Dual Threats From Trump and GOP Imperil Nursing Homes and Their Foreign-Born Workers

In a top-rated nursing residence in Alexandria, Virginia, the Rev. Donald Goodness is cared for by nurses and aides from varied elements of Africa. One in all them, Jackline Conteh, a naturalized citizen and nurse assistant from Sierra Leone, bathes and helps costume him most days and vigilantly intercepts any meal headed his means that incorporates gluten, as Goodness has celiac illness.

“We’re full of people that come from different international locations,” Goodness, 92, stated about Goodwin Home Alexandria’s employees. With out them, the retired Episcopal priest stated, “I’d be, and my constructing can be, desolate.”

The long-term well being care business is going through a double whammy from President Donald Trump’s crackdown on immigrants and the GOP’s proposals to cut back Medicaid spending. The business is extremely depending on international staff: Greater than 800,000 immigrants and naturalized residents comprise 28% of direct care workers at residence care businesses, nursing houses, assisted dwelling services, and different long-term care corporations.

However in January, the Trump administration rescinded former President Joe Biden’s 2021 coverage that protected well being care services from Immigration and Customs Enforcement raids. The administration’s broad immigration crackdown threatens to drastically cut back the variety of present and future staff for the business. “Individuals could also be right here on a inexperienced card, and they’re afraid ICE goes to point out up,” stated Katie Smith Sloan, president of LeadingAge, an affiliation of nonprofits that look after older adults.

Present staffing shortages and quality-of-care issues can be compounded by different insurance policies pushed by Trump and the Republican-led Congress, in response to nursing residence officers, resident advocates, and tutorial specialists. Federal spending cuts underneath negotiation could strip nursing houses of a few of their largest income sources by limiting methods states leverage Medicaid cash and making it tougher for brand spanking new nursing residence residents to retroactively qualify for Medicaid. Care for six in 10 residents is paid for by Medicaid, the state-federal well being program for poor or disabled People.

“We face the collision of two insurance policies right here that might additional erode staffing in nursing houses and current well being end result challenges,” stated Eric Roberts, an affiliate professor of inner medication on the College of Pennsylvania.

The business hasn’t recovered from covid-19, which killed greater than 200,000 long-term care facility residents and staff and led to huge employees attrition and turnover. Nursing houses have struggled to switch licensed nurses, who can discover better-paying jobs at hospitals and docs’ places of work, in addition to nursing assistants, who can earn extra working at big-box shops or fast-food joints. High quality points that preceded the pandemic have expanded: The proportion of nursing houses that federal well being inspectors cited for placing residents in jeopardy of rapid hurt or loss of life has risen alarmingly from 17% in 2015 to twenty-eight% in 2024.

Along with searching for to cut back Medicaid spending, congressional Republicans have proposed shelving the largest nursing residence reform in a long time: a Biden-era rule mandating minimal staffing ranges that may require many of the nation’s almost 15,000 nursing houses to rent extra staff.

The long-term care business expects demand for direct care staff to burgeon with an inflow of growing old child boomers needing skilled care. The Census Bureau has projected the variety of individuals 65 and older would develop from 63 million this 12 months to 82 million in 2050.

In an e-mail, Vianca Rodriguez Feliciano, a spokesperson for the Division of Well being and Human Providers, stated the company “is dedicated to supporting a powerful, secure long-term care workforce” and “continues to work with states and suppliers to make sure high quality look after older adults and people with disabilities.” In a separate e-mail, Tricia McLaughlin, a Division of Homeland Safety spokesperson, stated foreigners desirous to work as caregivers “want to try this by coming right here the authorized means” however didn’t tackle the impact on the long-term care workforce of deportations of courses of approved immigrants.

Goodwin Dwelling, a faith-based nonprofit, runs three retirement communities in northern Virginia for individuals who stay independently, want just a little help every day, have reminiscence points, or require the supply of around-the-clock nurses. It additionally operates a retirement neighborhood in Washington, D.C. Medicare charges Goodwin Home Alexandria as one of many best-staffed nursing houses within the nation. Forty % of the group’s 1,450 workers are foreign-born and are both searching for citizenship or are already naturalized, in response to Lindsay Hutter, a Goodwin spokesperson.

