President Donald Trump’s immigration crackdown is beginning to strain the long-term care workforce, raising concerns about how the effects could ripple across the nation’s senior population.

Providers that operate nursing homes and home care agencies say they have lost staff members as the Trump administration has moved to end deportation protections for hundreds of thousands of migrants with temporary legal status.

But the long-term care industry already faces persistent challenges in recruiting workers. Providers say the reduction in staff could threaten the quality of services they are able to offer to the nation’s senior population. Some said they would have to raise wages to attract more workers to fill positions, and they were set to pass on those cost increases to people receiving care.

Immigrant workforce

The issue underscores the critical role that foreign-born workers play in the long-term care industry. Immigrants make up about 28% of the workforce directly providing that care, according to an analysis of Census Bureau data from KFF, a health policy research group. In comparison, foreign-born workers account for about 19% of the entire U.S. civilian labor force.

Katie Smith Sloan, president of LeadingAge, an association representing nonprofit aging services providers, said the Trump administration’s immigration policies were already starting to disrupt facilities across the country as providers moved to terminate some caregivers in recent weeks. She said some employees had stopped showing up at work out of fear for themselves and their families.

The biggest impact so far has stemmed from the Trump administration’s decision to end various programs that grant migrants temporary legal status, which authorizes them to live and work in the United States.Although the Trump administration moved to end those protections by September, a federal judge recently blocked the administration from doing so.

Smith Sloan said the effects across the long-term care industry could become more pronounced as the administration ramps up efforts to restrict migrants from entering the United States. Cuts to Medicaid, which were included in the domestic policy bill that Republicans recently passed, could further strain providers, she added.

White House officials said Trump would ensure that sectors “have the workforce they need to be successful.”

“There is no shortage of American minds and hands to grow our labor force, and President Trump’s agenda to create jobs for American workers represents this administration’s commitment to capitalizing on that untapped potential while delivering on our mandate to enforce our immigration laws,” said Abigail Jackson, a White House spokesperson.

Other challenges

The administration’s attempt to clamp down on immigration comes at a time when the industry faces another challenge: the growing number of seniors. The U.S. population age 65 and older has been increasing at a rapid clip, meaning the long-term care industry will need more workers in the coming years to keep up.

“Barring some major change in fertility rates, we’re going to need immigrants to continue to supply the workforce that the country needs for aging care,” said Julia Gelatt, associate director of the U.S. immigration policy program at the Migration Policy Institute.

Some proponents of tighter immigration laws said that providers should focus on hiring U.S.-born workers or immigrants with legal status already in the country. Steven Camarota, research director at the Center for Immigration Studies, a think tank that favors restricting immigration, said providers should increase wages and benefits to attract workers.

Some experts said it was challenging, however, for providers to recruit Americans who could work a less strenuous job and receive a comparable wage in industries such as food service or retail.

“They don’t want the job,” said Rachel Blumberg, president and CEO of the Toby and Leon Cooperman Sinai Residences in Boca Raton, Fla. “That’s why we’re so reliant on immigrants.”

Immigrants also play an outsize role in the home care industry, making up about 32% of that workforce, according to KFF.