Uncertainty from the Trump administration's immigration crackdown could disproportionately affect industries that rely on immigrant workers, including nursing homes, where about 1 in 5 workers is an immigrant, according to an Axios report examining the intersection of federal immigration policy and critical care infrastructure.
Nursing and residential care facilities across the country employed about 3.49 million people as of May, up from 2.96 million at the industry's lowest point in January 2022, according to the report. More granular federal data shows there are only 1,400 fewer staff employed in nursing homes specifically than in February 2020. Staffing levels have mostly bounced back to pre-pandemic levels after cratering during the health emergency, but the labor reprieve could be short-lived.
Workforce Recovery at Risk
Clif Porter, CEO of the nursing home trade group American Health Care Association/National Center for Assisted Living, said, "I'm super excited when I go around the country and see the improvement not only on recruitment but on retention." Rachel Bunch, executive director at the Arkansas Health Care Association, said, "I have heard from a lot of administrators ... that this is giving them hope for the future."
Yet the fragile recovery in elder care staffing comes as the Trump administration's immigration policies are affecting federal operations, Senate confirmation politics and labor markets. Porter emphasized the irreplaceable nature of human caregiving, saying algorithms cannot replace a live caregiver lifting a patient and moving them from the bed to the shower.
Regulatory Protections Stripped
David Grabowski, a health care policy professor at Harvard Medical School, said, "It wasn't a perfect rule, but I do think having that floor would have really helped here, in terms of guarding against these really low-staff places," referring to federal staffing rules that were tossed by a federal court last year. The loss of minimum staffing requirements has left vulnerable residents without baseline protections even as the sector faces mounting demographic pressures.
The industry has doubled down on incentive programs and career ladders, according to Axios. Arkansas' state nursing home association has opened accredited educational programs for staff to earn higher certifications and degrees tuition-free while allowing enrollees to work while attending school.
Looming Demographic Crisis
The number of adults aged 80 and older is projected to double between 2025 and 2045, while the proportion of working-age adults declines, the report said. Nursing shortages across the entire U.S. health care sector are expected through 2038, according to a federal analysis.
Separately, Politico reported that sweeping federal spending reviews slowed government efforts related to immigration matters, including containment of the New World screwworm, and that Trump announced he would disrupt the plan to quickly confirm DNI nominee Jay Clayton, affecting Senate confirmation dynamics.
Why This Matters:
The convergence of immigration enforcement, demographic aging, and regulatory rollbacks threatens the stability of elder care at precisely the moment when millions of Americans will depend on it most. With immigrant workers comprising one-fifth of the nursing home workforce and federal protections against understaffing eliminated, vulnerable seniors face increased risk of inadequate care. The projected doubling of the population aged 80 and older over 20 years, combined with nursing shortages expected through 2038, creates a structural crisis that market incentives alone cannot resolve. Without robust public policy supporting both worker protections and pathways to employment for immigrant caregivers, the modest staffing gains achieved since the fourth year after pandemic lows could quickly evaporate, leaving families and communities to bear the consequences of policy choices that prioritize enforcement over care infrastructure.