Nursing homes face 2 threats: Trump's Medicaid cuts and his immigration crackdown

Jackline Conteh, 1 of galore African-born caregivers astatine nan Goodwin House Alexandria nursing home, cares for nan Rev. Donald Goodness, 92. Nursing homes are taxable to Immigration and Customs Enforcement raids nether nan Trump administration. Alyssa Schukar/for KFF Health News hide caption

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Alyssa Schukar/for KFF Health News

In a top-rated nursing location successful Alexandria, Va., nan Rev. Donald Goodness is cared for by nurses and aides from various parts of Africa. One of them, Jackline Conteh, a naturalized U.S. national and caregiver adjunct from Sierra Leone, bathes and helps dress him astir days and vigilantly intercepts immoderate repast headed his measurement that contains gluten, arsenic Goodness has celiac disease.

"We are afloat of group who travel from different countries," Goodness, 92, said astir Goodwin House Alexandria's staff. Without them, nan retired Episcopal leader said, "I would be, and my building would be, desolate."

"Nearly each 1 of america from Africa, we cognize really to attraction for older adults," says Jackline Conteh, a certified nursing adjunct from Sierra Leone. She stands pinch nan Rev. Donald Goodness. Alyssa Schukar/KFF Health News hide caption

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Alyssa Schukar/KFF Health News

The semipermanent wellness attraction manufacture is facing a double whammy from President Trump's crackdown connected immigrants and nan Republican Party's proposals to trim Medicaid spending. The manufacture is highly limited connected overseas workers: More than 800,000 immigrants and naturalized citizens comprise 28% of nonstop attraction employees astatine location attraction agencies, nursing homes, assisted surviving accommodation and different semipermanent attraction companies.

But successful January, nan Trump management rescinded erstwhile President Joe Biden's 2021 argumentation that protected wellness attraction facilities from Immigration and Customs Enforcement raids. The administration's wide migration crackdown threatens to drastically trim nan number of existent and early workers for nan industry. "People whitethorn beryllium present connected a greenish card, and they are acrophobic ICE is going to show up," said Katie Smith Sloan, president of LeadingAge, an relation of nonprofits that attraction for older adults.

A collision of policies

Staffing shortages and quality-of-care problems would beryllium compounded by different policies pushed by Trump and nan Republican-led Congress, according to nursing location officials, resident advocates and world experts. Federal spending cuts nether speech whitethorn portion nursing homes of immoderate of their largest gross sources by limiting ways states leverage Medicaid money and by making it harder for caller nursing location residents to retroactively qualify for Medicaid. Care for 6 successful 10 residents is paid for by Medicaid, nan state-federal wellness programme for mediocre aliases abnormal Americans.

"We are facing nan collision of 2 policies present that could further erode staffing successful nursing homes and coming wellness result challenges," said Eric Roberts, an subordinate professor of soul medicine astatine nan University of Pennsylvania.

The manufacture hasn't recovered from COVID-19, which killed much than 200,000 semipermanent attraction installation residents and workers and led to monolithic unit attrition and turnover. Nursing homes person struggled to switch licensed nurses, who tin find better-paying jobs astatine hospitals and doctors' offices, arsenic good arsenic nursing assistants, who tin gain much moving astatine big-box stores aliases fast-food joints. Quality issues that preceded nan COVID-19 pandemic person expanded: The percent of nursing homes that national wellness inspectors cited for putting residents successful jeopardy of contiguous harm aliases decease has risen alarmingly from 17% successful 2015 to 28% successful 2024.

In summation to seeking to trim Medicaid spending, legislature Republicans person projected shelving nan biggest nursing location betterment successful decades: a Biden-era norm mandating minimum staffing levels that would require most of nan United States' astir 15,000 nursing homes to prosecute much workers.

The semipermanent attraction manufacture expects request for nonstop attraction workers to burgeon pinch an influx of aging babe boomers needing master care. The Census Bureau has projected that nan number of group 65 aliases older will turn from 63 cardinal this twelvemonth to 82 cardinal successful 2050.

In an email, Vianca Rodriguez Feliciano, a spokesperson for nan Department of Health and Human Services, said nan agency "is committed to supporting a strong, unchangeable semipermanent attraction workforce" and "continues to activity pinch states and providers to guarantee value attraction for older adults and individuals pinch disabilities." In a abstracted email, Tricia McLaughlin, a Department of Homeland Security spokesperson, said foreigners wanting to activity arsenic caregivers "need to do that by coming present nan ineligible way" but did not reside nan effect connected nan semipermanent attraction workforce of deportations of classes of authorized immigrants.

A committedness to nan job

Goodwin Living, a faith-based nonprofit, runs 3 status communities successful Northern Virginia for group who unrecorded independently, request a small assistance each day, person representation issues aliases require nan readiness of around-the-clock nurses. It besides operates a status organization successful Washington, D.C. Medicare rates Goodwin House Alexandria arsenic 1 of nan best-staffed nursing homes successful nan country. Forty percent of nan organization's 1,450 labor are foreign-born and are either seeking citizenship aliases are already naturalized, according to Lindsay Hutter, a Goodwin spokesperson.

