Jordan Rau, KFF Health News
In a top-rated nursing house in Alexandria, Virginia, the Rev. Donald Goodness is cared for by nurses and aides from varied components of Africa. One of them, Jackline Conteh, a naturalized citizen and nurse assistant from Sierra Leone, bathes and helps gown him most days and vigilantly intercepts any meal headed his means that incorporates gluten, as Goodness has celiac illness.
“We are full of people who come from other countries,” Goodness, 92, mentioned about Goodwin House Alexandria’s employees. Without them, the retired Episcopal priest mentioned, “I would be, and my building would be, desolate.”
The long-term well being care trade is dealing with a double whammy from President Donald Trump’s crackdown on immigrants and the GOP’s proposals to cut back Medicaid spending. The trade is extremely depending on international employees: More than 800,000 immigrants and naturalized residents comprise 28% of direct care employees at house care businesses, nursing properties, assisted residing services, and different long-term care firms.
But in January, the Trump administration rescinded former President Joe Biden’s 2021 coverage that protected health care facilities from Immigration and Customs Enforcement raids. The administration’s broad immigration crackdown threatens to drastically scale back the variety of present and future employees for the trade. “People may be here on a green card, and they are afraid ICE is going to show up,” mentioned Katie Smith Sloan, president of LeadingAge, an affiliation of nonprofits that take care of older adults.
Existing staffing shortages and quality-of-care issues can be compounded by different insurance policies pushed by Trump and the Republican-led Congress, in keeping with nursing house officers, resident advocates, and tutorial specialists. Federal spending cuts below negotiation could strip nursing properties of a few of their largest income sources by limiting methods states leverage Medicaid cash and making it tougher for brand 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 Americans.
“We are facing the collision of two policies here that could further erode staffing in nursing homes and present health outcome challenges,” mentioned Eric Roberts, an affiliate professor of inner medication on the University of Pennsylvania.
The trade hasn’t recovered from covid-19, which killed more than 200,000 long-term care facility residents and employees and led to large employees attrition and turnover. Nursing properties have struggled to exchange licensed nurses, who can discover better-paying jobs at hospitals and medical doctors’ workplaces, in addition to nursing assistants, who can earn extra working at big-box shops or fast-food joints. Quality points that preceded the pandemic have expanded: The proportion of nursing properties that federal well being inspectors cited for placing residents in jeopardy of instant hurt or demise has risen alarmingly from 17% in 2015 to twenty-eight% in 2024.
In addition to searching for to cut back Medicaid spending, congressional Republicans have proposed shelving the most important nursing house reform in many years: a Biden-era rule mandating minimal staffing ranges that would require most of the nation’s almost 15,000 nursing properties 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 12 months to 82 million in 2050.
In an electronic mail, Vianca Rodriguez Feliciano, a spokesperson for the Department of Health and Human Services, mentioned the company “is committed to supporting a strong, stable long-term care workforce” and “continues to work with states and providers to ensure quality care for older adults and individuals with disabilities.” In a separate electronic mail, Tricia McLaughlin, a Department of Homeland Security spokesperson, mentioned foreigners eager to work as caregivers “need to do that by coming here the legal way” however didn’t tackle the impact on the long-term care workforce of deportations of lessons of licensed immigrants.
Goodwin Living, a faith-based nonprofit, runs three retirement communities in northern Virginia for individuals who dwell independently, want slightly 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 House Alexandria as one of many best-staffed nursing homes within the nation. Forty p.c of the group’s 1,450 workers are foreign-born and are both searching for citizenship or are already naturalized, in keeping with Lindsay Hutter, a Goodwin spokesperson.
“As an employer, we see they stay on with us, they have longer tenure, they are more committed to the organization,” 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 outside,” 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 come back to the United States. She received, although she couldn’t afford to deliver her husband and two kids alongside on the time. After she acquired a nursing assistant certification, Goodwin employed her in 2012.
Conteh mentioned caring for elders is embedded within the tradition of African households. When she was 9, she helped feed and gown 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 within the United States in 2017; she cares for him as a result of he has coronary heart failure.
“Nearly every one of us from Africa, we know how to care for older adults,” she mentioned.
Her daughter is now within the United States, whereas her son remains to be in Africa. Conteh mentioned she sends cash to him, her mother-in-law, and one in all her sisters.
In the nursing house the place Goodness and 89 different residents dwell, Conteh helps with each 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 known as “small houses” 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 City, retiring in 1997. He and his late spouse moved to Alexandria to be nearer to their daughter, and in 2011 they moved into impartial residing on the Goodwin House. In 2023 he moved into one of many expert nursing small homes, the place Conteh began caring for him.
“I have a bad leg and I can’t stand on it very much, or I’d fall over,” he mentioned. “She’s in there at 7:30 in the morning, and 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 want to come out, he want to eat in his room,” she mentioned. “He don’t want to be with the other people in the dining room, so I start making friends with him.”
She confirmed him a photograph of Sierra Leone on her cellphone and advised him of the climate there. He advised her about his work on the church and the way his spouse did laundry for the choir. The breakthrough, she mentioned, got here sooner or later when he agreed to lunch together with her within the eating room. Long 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 that work in my building become so important to us,” Goodness mentioned.
While 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, including refugees who fled nations beset by wars or pure disasters. This month, the Department of Homeland Security revoked the work permits for migrants and refugees from Cuba, Haiti, Nicaragua, and Venezuela who arrived below a Biden-era program.
“I’ve just spent my morning firing good, honest people because the federal government told us that we had to,” Rachel Blumberg, president of the Toby & Leon Cooperman Sinai Residences of Boca Raton, a Florida retirement neighborhood, mentioned in a video posted on LinkedIn. “I am so sick of people saying that we are deporting people because they are criminals. Let me tell you, they are not all criminals.”
At Goodwin House, Conteh is fearful for her fellow immigrants. Foreign employees at Goodwin hardly ever discuss their backgrounds. “They’re scared,” she mentioned. “Nobody trusts anybody.” Her neighbors in her residence complicated fled the U.S. in December and returned to Sierra Leone after Trump received the election, leaving their kids with family.
“If all these people leave the United States, they go back to Africa or to their various countries, what will become of our residents?” Conteh requested. “What will become of our old people that we’re taking care of?”