Trump’s immigration policy shakes up the elder care sector: ‘Losing these caregivers is a profound blow’

Florida has historically been an oasis for retirees. Nearly a third of the state’s elder care workforce is concentrated in the south end of the peninsula, between Miami and Palm Beach. For a long time, newly arrived immigrants were a reliable source of candidates for these jobs in an industry that has historically struggled to maintain the necessary staffing levels, both due to the inherent demands of the job and the low pay—barely above Florida’s minimum wage. Now, the Trump administration’s immigration policies, which include an agenda to detain 3,000 people per day, have begun to take their toll on this sector.

While the impact has been felt nationally, in South Florida, the place of residence for the majority of the hundreds of thousands of immigrants suddenly left without legal status after the administration canceled their temporary protections or humanitarian permits — including Haitians, Cubans, Venezuelans, and Nicaraguans — the blow has been particularly brutal, said experts, business owners, and service provider associations.

In Miami, they are known as chechei—recreating the way the acronym for Home Health Aide, HHA, sounds to a Spanish speaker. Many of the Latin American immigrants who have arrived in the U.S. recent years, willing to work hard, have found that by completing a 75-hour course, they could obtain a certificate to care for the elderly or disabled, for around $14 an hour. Some have become certified nursing assistants (CNAs), which lets them work in senior residences or nursing homes, where they earn just over $15 an hour but receive some additional benefits such as health insurance or bonuses.

Esmeralda Vigay, from the Miami franchise of Home Instead, a renowned national network specializing in home care for seniors, said that the staff, “made up of people of all nationalities,” has recently been reduced, and they are having difficulty replacing those who leave. “Many patients who had a caregiver for a long time, to whom they had grown accustomed and with whom they had formed an affectionate bond, have suddenly found themselves looking for another one,” she said.

Leiza Rodríguez, who runs a small family-run day care business for seniors in Homestead, south of Miami, said that one of her four employees, a Cuban man who had arrived less than two years earlier through the humanitarian parole program known as CHNV, suddenly “had his work permit taken away.” The man drove the bus that picks up about 25 clients from their homes each day to take them to the clinic, a key function of the business. Rodríguez had to “move quickly” to replace him, but the position requires background checks, drug tests, and other paperwork that takes time. “We lost money,” she said.

“Many people I know, including other businesses, have been affected,” said Rodríguez, who has run the care center since 2011. All of her employees have always had “work permits and their papers in order,” including those who had “asylum or parole,” she added.

The Trump administration revoked the legal status of half a million people who arrived in the U.S. through the CHNV program and hundreds of thousands more who entered using the CBP One program in April. It also canceled Temporary Protected Status (TPS) for half a million Haitians, some 600,000 Venezuelans, and tens of thousands of Hondurans and Nicaraguans.

In Florida, home to one of the largest elderly populations in the country, Governor Ron DeSantis has sought to position himself at the forefront of the national crackdown on immigrants, pushing through agreements with local authorities to arrest people based on their immigration status, building new detention centers like the infamous Alligator Alcatraz, and pushing through restrictive policies that have been challenged in court.

“Despite the administration’s claim of targeting criminals, we know that all immigrants are under threat, with whole communities being terrorized,” said Leslie Frane, vice president of the Service Employees International Union (SEIU), the nation’s largest health care workers union, with nearly 2 million members. “As the nation’s largest health care union, we can see the chilling impact across our care system especially. Three in ten home care workers are immigrants and 21 percent of the nursing assistant workforce are immigrants,” she added. They make up an essential workforce that’s been largely invisible, but enables millions of Americans to work, thrive and live with dignity, including children, seniors, and people with disabilities.

Lisa Sanders of LeadingAge, an influential organization representing nonprofits serving older adults, said one member in Florida had to lay off 10 people after the CHNV ended and anticipates laying off more when TPS for Haitians expires in February 2026. Another member, Rachel Blumberg of Toby & Leon Cooperman Sinai Residences in Boca Raton, north of Miami, predicted that with the TPS ending, they risked losing eight percent of their 430 employees.