“As an employer, we see they keep on with us, they’ve longer tenure, they’re extra dedicated to the group,” stated Rob Liebreich, Goodwin’s president and CEO.

Jackline Conteh spent a lot of her youth shuttling between Sierra Leone, Liberia, and Ghana to keep away from wars and tribal conflicts. Her mom was killed by a stray bullet in her residence nation of Liberia, Conteh stated. “She was sitting outdoors,” Conteh, 56, recalled in an interview.

Conteh was working as a nurse in a hospital in Sierra Leone in 2009 when she realized of a lottery for visas to return to the US. She received, although she couldn’t afford to convey her husband and two kids alongside on the time. After she acquired a nursing assistant certification, Goodwin employed her in 2012.

Conteh stated taking good care of elders is embedded within the tradition of African households. When she was 9, she helped feed and costume her grandmother, a job that rotated amongst her and her sisters. She washed her father when he was dying of prostate most cancers. Her husband joined her in the US in 2017; she cares for him as a result of he has coronary heart failure.

“Practically each certainly one of us from Africa, we all know find out how to look after older adults,” she stated.

Her daughter is now in the US, whereas her son continues to be in Africa. Conteh stated she sends cash to him, her mother-in-law, and certainly one of her sisters.

Within the nursing residence the place Goodness and 89 different residents stay, Conteh helps with day by day duties like dressing and consuming, checks residents’ pores and skin for indicators of swelling or sores, and tries to assist them keep away from falling or getting disoriented. Of 102 workers within the constructing, damaged up into eight residential wings referred to as “small homes” and a wing for reminiscence care, a minimum of 72 had been born overseas, Hutter stated.

Donald Goodness grew up in Rochester, New York, and spent 25 years as rector of The Church of the Ascension in New York Metropolis, retiring in 1997. He and his late spouse moved to Alexandria to be nearer to their daughter, and in 2011 they moved into impartial dwelling on the Goodwin Home. In 2023 he moved into one of many expert nursing small homes, the place Conteh began caring for him.

“I’ve a foul leg and I can’t stand on it very a lot, or I’d fall over,” he stated. “She’s in there at 7:30 within the morning, and he or she helps me bathe.” Goodness stated Conteh is exacting about cleanliness and can inform the housekeepers if his room will not be stored correctly.

Conteh stated Goodness was withdrawn when he first arrived. “He don’t need to come out, he need to eat in his room,” she stated. “He don’t need to be with the opposite individuals within the eating room, so I begin making mates with him.”

She confirmed him a photograph of Sierra Leone on her cellphone and instructed him of the climate there. He instructed her about his work on the church and the way his spouse did laundry for the choir. The breakthrough, she stated, got here at some point when he agreed to lunch along with her within the eating room. Lengthy out of his shell, Goodness now sits on the neighborhood’s resident council and enjoys distributing the mail to different residents on his flooring.

“The people who work in my constructing turn out to be so necessary to us,” Goodness stated.

Whereas Trump’s 2024 election marketing campaign centered on foreigners right here with out authorization, his administration has broadened to focus on these legally right here, together with refugees who fled international locations beset by wars or pure disasters. This month, the Division of Homeland Safety revoked the work permits for migrants and refugees from Cuba, Haiti, Nicaragua, and Venezuela who arrived underneath a Biden-era program.

“I’ve simply spent my morning firing good, trustworthy individuals as a result of the federal authorities instructed us that we needed to,” Rachel Blumberg, president of the Toby & Leon Cooperman Sinai Residences of Boca Raton, a Florida retirement neighborhood, stated in a video posted on LinkedIn. “I’m so sick of individuals saying that we’re deporting individuals as a result of they’re criminals. Let me inform you, they don’t seem to be all criminals.”

At Goodwin Home, Conteh is fearful for her fellow immigrants. Overseas staff at Goodwin hardly ever speak about their backgrounds. “They’re scared,” she stated. “No person trusts anyone.” Her neighbors in her condominium advanced fled the U.S. in December and returned to Sierra Leone after Trump received the election, leaving their kids with family members.

“If all these individuals depart the US, they return to Africa or to their varied international locations, what is going to turn out to be of our residents?” Conteh requested. “What’s going to turn out to be of our outdated people who we’re taking good care of?”