Nearly 70 million Americans are aged 65 or older, with government estimates indicating that approximately 70 percent of this population will require some form of care during their lifetime. A significant portion of the elder care workforce consists of immigrants, including those under programs such as Deferred Action for Childhood Arrivals (DACA) and Temporary Protected Status (TPS), as well as many undocumented workers providing in-home support. However, recent changes and enforcement in immigration policies are constraining this labor pool, raising concerns about the capacity to meet growing elder care demands.

At Channing House, a senior living community in Palo Alto, California, administrators report the dismissal of several DACA recipients whose work permits were not renewed in time due to government processing delays. More layoffs are expected as the facility prepares for the potential loss of workers with expiring TPS protections following a recent Supreme Court ruling. The court upheld the Trump administration's authority to terminate TPS for nationals from countries like Haiti and Syria, a decision that could ultimately affect more than a million individuals protected under the program. Many of these workers have played critical roles in elder care, including managing diet, medication, and daily hygiene for residents.

Gloria Castellanos, director of dining services at Channing House and a TPS recipient, emphasized her desire simply to continue working after two decades of service. Residents have expressed frustration and anxiety over the possible loss of immigrants who have formed long-standing caregiving relationships. “What can be done, and who are we going to ask to do it?” asked Lou Thompson, a resident and former transportation expert, reflecting the community’s uncertainty.

The Trump administration has tightened scrutiny on DACA beneficiaries, whose two-year work permits now face longer and more detailed renewal processes, resulting in thousands temporarily leaving the workforce. A May policy alert indicated that renewals would no longer be automatic but instead subject to individual review. Meanwhile, the Supreme Court ruling on TPS marks a turning point in the government’s effort to limit the program, which officials argue has become a de facto permanent immigration policy despite originally intended as a temporary measure.

Industry leaders warn of the consequences. Katie Smith Sloan, CEO of LeadingAge, which represents thousands of aging service providers, called the policy shifts “a government-mandated disservice” to older adults. The sector is already grappling with staffing shortages; a 2023 survey of 400 nursing homes found more than half had refused new residents due to insufficient personnel. Hebrew SeniorLife, a nonprofit with several campuses in the Boston area, reports losing dozens of immigrant workers since 2017. They anticipate terminating additional Haitian employees whose TPS protections expire soon, a change expected to disrupt care for approximately 4,500 seniors daily.

Low Medicaid reimbursement rates further complicate efforts to increase wages and attract new workers. Health economist Brian McGarry of the University of Rochester highlighted the challenge of raising pay when Medicaid typically covers only 82 cents on the dollar for nursing home expenses. He warned that declining staff levels can adversely affect resident outcomes.

The human impact of these policies was evident at a June gathering at Channing House, where immigrant staff shared their uncertainties and fears. Yadira Aldana, a DACA recipient overseeing nursing staff, described how delays in renewal processing cause anxiety and threaten the stability of their lives and careers. Licensed nurse Marlene Vasquez recounted how the expiration of her work authorization forced her to leave a job she loved. Her absence was felt keenly by Kent Mather, an 88-year-old resident with Parkinson’s disease whom she formerly cared for.

The intersection of immigration policy and elder care workforce availability continues to pose a critical challenge as the U.S. population ages and demand for quality care intensifies.