“These are people who are working legally, working hard, paying taxes, contributing to their communities,” Sanders said, adding that members across the country are facing this situation, including some who “don’t want to speak out because they don’t want to attract attention and are concerned about the well-being of their staff.”

A risk for older adults

In an April 30 letter to DHS Secretary Kristi Noem, LeadingAge said the elimination of protections like TPS for Haiti and Venezuela, as well as the CHNV program, put older adults at risk by destabilizing the workforce that cares for them. “Your agency’s decisions to terminate the temporary parole for all CHNV individuals and roll back TPS designations for Haiti and Venezuela have created immediate uncertainty and concern for employers and workers alike,” wrote Katie Smith Sloan, president and CEO of LeadingAge. “Many of our members will lose deeply valued, experienced staff at a time when replacement workers are exceedingly difficult to find. This is not a future concern — this is an April 2025 concern," she added, urging DHS “to reconsider its recent decisions” and “commit to exploring more permanent immigration pathways for these essential workers.”

Foreign-born workers represent 31% of the home care workforce, 21% of residential care aides, 21% of nursing assistants, and 30% of cleaning and maintenance staff in nursing homes, said a LeadingAge spokesperson. “For a sector such as ours, losing these valued caregivers is a profound blow. Why would the U.S. government force our members to fire them? It makes no sense,” she added.

Sanders explained that the sector has long faced challenges related to reimbursement rates from Medicaid, the government health insurance program for low-income people. The cost of services is directly related to the reimbursement received by providers, many of whom operate as nonprofits. Salaries are directly related to costs and reimbursements, and some members turn to philanthropy to cover their needs, she explained. On the other hand, there is an “unquestionable relationship between staffing and quality of care.”

A scientific study by the Pension Research Council at the Wharton School (University of Pennsylvania) linked staffing shortages to increased use of sedatives in nursing home patients with dementia or difficult behavior. The study found that increasing staffing levels led to a decrease in the use of antipsychotic medications. According to the researchers, many for-profit nursing homes use sedatives as a form of control when they are understaffed because “patients in chemical restraints require less work,” allowing them to operate with fewer workers.

“If immigration policies restrict access to a key segment of the long-term care workforce, staffing could worsen—amplifying the risks we identify,” said Professor Jong Myeong Lim of the University of Miami, one of the study’s authors. “Studying how broader labor and immigration policies intersect with care quality and abuse risks in nursing homes is both timely and critical.”

Other LeadingAge members have noted that their foreign employees represent between 40% and 75% of their staff, many of whom have been working legally in the country for years and hold essential roles, and that losing them would have a critical impact on the care of thousands of older adults. These organizations described a growing emotional burden among staff, who are living with uncertainty and fear, and affirmed that these workers are not just numbers, but colleagues, friends, and valued members of the community.

Some have taken steps such as hiring immigration attorneys “to navigate these issues and pursue other legal avenues” to remain in the country, the LeadingAge spokesperson said, without providing details. “Each lost employee must be replaced. Until that can happen, providers have to make difficult decisions. Will the number of available beds in a nursing home have to be reduced, because they do not have sufficient staff?”

“This issue has both immediate impact and long term impact: with fewer foreign-born workers allowed to work here, how will the pipeline be filled?” he added.

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL), which represents long-term care providers, said that “immigrants represent a significant portion of the long-term care workforce” and that they have supported streamlining legal pathways for international caregivers to enter the system to strengthen this workforce and “prepare for the growing demand for long-term care.”

SIEU’s Frane added, “When you consider that 10,000 Americans turn 65 every day, it’s clear that our care economy is truly unsustainable without an immigrant workforce. As more immigrant workers lose their protection, families will be deprived of the care they rely on and the cost of care will skyrocket for all of us.”