Jackline Conteh, one in every of many African-born caregivers on the Goodwin Home Alexandria nursing residence, cares for the Rev. Donald Goodness, 92. Nursing houses are topic to Immigration and Customs Enforcement raids underneath the Trump administration.
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In a top-rated nursing residence in Alexandria, Va., the Rev. Donald Goodness is cared for by nurses and aides from varied components of Africa. One among them, Jackline Conteh, a naturalized U.S. citizen and nurse assistant from Sierra Leone, bathes and helps costume him most days and vigilantly intercepts any meal headed his means that accommodates gluten, as Goodness has celiac illness.
“We’re full of people that come from different international locations,” Goodness, 92, stated about Goodwin Home Alexandria’s employees. With out them, the retired Episcopal priest stated, “I might be, and my constructing can be, desolate.”
“Almost each one in every of us from Africa, we all know the way to take care of older adults,” says Jackline Conteh, a licensed nursing assistant from Sierra Leone. She stands with the Rev. Donald Goodness.
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The long-term well being care trade is dealing with a double whammy from President Trump’s crackdown on immigrants and the Republican Social gathering’s proposals to scale back Medicaid spending. The trade is very depending on international employees: Greater than 800,000 immigrants and naturalized residents comprise 28% of direct care workers at residence care businesses, nursing houses, assisted dwelling services and different long-term care corporations.
However in January, the Trump administration rescinded former President Joe Biden’s 2021 coverage that protected well being care services from Immigration and Customs Enforcement raids. The administration’s broad immigration crackdown threatens to drastically cut back the variety of present and future employees for the trade. “Folks could also be right here on a inexperienced card, and they’re afraid ICE goes to point out up,” stated Katie Smith Sloan, president of LeadingAge, an affiliation of nonprofits that take care of older adults.
A collision of insurance policies
Staffing shortages and quality-of-care issues can be compounded by different insurance policies pushed by Trump and the Republican-led Congress, in keeping with nursing residence officers, resident advocates and tutorial consultants. Federal spending cuts underneath negotiation could strip nursing houses of a few of their largest income sources by limiting methods states leverage Medicaid cash and by making it more durable for brand new nursing residence residents to retroactively qualify for Medicaid. Care for six in 10 residents is paid for by Medicaid, the state-federal well being program for poor or disabled Individuals.
“We face the collision of two insurance policies right here that might additional erode staffing in nursing houses and current well being final result challenges,” stated Eric Roberts, an affiliate professor of inside medication on the College of Pennsylvania.
The trade hasn’t recovered from COVID-19, which killed greater than 200,000 long-term care facility residents and employees and led to huge employees attrition and turnover. Nursing houses have struggled to interchange licensed nurses, who can discover better-paying jobs at hospitals and docs’ workplaces, in addition to nursing assistants, who can earn extra working at big-box shops or fast-food joints. High quality points that preceded the COVID-19 pandemic have expanded: The share of nursing houses that federal well being inspectors cited for placing residents in jeopardy of rapid hurt or loss of life has risen alarmingly from 17% in 2015 to twenty-eight% in 2024.
Along with looking for to scale back Medicaid spending, congressional Republicans have proposed shelving the largest nursing residence reform in many years: a Biden-era rule mandating minimal staffing ranges that would require most of the US’ almost 15,000 nursing houses to rent extra employees.
The long-term care trade expects demand for direct care employees to burgeon with an inflow of getting old child boomers needing skilled care. The Census Bureau has projected that the variety of folks 65 or older will develop from 63 million this 12 months to 82 million in 2050.
In an electronic mail, Vianca Rodriguez Feliciano, a spokesperson for the Division of Well being and Human Companies, stated the company “is dedicated to supporting a robust, steady long-term care workforce” and “continues to work with states and suppliers to make sure high quality take care of older adults and people with disabilities.” In a separate electronic mail, Tricia McLaughlin, a Division of Homeland Safety spokesperson, stated foreigners eager to work as caregivers “want to do this by coming right here the authorized means” however didn’t handle the impact on the long-term care workforce of deportations of lessons of licensed immigrants.
A dedication to the job
Goodwin Residing, a faith-based nonprofit, runs three retirement communities in Northern Virginia for individuals who dwell independently, want just a little help every day, have reminiscence points or require the supply of around-the-clock nurses. It additionally operates a retirement neighborhood in Washington, D.C. Medicare charges Goodwin Home Alexandria as one of many best-staffed nursing houses within the nation. Forty % of the group’s 1,450 workers are foreign-born and are both looking for citizenship or are already naturalized, in keeping with Lindsay Hutter, a Goodwin spokesperson.