"As an employer, we spot they enactment connected pinch us, they person longer tenure, they are much committed to nan organization," said Rob Liebreich, Goodwin's president and CEO.

Jackline Conteh spent overmuch of her younker shuttling betwixt Sierra Leone, Liberia and Ghana to debar wars and tribal conflicts. Her mother was killed by a stray slug successful her location state of Liberia, Conteh said. "She was sitting outside," Conteh, 56, recalled successful an interview.

Conteh was moving arsenic a caregiver successful a infirmary successful Sierra Leone successful 2009 erstwhile she learned of a lottery for visas to travel to nan United States. She won, though she couldn't spend to bring her hubby and 2 children on astatine nan time. After she sewage a nursing adjunct certification, Goodwin hired her successful 2012.

Conteh said taking attraction of elders is embedded successful nan civilization of African families. When she was 9, she helped provender and dress her grandmother, a occupation that rotated among her and her sisters. She washed her begetter erstwhile he was dying of prostate cancer. Her hubby joined her successful nan United States successful 2017; she cares for him because he has bosom failure.

"We cognize really to attraction for older adults," she said.

Her girl is now successful nan United States, while her boy is still successful Africa. Conteh said she sends money to him, her mother-in-law and 1 of her sisters.

Jackline Conteh helps Donald Goodness pinch his hairsbreadth and different "activities of regular living," arsenic it is known successful nan attraction industry, astatine Goodwin House Alexandria successful Virginia. Alyssa Schukar/for KFF Health News hide caption

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Alyssa Schukar/for KFF Health News

In nan nursing location wherever Goodness and 89 different residents live, Conteh helps pinch regular tasks for illustration dressing and eating, checks residents' tegument for signs of swelling aliases sores, and tries to thief them debar falling aliases getting disoriented. Of 102 labor successful nan building, surgery up into 8 residential wings called "small houses" and a helping for representation care, astatine slightest 72 were calved abroad, Hutter said.

"I commencement making friends pinch him"

Donald Goodness grew up successful Rochester, N.Y., and spent 25 years arsenic rector of nan Church of nan Ascension successful New York City, retiring successful 1997. He and his now-deceased woman moved to Alexandria to beryllium person to their daughter, and successful 2011 they moved into independent surviving astatine Goodwin House. In 2023, he moved into 1 of nan skilled nursing mini houses, wherever Conteh started caring for him.

"I person a bad limb and I can't guidelines connected it very much, aliases I'd autumn over," he said. "She's successful location astatine 7:30 successful nan morning, and she helps maine bathe." Goodness said Conteh is exacting astir cleanliness and will show nan housekeepers if his room is not kept properly.

Conteh said Goodness was withdrawn erstwhile he first arrived. "He don't want to travel retired — he want to eat successful his room," she said. "He don't want to beryllium pinch nan different group successful nan eating room, truthful I commencement making friends pinch him."

She showed him a photograph of Sierra Leone connected her telephone and told him of nan upwind there. He told her astir his activity astatine nan religion and really his woman did laundry for nan choir. The breakthrough, she said, came 1 time erstwhile he agreed to luncheon pinch her successful nan eating room. Long retired of his shell, Goodness now sits connected nan community's resident assembly and enjoys distributing nan message to different residents connected his floor.

The Rev. Donald Goodness was rector of a New York City religion earlier retiring. He still watches sermons done nan church's website. Alyssa Schukar/KFF Health News hide caption

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Alyssa Schukar/KFF Health News

"The group that activity successful my building go truthful important to us," Goodness said.

Revoked activity permits

While Trump's 2024 predetermination run focused connected foreigners successful nan U.S. without authorization, his management has broadened nan attraction to target those legally successful nan U.S., including refugees who fled countries beset by wars aliases earthy disasters. This month, nan Department of Homeland Security revoked nan activity permits for migrants and refugees from Cuba, Haiti, Nicaragua and Venezuela who arrived nether a Biden-era program.

"I've conscionable spent my greeting firing good, honorable group because nan national authorities told america that we had to," Rachel Blumberg, president of nan Toby & Leon Cooperman Sinai Residences Boca Raton, a Florida status community, said successful a video posted connected LinkedIn. "I americium truthful sick of group saying that we are deporting group because they are criminals. Let maine show you, they are not each criminals."

At Goodwin House, Conteh is fearful for her chap immigrants. Foreign workers astatine Goodwin seldom talk astir their backgrounds. "They're scared," she said. "Nobody trusts anybody." Her neighbors successful her flat analyzable fled nan U.S. successful December and returned to Sierra Leone aft Trump won nan election, leaving their children pinch relatives.

"If each these group time off nan United States, they spell backmost to Africa aliases to their various countries, what will go of our residents?" Conteh asked. "What will go of our aged group that we're taking attraction of?"

KFF Health News is simply a nationalist newsroom that produces in-depth publicity astir wellness issues and is 1 of nan halfway operating programs astatine KFF — nan independent root for wellness argumentation research, polling, and journalism.