As the Associated Press reported July 14 in a piece that is justifiably going viral, there’s a quiet catastrophe unfolding in America’s nursing homes. It’s not a story of medical error or corporate greed. It’s a policy decision — one that may, in the most practical terms, soon render the care of our parents and grandparents impossible to sustain.
Across the country, skilled nursing facilities are losing some of their most reliable and compassionate workers. Not because these caregivers did anything wrong. Not because they’re leaving for higher pay or better working conditions. But because their legal ability to work in this country is being stripped away by federal action — or inaction.
The latest shift in immigration policy by President Trump’s administration is aimed at revoking or rolling back Temporary Protected Status (TPS) for thousands of immigrant workers, many of whom have been here for years — some for decades. These are the quiet and fine professionals who change bedsheets, feed patients, help them bathe and dress, and sit with them during their hardest days.
They don’t make headlines. They make the system work.
The AP reported that in places like Atlanta, CEOs of nonprofit homes say their already strained staffing pipelines are “getting smaller and smaller.” Eight TPS workers at one facility are set to be forced out. That’s a handful of people — yet they may prove impossible to replace. The staffing crisis in elder care isn’t hypothetical anymore — it’s here.
As a shareholder at a law firm that has long embraced the responsibility of representing families when they have been let down by our long-term care system, I want to make one thing absolutely clear: Our long-term care system depends on immigrants. Always has. Always will.
But even that only scratches the surface. The deeper problem is this: We are running out of people willing — and able — to do this work at all.
Understaffing isn’t a new challenge in nursing homes. Even before the pandemic, elder care facilities were scrambling to find qualified, compassionate workers. Not just bodies to fill a schedule, but people who truly care. People who treat caregiving not as a gig, but as a calling. Finding them was already like hunting for unicorns. These new immigration policies don’t make the search harder. They make it impossible.
One in four direct care workers in the U.S. is foreign-born. In cities like Miami, New York or Los Angeles, that number can be more than half. These are not fly-by-night workers. They are trained, vetted and legally authorized. Without them, the entire system teeters.
What we’re witnessing now isn’t a return to order or a tightening of standards — it’s a slow-motion collapse of one of the most fragile corners of our health care system. When the last lifeline of staffing is cut, there won’t be anyone left to show up for our seniors. Not enough hands to change dressings, to lift bodies, to listen. Not enough people who care — in both senses of the word.
When you gut the immigration pipeline, you gut the care pipeline. There’s no margin left in long-term care — not after COVID, not after years of underfunding, not after burnout drove thousands from the field. What’s left are the workers who stayed. And now we’re telling many of them they’re no longer welcome.
Seniors won’t suffer all at once. It will be in waves: fewer staff per shift, slower response times, more neglected hygiene, more falls, more infections. And more lawsuits. The delivery of safe care will be impossible to deliver. You can’t have a functioning nursing home without people to run it.
This is the cost of treating immigration like a rhetorical punching bag instead of a cornerstone of America’s caregiving infrastructure.
Congress can — and must — act now. It should move to protect workers with TPS from arbitrary removal and expand pathways for legal immigration in the direct care workforce. These are not theoretical policies — they are lifelines for patients, families and every frontline worker trying to hold this fragile system together.
There are some failures a system can recover from. But if we let this one unfold unchecked, there won’t be a system left to fix.
Sean C. Domnick is a shareholder at Rafferty Domnick Cunningham & Yaffa, a national boutique law firm based in Palm Beach Gardens and Pensacola.