“As an employer, we see they keep on with us, they’ve longer tenure, they’re extra dedicated to the group,” stated Rob Liebreich, Goodwin’s president and CEO.
Jackline Conteh spent a lot of her youth shuttling between Sierra Leone, Liberia and Ghana to keep away from wars and tribal conflicts. Her mom was killed by a stray bullet in her residence nation of Liberia, Conteh stated. “She was sitting outdoors,” Conteh, 56, recalled in an interview.
Conteh was working as a nurse in a hospital in Sierra Leone in 2009 when she discovered of a lottery for visas to return to the US. She gained, although she could not afford to convey her husband and two youngsters alongside on the time. After she received a nursing assistant certification, Goodwin employed her in 2012.
Conteh stated taking good care of elders is embedded within the tradition of African households. When she was 9, she helped feed and costume her grandmother, a job that rotated amongst her and her sisters. She washed her father when he was dying of prostate most cancers. Her husband joined her in the US in 2017; she cares for him as a result of he has coronary heart failure.
“We all know the way to take care of older adults,” she stated.
Her daughter is now in the US, whereas her son continues to be in Africa. Conteh stated she sends cash to him, her mother-in-law and one in every of her sisters.
Jackline Conteh helps Donald Goodness along with his hair and different “actions of every day dwelling,” as it’s recognized within the care trade, at Goodwin Home Alexandria in Virginia.
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Within the nursing residence the place Goodness and 89 different residents dwell, Conteh helps with every day duties like dressing and consuming, checks residents’ pores and skin for indicators of swelling or sores, and tries to assist them keep away from falling or getting disoriented. Of 102 workers within the constructing, damaged up into eight residential wings known as “small homes” and a wing for reminiscence care, at the least 72 had been born overseas, Hutter stated.
“I begin making pals with him”
Donald Goodness grew up in Rochester, N.Y., and spent 25 years as rector of the Church of the Ascension in New York Metropolis, retiring in 1997. He and his now-deceased spouse moved to Alexandria to be nearer to their daughter, and in 2011 they moved into unbiased dwelling at Goodwin Home. In 2023, he moved into one of many expert nursing small homes, the place Conteh began caring for him.
“I’ve a foul leg and I can not stand on it very a lot, or I would fall over,” he stated. “She’s in there at 7:30 within the morning, and he or she helps me bathe.” Goodness stated Conteh is exacting about cleanliness and can inform the housekeepers if his room shouldn’t be saved correctly.
Conteh stated Goodness was withdrawn when he first arrived. “He do not wish to come out — he wish to eat in his room,” she stated. “He do not wish to be with the opposite folks within the eating room, so I begin making pals with him.”
She confirmed him a photograph of Sierra Leone on her telephone and advised him of the climate there. He advised her about his work on the church and the way his spouse did laundry for the choir. The breakthrough, she stated, got here at some point when he agreed to lunch together with her within the eating room. Lengthy out of his shell, Goodness now sits on the neighborhood’s resident council and enjoys distributing the mail to different residents on his ground.
The Rev. Donald Goodness was rector of a New York Metropolis church earlier than retiring. He nonetheless watches sermons by means of the church’s web site.
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“The folks that work in my constructing develop into so essential to us,” Goodness stated.
Revoked work permits
Whereas Trump’s 2024 election marketing campaign centered on foreigners within the U.S. with out authorization, his administration has broadened the main target to focus on these legally within the U.S., together with refugees who fled international locations beset by wars or pure disasters. This month, the Division of Homeland Safety revoked the work permits for migrants and refugees from Cuba, Haiti, Nicaragua and Venezuela who arrived underneath a Biden-era program.
“I’ve simply spent my morning firing good, trustworthy folks as a result of the federal authorities advised us that we needed to,” Rachel Blumberg, president of the Toby & Leon Cooperman Sinai Residences Boca Raton, a Florida retirement neighborhood, stated in a video posted on LinkedIn. “I’m so sick of individuals saying that we’re deporting folks as a result of they’re criminals. Let me let you know, they don’t seem to be all criminals.”
At Goodwin Home, Conteh is fearful for her fellow immigrants. International employees at Goodwin not often discuss their backgrounds. “They’re scared,” she stated. “No one trusts anyone.” Her neighbors in her condominium complicated fled the U.S. in December and returned to Sierra Leone after Trump gained the election, leaving their youngsters with relations.
“If all these folks go away the US, they return to Africa or to their varied international locations, what’s going to develop into of our residents?” Conteh requested. “What’s going to develop into of our previous folks that we’re taking good care of?”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.
