Atlanta, Georgia — At A.G. Rhodes, a nonprofit nursing home network based in Georgia, immigrants make up 40% of the workforce. That number isn’t a statistic to management — it’s a daily reality. So when federal immigration policy started shifting in ways that directly affect nursing home workers, leadership didn’t need a report to feel it.
“A lot of our staff are in visa programs,” said CEO Reginald Cateau. “The impact is obvious, right? If a significant percentage of nursing home staff are immigrant workers, and if those immigrant visas are in jeopardy, then we lose a lot of staff that we’re not prepared to replace.”
Industry reports detail a growing crisis: visa fee hikes, changes to temporary protected status, and tightened work authorization renewals are piling up into a workforce disaster for an industry that already can’t find enough people to do the job.
The $100,000 Fee That Changed the Math
For nursing homes that recruit skilled workers through the H-1B visa program — typically for supervisory nurses, rehabilitation staff, and care plan coordinators — a new $100,000 fee has effectively shut the door. New H-1B petitions filed on or after September 21, 2025, are subject to the increased fee, and for operators running on thin margins, it’s simply not feasible.
Nationally, immigrants represent 21% to 25% of the nursing home workforce. For certain roles — housekeeping, dietary, direct care — those percentages run even higher. The workforce math is unforgiving: you can’t absorb the loss of one in four workers without serious consequences for residents.
The pressure doesn’t stop at H-1B. The EB-3 visa, which has historically been the main pipeline for registered nurses and licensed practical nurses, is capped, backlogged, and slow. “These constraints make it extremely difficult for providers to respond to urgent workforce needs, even when there are no available domestic workers,” said Amanda Mead, director of workforce policy at LeadingAge.
TPS Changes Are Hitting the Floor First
The removal of temporary protected status for Haitian nationals — which took effect in November — hit some facilities fast and hard. At one A.G. Rhodes location, the housekeeping department was almost entirely composed of workers affected by the change. The organization scrambled to hire and train replacements in a matter of weeks.
“We had to pivot quickly and hire staff to replace them. Of course, we will give them the moratorium, but that’s a lot of work, right?” Cateau said.
The TPS situation carries particular weight for the sector. This isn’t just a staffing problem — it’s a care continuity problem. Long-term relationships between caregivers and residents are central to quality care, and when immigration policy disrupts those relationships, residents feel it.
Uncertainty Is the Real Problem
Beyond specific policy changes, it’s the unpredictability that’s breaking operators’ ability to plan. DHS has shortened work authorization renewal windows, increased scrutiny of existing approvals, and expanded enforcement activity. Even workers who are lawfully employed are scared — and absenteeism is rising as a result.
“For providers, this can mean sudden staffing losses, increased absenteeism, and difficulty planning schedules or maintaining consistent staffing levels,” Mead said. “For older adults, especially those with complex needs, these disruptions undermine continuity of care.”
Operators like Cateau aren’t arguing against immigration enforcement. They want a system that balances security with the reality that nursing homes can’t function without the workers these policies are now pushing out. “I am an immigrant in the United States,” he said. “I think I’ve done a fair job, right? There’s a place for immigration.”
The domestic workforce alone won’t close the gap. With an aging population and a shrinking pool of younger workers, nursing homes can’t recruit their way out of an immigration-driven staffing crisis. Without meaningful reform, the gap between demand for care and available workers will keep widening — and it’s residents who’ll feel it first.
