Wisconsin’s long-term-care providers say recent federal immigration decisions are worsening a staffing shortage that already leaves some older adults and people with disabilities without reliable access to care. The Trump administration suspended nearly all refugee programs in January 2025 and has ended Temporary Protected Status for immigrants from 13 countries through 14 program terminations. Leaders in Wisconsin’s aging-services sector say the changes have halted overseas recruitment plans, removed trained workers from the labor pool and made it harder for facilities to keep beds and home-care slots available. “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 nursing homes, home-health agencies and other organizations serving older adults. About 30% of direct-care workers nationwide are immigrants, according to KFF. The workforce includes nursing assistants, personal-care aides and home-health aides who help older adults and people with disabilities with daily activities and medical needs. The shortage has direct consequences for Wisconsin residents. Myranda Gereau, a 30-year-old Sheboygan resident who is quadriplegic and has a tracheostomy, requires round-the-clock care. She has spent years trying to find enough nurses and worries about whether gaps in scheduling could threaten her ability to live independently. “This is literally my life we’re talking about,” Gereau said. “When you take that caregiver out of the equation, those people suffer.” Sloan said some home-health agencies cannot accept new clients, while nursing homes have closed beds or entire wings. When facilities cannot provide care, families and hospitals often have to absorb the additional responsibility. Robin Wolzenburg, director of operations at Koru Health, which operates senior-living communities around Wisconsin, previously worked with refugee-resettlement agencies to place new arrivals in nursing-home jobs. She said those placements effectively stopped after the administration suspended refugee admissions. “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.” Wisconsin providers had invested years and substantial sums in international recruitment. 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. When visas became difficult to obtain, the facility repurposed the housing for existing staff. “International recruitment is a multi-year strategy, and it doesn’t happen overnight,” Battiato said. “One election can change the strategy that was built over years.” Valley VNA Senior Care in Neenah had been trying for at least five years to hire 15 to 20 workers from abroad. The nonprofit also lost employees whose Temporary Protected Status ended, said human-resources coordinator Cheryl Ehlers. “We lost them as staff members because they lost their protected status,” Ehlers said, adding that the workers would be welcome to return if they were able to come back to the United States. The administration has said Temporary Protected Status is temporary and that people whose protections end can seek other legal pathways. Nearly 350,000 Haitian immigrants lost TPS on Aug. 4, according to the information cited by health-policy researchers. KFF estimated 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 now face the loss of work authorization and 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, describing the consequences for employers, patients and workers. Some clients are considering asylum applications, returning to Haiti or remaining in the United States without legal status while they weigh their options. The employment losses are also straining support organizations. Zabi Sahibzada, refugee-resettlement director for Jewish Social Services of Madison, said three full-time and one part-time caseworkers oversee more than 500 people, in addition to new individuals seeking assistance. He estimates that about 30% of his clients who worked in the medical sector have lost their jobs, driving demand for help with food, rent, health care and legal services. The shortage is expected to persist even without immigration-policy changes. The U.S. Bureau of Labor Statistics projects 847,000 new home-health-aide jobs over the next decade, the largest projected increase of any job category. But the median annual pay for home-health and personal-care aides was $35,800 in 2025, a level providers say makes recruitment difficult for demanding work. Wisconsin lawmakers from both parties have pursued one possible response. State Sen. Jesse James, R-Thorp, Rep. Joel Kitchens, R-Sturgeon Bay, and Rep. Sylvia Ortiz-Velez, D-Milwaukee, co-authored legislation that passed in April allowing DACA recipients to obtain professional licenses in nursing and other fields. Providers are also using worker housing, local recruiting and retention programs to fill openings. But Wolzenburg said many assisted-living facilities have limited admissions because they cannot guarantee adequate staffing, sometimes forcing residents to seek care outside the communities where they have lived for decades. For residents who depend on a familiar caregiver, the consequences extend beyond scheduling. Sloan said losing a longtime aide can sever a relationship built around intimate knowledge of a person’s routines, preferences and needs. “You’ve really lost an important part of your life,” Sloan said.