. “Across the country, foreign-born workers with legal status, including parolees and TPS holders from Haiti and Venezuela, play a meaningful role in care settings, including nursing homes, home health, home care and hospice agencies, and a range of senior living communities, including affordable housing for low-income older adults. Absent significant policy intervention, we can be certain today’s workforce shortage will intensify as the gap between need and capacity widens with each passing year.”  

Foreign-born staff currently make up about 20% of the long-term care workforce, according to industry estimates. Many work in roles that are already difficult to fill, such as certified nursing assistants, housekeeping, and hospice care. 

Rachel Blumberg, CEO of Toby & Leon Cooperman Sinai Residences in Boca Raton, Florida, said her facility could lose up to 8% of its workforce due to upcoming TPS terminations. “This loss reverberates across our entire campus,” she said, warning that the impact would reach far beyond individual staff members.

In Virginia, Rob Liebreich, CEO of Goodwin Living, emphasized that 40% of his staff are foreign-born, with 65 working under TPS or humanitarian parole. “These changes are not merely a theoretical risk of losing 65 members of our staff,” he said. “America lacks the available workforce to honor these older Americans with dignified care.”

The group is requesting four key reforms: allowing CHNV parolees to stay for their full authorized terms, reinstating earlier TPS expiration dates for Haiti and Venezuela, extending TPS designations due to the national caregiver shortage, and establishing permanent immigration pathways for essential workers.

These pleas are supported by recent research. A JAMA research letter published in April found the U.S. healthcare system employs more than 1 million immigrants, including about 70,000 in nursing homes. Of those, nearly 192,000 are undocumented, with many working as certified nursing assistants.

Data also show that immigrant workers tend to stay in direct care roles longer than their U.S.-born counterparts, according to PHI, a research and advocacy group focused on the direct care workforce.

“Deportations could especially compromise long-term care,” the JAMA authors wrote. “The resulting shortages could reverberate through emergency departments and hospitals.”

Even facilities that received temporary legal relief remain concerned. A New England member of LeadingAge said a recent court stay prevented the loss of 28 trained workers. “If these federal changes are not reversed or mitigated, we could lose up to 20% of our workforce in the coming months,” the member said.

Industry leaders argue that failing to protect this vital labor force could destabilize an already stretched long-term care system. Without immediate policy adjustments, providers say both the caregivers and the people they serve are at risk.