Twin Threats From Trump and GOP Imperil Nursing Houses and Their Overseas-Born Employees

In a top-rated nursing house in Alexandria, Virginia, the Rev. Donald Goodness is cared for by nurses and aides from varied elements of Africa. One in every of 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 nations,” Goodness, 92, mentioned about Goodwin Home Alexandria’s workers. With out them, the retired Episcopal priest mentioned, “I’d be, and my constructing can be, desolate.”

The long-term well being care trade 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 trade is very depending on international employees: Greater than 800,000 immigrants and naturalized residents comprise 28% of direct care staff at house care companies, nursing houses, assisted dwelling amenities, and different long-term care firms.

However in January, the Trump administration rescinded former President Joe Biden’s 2021 coverage that protected well being care amenities from Immigration and Customs Enforcement raids. The administration’s broad immigration crackdown threatens to drastically cut back the variety of present and future employees for the trade. “Folks could also be right here on a inexperienced card, and they’re afraid ICE goes to point out up,” mentioned Katie Smith Sloan, president of LeadingAge, an affiliation of nonprofits that take care of 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, based on nursing house officers, resident advocates, and educational consultants. Federal spending cuts below 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 house 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 final result challenges,” mentioned Eric Roberts, an affiliate professor of inside drugs on the College of Pennsylvania.

The trade hasn’t recovered from covid-19, which killed greater than 200,000 long-term care facility residents and employees and led to huge workers 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 instant 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 most important nursing house reform in a long time: a Biden-era rule mandating minimal staffing ranges that would require most of the nation’s practically 15,000 nursing houses to rent extra employees.

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

In an e mail, Vianca Rodriguez Feliciano, a spokesperson for the Division of Well being and Human Providers, mentioned the company “is dedicated to supporting a powerful, steady long-term care workforce” and “continues to work with states and suppliers to make sure high quality take care of older adults and people with disabilities.” In a separate e mail, Tricia McLaughlin, a Division of Homeland Safety spokesperson, mentioned 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 Residing, a faith-based nonprofit, runs three retirement communities in northern Virginia for individuals who reside independently, want a bit of help every day, have reminiscence points, or require the supply of around-the-clock nurses. It additionally operates a retirement group 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 staff are foreign-born and are both searching for citizenship or are already naturalized, based on 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,” mentioned 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 house nation of Liberia, Conteh mentioned. “She was sitting exterior,” Conteh, 56, recalled in an interview.

Conteh was working as a nurse in a hospital in Sierra Leone in 2009 when she discovered of a lottery for visas to come back to the US. She gained, although she couldn’t afford to convey her husband and two youngsters alongside on the time. After she bought a nursing assistant certification, Goodwin employed her in 2012.

Conteh mentioned 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.

“Almost each certainly one of us from Africa, we all know how you can take care of older adults,” she mentioned.

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

Within the nursing house the place Goodness and 89 different residents reside, 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 staff within the constructing, damaged up into eight residential wings referred to as “small homes” and a wing for reminiscence care, at the least 72 have been born overseas, Hutter mentioned.

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 mentioned. “She’s in there at 7:30 within the morning, and he or she helps me bathe.” Goodness mentioned Conteh is exacting about cleanliness and can inform the housekeepers if his room is just not saved correctly.

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

She confirmed him a photograph of Sierra Leone on her telephone 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 mentioned, got here someday when he agreed to lunch together with her within the eating room. Lengthy out of his shell, Goodness now sits on the group’s resident council and enjoys distributing the mail to different residents on his ground.

“The folks that work in my constructing turn into so necessary to us,” Goodness mentioned.

Whereas Trump’s 2024 election marketing campaign targeted on foreigners right here with out authorization, his administration has broadened to focus on these legally right here, together with refugees who fled nations 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 below a Biden-era program.

“I’ve simply spent my morning firing good, sincere 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 group, mentioned 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 employees at Goodwin hardly ever speak about their backgrounds. “They’re scared,” she mentioned. “No person trusts anyone.” Her neighbors in her condo complicated fled the U.S. in December and returned to Sierra Leone after Trump gained the election, leaving their youngsters with kinfolk.

“If all these individuals depart the US, they return to Africa or to their varied nations, what is going to turn into of our residents?” Conteh requested. “What’s going to turn into of our outdated folks that we’re taking good care of?”