DAILY NEWS CLIP: January 28, 2025

Trump’s planned immigration purge threatens care for the state’s elderly


The Boston Globe – Monday, January 27, 2025
By Kay Lazar

She has lived through armed gangs seizing her home in Pernier, Haiti, and not knowing whether it’s safe to walk outside. Now, when she closes her eyes at night, it’s not gunfire that keeps her awake but fears that she will lose the new, tranquil life she’s built in Massachusetts.

In the two short years since she fled Haiti, Erna trained as a nursing assistant, became certified, and now works as a nurse aide in an assisted living residence in Greater Boston.

“I don’t want to go back to Haiti,” said the 31-year-old Milton resident, who worked as an accountant in her home country. ”It’s not secure there.” The Globe is not using Erna’s full name because of concerns about her immigration status going forward.

Such fears and anxieties are coursing through health care facilities, especially in places where low-paid immigrants provide a large share of the care for elderly and frail residents, including bathing, feeding, and keeping them company.

In Massachusetts nursing homes alone, 40 percent of the front-line staff are immigrants, many from Haiti. They include nursing assistants, licensed nurses, and those working in housekeeping and dining services.

Trump’s executive orders, which seek sweeping changes to America’s immigration system, have sent a chill through the workforce, as everyone from policy experts to nurses aides strive to understand the impact of the directives.

Among the concerns is Trump’s ordered “review” of the Temporary Protected Status program, which grants temporary work permits and protection from deportation to migrants, including Erna, from specific countries like Haiti experiencing armed conflicts or environmental disasters.

An estimated 35,320 immigrants in Massachusetts are here under Temporary Protected Status, and the nursing home industry believes about 5,000 of them are employed in nursing homes. That’s causing some uneasiness.

“The elimination, or even the threat to repeal the work authorization status or Temporary Protected Status… will have a devastating impact on our ability to meet the care needs of the more than 100,000 residents and families who each year depend on our services,” said Tara Gregorio, president of Massachusetts Senior Care, a trade association for nursing homes.

Even before Trump’s immigration crackdown, the industry had been struggling to attract and retain enough of these vital workers, prompting some Massachusetts nursing homes to close their doors to new patients.

“The Commonwealth’s skilled nursing facilities are already denying new admissions due to critical workforce challenges with 1 in 7 positions vacant,” Gregorio said. “Repeal of the work authorization and TPS status for the individuals working in our setting would have a cascading effect, exacerbate our labor crisis and put at risk our most vulnerable older adults.”

Trump’s actions come amid a rapidly aging US population that will require more elder care, with the number of people over 65 projected to increase by nearly 50 percent by 2050, according to the Population Reference Bureau.

That’s raising questions about whether there will be enough workers to care for aging Boomers, let alone the next generation.

Already, severe nursing home staffing shortages in Massachusetts have created a dangerous domino effect in the state’s hospitals, leading to long wait times in many emergency rooms, health leaders say. Hospitals can’t free up enough beds in emergency departments because many of the places where patients are discharged to, like nursing homes, are also swamped.

“Job vacancies within these settings are a major driver behind the hospital capacity challenges being seen today. Upwards of 2,000 patients are stuck in [Massachusetts] hospitals because, to no fault of their own, they cannot access the next level of care they need,” said Adam Delmolino, senior director of virtual care and clinical affairs at the Massachusetts Health and Hospital Association.

“In turn, this drives up wait times and backups that reverberate throughout the entire system,” he said.

David Grabowski, a health policy researcher at Harvard Medical School, said actions to reduce the number of people working in nursing homes in Massachusetts, or anywhere in the US, will hurt the quality of care.

His recent research revealed “strong and consistent evidence that increased immigration leads to improved patient care, particularly for those who are in nursing homes for short stays, typically rehabilitation.”

His latest research found that during the pandemic, many US-born nursing home workers fled the industry, but immigrants remained.

“This is not a job that people are queuing up to take. They’re paid close to minimum wage. The work is really challenging. There aren’t often benefits,” Grabowski said.

But immigrants may have stronger incentives to enter and remain in these jobs because they have fewer options, he said.

“Based on our data, foreign-born workers stay longer, and that’s good for resident care,” he added. “If you have an individual with dementia, it’s good to have the same staff every day, and consistency is really important.”

Grabowski noted that other countries, like Canada, have programs that provide a faster track to permanent residency for immigrants interested in working in long-term health care.

“So during a time when [the US] should be thinking more innovatively about recruiting more individuals to work in nursing homes, we’re going in the opposite direction,” he said.

The trade association that represents both assisted living and nursing homes nationwide said in a statement that the Trump administration and Congress need to “think beyond our borders” to solve the country’s growing caregiver shortage.

“Streamlining legal pathways for passionate people to come to our country and serve our seniors is an important part of how our sector will answer the growing demand for long-term care,” said Clif Porter, president and chief executive of the American Health Care Association/National Center for Assisted Living.

In Massachusetts, the state’s health and hospital association is lobbying lawmakers for more money to train additional nurses aides and advance the skills of entry-level employees to make the field more attractive by developing more career pathways in health care.

“For the sake of patient care, it is imperative that every qualified caregiver – from every background and nationality – has a pathway to serve in the settings where they are needed the most,” said Delmolino of the Massachusetts Health and Hospital Association.

Leaders in home health care are also uneasy about immigration cuts and their potential impact on recruiting and retaining workers. They struggle with similarly acute staffing shortages, with an additional hurdle thrown in, said Jake Krilovich, executive director of the Home Care Alliance of Massachusetts.

The country’s tense political climate means home health workers may face racism or anti-immigrant sentiments when they walk into a home to provide care.

“Our workforce goes in alone,” Krilovich said. “It’s an isolating job and workplace safety is a concern.”

The organization represents about 100,000 caregivers.

For Erna, the nurse assistant who fled violence in Haiti, the thought that she might be sent back there under potential immigration cuts is distressing.

“I wish [Trump] changes his mind about deportation. Immigrants are good people,” she said. “Living in Massachusetts, I live in peace. I am not afraid.”

Access this article at its original source.

Digital Millennium Copyright Act Designated Agent Contact Information:

Communications Director, Connecticut Hospital Association
110 Barnes Road, Wallingford, CT
rall@chime.org, 203-265-7611