Wisconsin’s long-term-care system is losing workers and potential hires as the federal government restricts refugee admissions and ends Temporary Protected Status for immigrants from several countries, according to care providers, advocates and an immigration attorney. The changes are hitting a workforce that already faces intense shortages as the nation’s population ages. Nearly 19% of the U.S. population was over 65 in 2025, and many older adults will eventually need assistance at home or in residential care. About 30% of direct-care workers nationwide are immigrants, according to KFF. They include nursing assistants, personal-care aides and home-health aides who help older adults and people with disabilities with daily activities and medical needs. “We have basically cut off or severely limited every pipeline that we have for bringing in, for welcoming foreign-born workers,” said Katie Smith Sloan, CEO of LeadingAge, a national network of nonprofit providers. “We don’t have a sort of ready supply of U.S.-born individuals who are clamoring to work in aging services.” Sloan said some home-health agencies are unable to accept new clients, while nursing homes have closed beds or entire wings because they lack staff. Those gaps can shift more responsibility to hospitals and family caregivers. For Myranda Gereau of Sheboygan, reliable care is essential to living independently. Gereau, 30, is quadriplegic, has a tracheostomy and requires round-the-clock assistance. She said she has spent years trying to find enough nurses and worrying about whether scheduled caregivers will be available. “This is literally my life we’re talking about,” Gereau said. “There are people’s lives that are needing care, and then when you take that caregiver out of the equation, those people suffer.” Robin Wolzenburg, director of operations at Koru Health, which operates senior-living communities in Wisconsin, previously worked with refugee resettlement agencies to place newcomers in nursing-home jobs. Those efforts effectively ended in January 2025, after the Trump administration suspended refugee programs. “We saw just a marked halt in refugees coming in,” Wolzenburg said. “It didn’t seem like it was a trickle – it just seemed like it stopped.” The administration said the suspension was intended to prevent the arrival of refugees while resources were insufficient to support them. The policy has forced some Wisconsin providers to abandon hiring plans developed over several years. At Valley VNA Senior Care in Neenah, officials had spent at least five years trying to recruit 15 to 20 workers from overseas. Human Resources Coordinator Cheryl Ehlers said the organization eventually stopped hearing from the agency assisting with the effort. Valley VNA also lost employees whose legal ability to work depended on Temporary Protected Status, or TPS. “We did have some staff that unfortunately had to go back,” Ehlers said. “We lost them as staff members because they lost their protected status.” TPS allows people from countries designated as unsafe because of war, natural disaster or other crises to live and work temporarily in the United States. The federal government has ended 14 TPS programs affecting people from 13 countries. Nearly 350,000 Haitians lost TPS on Aug. 4, and KFF estimates that about 53,000 TPS holders worked in health care in 2024. Marc Christopher, an immigration attorney representing Haitian immigrants in central Wisconsin, said many of his clients work in home health care and nursing. They are losing work permits and facing the possibility of deportation even as Haiti remains under a Level 4 “Do Not Travel” advisory from the U.S. State Department because of gang violence and humanitarian conditions. “It’s a lose-lose-lose for our community,” Christopher said. “The employers ... are losing valuable labor. For the people that they’re taking care of, they’re losing good quality care. And obviously, it’s a lose for my clients.” Some clients are applying for asylum, Christopher said, but those cases can take years. Others must decide whether to leave the country or remain without legal status. The consequences extend beyond employers and patients. Zabi Sahibzada, refugee resettlement director for Jewish Social Services of Madison, said three full-time caseworkers and one part-time caseworker are serving more than 500 people, along with others seeking help. He estimates that roughly 30% of his working clients lost medical-sector jobs after their immigration or work eligibility changed. Those clients now need assistance with food, rent, medical care and legal services, even as the agency faces limited funding. Some also lost driving privileges or other eligibility required for employment. Wisconsin lawmakers have taken at least one step to broaden the pool of eligible health-care workers. State Sen. Jesse James, R-Thorp, Rep. Joel Kitchens, R-Sturgeon Bay, and Rep. Sylvia Ortiz-Velez, D-Milwaukee, co-authored legislation that became law in April allowing people protected under the Deferred Action for Childhood Arrivals program to obtain professional licenses, including in nursing and other fields. But providers say licensing changes cannot quickly replace workers lost through immigration policy. The U.S. Bureau of Labor Statistics projects that home-health aide jobs will grow by 847,000 over the next decade, the largest projected increase of any occupation. Yet the median annual pay for home-health and personal-care aides was $35,800 in 2025. “The market is so tight, and the competition is so tight, and caregiving is a tough job,” Wolzenburg said. “You’re caring for the most vulnerable people in our population.” Some Wisconsin organizations are adapting by offering housing and other incentives to recruit locally. Kate Battiato, vice president of media and community impact for LeadingAge Wisconsin, said one nursing-home CEO in Sparta spent more than $100,000 to build five apartments for overseas employees. After visas became difficult to obtain, the facility repurposed the apartments for existing workers. “International recruitment is a multi-year strategy, and it doesn’t happen overnight,” Battiato said. “One election can change the strategy that has been built over years.” Battiato said worker-housing programs have nevertheless helped some providers attract and retain people from nearby communities. Still, staffing shortages have forced assisted-living facilities to limit admissions, making it harder for older residents to remain near the communities where they have lived for decades. Sloan said the loss of a caregiver can also sever a relationship built over years. A consistent aide may know a client’s routines, preferences and personal history, she said. “You’ve really lost an important part of your life,” Sloan said.