The White House recently issued several executive orders that have ramped up the nation’s immigration enforcement policies.

The health care sector may be facing a host of staffing and operational challenges as the regulatory moves unfold, according to Hannah Liu, manager of immigration advocacy at Asian Americans Advancing Justice (AAJC). A tightening of immigration policies has come with “concern, panic and confusion” across diverse communities nationwide, Liu stated.

“As the effects of these hostile immigration policies play out, patients may also face the life-or-death situations that arise from interruptions in care caused by staffing shortages,” Liu told Hospice News in an email. “Immigrants in the health care industry may fear the possibility of arrest and detention, including in workplaces like hospitals, palliative care facilities and clinics.”

Immigration policy changes

A recent executive order stipulated that the U.S. Department Homeland Security (DHS) will take “all appropriate action” to enable the U.S. Immigration and Customs Enforcement (ICE), the U.S. Customs and Border Protection (CBP) and the U.S. Citizenship and Immigration Services (USCIS) to set priorities for their agencies that “protect the public safety and national security interests of the American people.”

The executive order allows regulatory authorities to seek actions to identify and publicize information about undocumented immigrants, pursue expedited deportations and impose civil fines and penalties. Failure to comply with legal obligations can in some cases result in individuals being treated as a “civil and criminal enforcement priority,” according to the executive order’s language.

The executive order also ended the practice that some refer to as “catch and release,” which allows migrants to remain in the United States while awaiting legal proceedings.

The Trump administration has issued numerous/several executive actions and initiatives related to immigration enforcement since taking office in January.

Most recently (on Monday/this week), President Trump signed another executive order aimed at addressing immigration issues at the United States’ northern border. The White House also cited criminals at large as an “unusual and extraordinary threat” to national security. The administration is currently assessing whether the Canadian government has taken sufficient action to alleviate illegal migration, the White House indicated in the executive order.

Available evidence does not support claims that immigrants allegedly commit crimes at higher rates than American citizens, according to a report from the Brennan Center for Justice. Corroborating data from the National Institute of Justice has been removed from the federal agency’s website since Trump took office.

While not all immigrants or those found in violation of new policies are at risk of deportation, the recent decision to lift restrictions prohibiting ICE officers from making arrests is “certainly cause for concern,” Liu stated. ICE has already “erroneously detained U.S. citizens and those with legal status,” she added.

Impacts to immigrant health care workers

Some providers are navigating complex staffing challenges associated with the evolving immigration policies. Case in point, states with harsher restrictions on immigrant workers have found direct correlations with reduced staffing levels in health care settings, according to a recent study published in the Oxford Bulletin of Economics and Statistics.

The new policies may have some immigrant health care workers afraid to come to work, according to Liu. This trend could result in an added layer of challenge to prolific staffing shortages.

“Health care facilities should be areas that provide safety and medical care without discrimination,” Liu said. “Due to the chilling effects caused by the administration’s executive actions, it’s critical to make sure that providers know the rights of their institutions and their patients.”

Nearly 2.8 million immigrants were health care employees in 2021, representing 18% of the United State’s overall health care workforce that year, according to research analysis from the Migration Policy Institute (MPI).

“Immigrant professionals have long played an important role in the U.S. health care workforce and make up disproportionate shares of both certain high- and low-skilled health-care workers,” MIP authors wrote in the analysis report.

Foreign-born individuals made up 26% of physicians and surgeons nationwide and 40% of home health aide workers, the analysis found. The MIP analysis spanned data from the U.S. Bureau of Labor Statistics (BLS) and the U.S. Census Bureau’s 2021 American Community Survey.

Immigrants in the health care sector can have a variety of legal statuses. Some are naturalized citizens, legal permanent residents and temporary workers, according to MIP. Others are recipients of Temporary Protected Status (TPS) and the Deferred Action for Childhood Arrivals (DACA) program.

Some geographic regions may be seeing greater effects of the immigration policies compared to others.

“In a number of states, immigrants make up much higher shares of physicians and surgeons than of all health care workers or all workers in general,” MIP authors stated.

States with the highest rates of immigrant health care workers in 2021 included New York (37%), California (35%), New Jersey (32%), Florida (30%), Maryland and Hawaii (26% each) and Nevada (24%), according to the MIP analysis. Michigan had the highest volume of immigrant physicians, which represented 28% of the state’s clinical workforce. Foreign-born physicians made up 32% of health care workers in New Jersey, Maryland and the District of Columbia, the analysis found.

Immigrants constitute roughly 28% of all direct care workers nationally and represent a higher proportion of this workforce in states with rapidly growing aging populations such as New York, New Jersey, California and Florida, PHI reported. 

Trump’s “restrictive policies” do not take into account the fundamental role that immigrant direct care workers hold in America’s care economy, said Murray Devine, senior director of communication and marketing at PHI. The New York-based organization seeks to transform the senior care, long-term care workforce through policy, research and advocacy efforts. 

“Beyond the ethical implications of these actions, the Trump administration’s proposed immigration policies have become increasingly concerning for the strength of the direct care workforce,” Devine told Hospice News in an email. “Policymakers must recognize the real consequences that policy actions targeting immigrants will have for all Americans. We are concerned about the consequences of these actions for the direct care workers who provide essential care and support, and for the millions of people and families who depend on them each day.”

One avenue to address issues is ensuring that employees are briefed on the appropriate protocol for encounters with immigration enforcement that uphold civil rights and privacy laws in their respective jurisdictions, Liu said.

Hospice and health care providers can also ensure equitable access to care by continuing to offer services and information in languages for those who are limited English proficient (LEP) and reaffirming their commitment to serving immigrant communities, she stated.

Another important point for hospice providers to understand is that they have no legal obligation to share the immigration status of a patient with federal immigration authorities, according to Liu. Health care providers should refrain from collecting this data unless absolutely necessary, she added.

Several hospice providers did not respond to Hospice News’ request for commentary on the new immigration policies.