Immigration crackdown could lead to worker shortages at elder care facilities on Long Island, advocates say

Employees at elder care facilities on Long Island and across the state who have temporary protected status are receiving deportation letters from the Trump administration, putting already understaffed nursing homes and assisted living communities at risk of being unable to care for their most vulnerable residents, according to advocates and trade groups.

A central focus of President Donald Trump's mass deportation policy includes winding down TPS, a program expanded under former President Joe Biden that allows people already living in the United States to stay and work legally if their home countries are deemed unsafe due to civil unrest or natural disasters.

Workers from many countries with TPS designation are overrepresented in elder care roles, experts said, including Haiti, Venezuela, Honduras and Nicaragua.

Earlier this month, a federal judge temporarily blocked the Department of Homeland Security from ending Haiti’s TPS designation.

'They're very nervous'

Stephen Hanse, president and chief executive of the New York State Health Facilities Association, which represents the nursing home industry, said elder care employees with TPS, including those working on the Island, have begun receiving letters stating their temporary work visas have been revoked.

"I've spoken to a number of providers that have staff that have received these letters and they're very nervous," said Hanse, adding the industry is also struggling to secure visas for nurses traveling to the United States from abroad.

"These are active members of the community," he said. "They're providing essential care in nursing homes that are already struggling with a workforce crisis ... And this is only going to exacerbate this crisis."

DHS said it could not provide information on the arrest, detention or removal of employees working at elder care facilities but in a statement this week defended ending TPS protections.

"Temporary Protected Status was designed to be just that — TEMPORARY," the agency said. "Granted for 18 months under extraordinary circumstances. It was never meant to last a quarter of a century. For many of these countries, TPS was granted in the 90s after natural disasters. Now that conditions have improved, it is time to return home."

Experts contend the elder care industry is heavily regulated by state and federal agencies and only individuals legally allowed to work in the country, even on a temporary basis, are permitted to work in long-term care facilities.

The state Health Department declined to comment.

Potential 'bottlenecks' in care

Stephanie Woolhandler, a professor of public health at Hunter College in Manhattan and the co-author of an April report examining how the administration's deportation strategy could affect care at nursing homes, hospitals and home health care agencies, said the policy will have a trickle-down effect on the entire health care continuum.

"Deporting immigrants who have been living and working in the U.S. legally, and making it difficult for potential immigrants to enter, will worsen the existing shortages of health care personnel," Woolhandler said earlier this week. "As shortages of nursing home and home care workers worsen, hospitals and emergency rooms may be unable to discharge frail patients needing long-term care services. This will create bottlenecks that delay care for anyone seeking hospital or emergency room care."

The nonpartisan Migration Policy Institute said immigrants comprise 37% of the state’s health care workforce and 74% of New York's home health aides, the highest levels in the country.

Nationwide, immigrants make up 28% of the workforce for long-term care services, according to KFF, a nonpartisan organization focused on health policy.

As of 2023, there were more than 820,000 immigrants providing long-term care in the United States, including more than 500,000 naturalized citizens and more than 300,000 noncitizen immigrants, according to KFF data.

LeadingAge, which represents nonprofit providers of aging services, issued a report in September that found 31% of the nation’s home care workforce are foreign-born, along with more than 30% of nursing home housekeepers and maintenance workers, and 21% of residential care aides and nursing assistants.

"Hospitals, nursing homes and other providers are facing tremendous workforce challenges amid growing and changing patient demand," said Janae Quackenbush, spokeswoman for the Healthcare Association of New York State. "The dedicated, foreign-born workers they employ are essential to these organizations’ ability to maintain the services they provide. Policies that reduce the health care workforce will reduce access to care."

Staffing shortage

Many elder care facilities, including those on Long Island, saw an exodus of employees during the COVID-19 pandemic. Staffing levels were beginning to stabilize before the immigration crackdown, industry officials said.

An annual report on the status of the nursing home industry, released last year by the American Health Care Association, found nearly 100% of facilities across the country have open positions and most have staffing levels lower than before the pandemic.

Almost half of nursing homes surveyed by the health care association said they have had to limit new facility admissions because of labor shortages.

"We have a growing number of older adults who need services and we have a shrinking workforce," said Sebrina Barrett, chief executive of LeadingAge New York. "So anything added that will further reduce the workforce, such as someone's legal status or authorization to work being ... revoked will exacerbate a crisis where we don't have enough people to do these jobs."

A national spokeswoman for LeadingAge said there have been anecdotal reports of employees refusing to come to work because of fears of workforce raids — or those who are staying home with their children after not sending them to school — because of fears about Immigration and Customs Enforcement.

There have been no confirmed reports of ICE raids at nursing homes or assisted living facilities in New York. 

Karen Lipson, executive vice president of LeadingAge New York, said residents of nursing homes and those with home health aides develop close relationships with the individuals caring for them.

"The staff get to know the residents' preferences and their needs," Lipson said. "They can tell when their condition changes, and they can alert the higher level staff in the facility. And they are losing the comfort of familiar faces and the expertise that they've developed."

By Robert Brodsky

robert.brodsky@newsday.com@BrodskyRobert

Robert Brodsky is a breaking news reporter who has worked at Newsday since 2011. He is a Queens College and American University alum.