Imagine trying to care for 150 elderly residents without the help of dozens of immigrant workers. That’s the reality Terry Hodge faces at Bethany Health Care Center in Framingham, Massachusetts. More than 40% of her staff, including nursing assistants, housekeepers, and dietary aides, were born outside the U.S. Without them, she says, the facility simply couldn’t function. “Our residents depend on these workers for everything—getting out of bed, eating, even just having someone to talk to,” Hodge explains. “They’re not just employees; they’re essential to the well-being of the people we serve.” But President Trump’s plans to tighten immigration rules have left Hodge and her team worried. Many of her workers are asylum seekers or part of programs like DACA and Temporary Protected Status, which Trump has targeted in the past. “They’re anxious about their future, and we’re anxious about losing them,” she says. This comes at a time when the U.S. is facing a growing need for caregivers. The number of seniors is expected to jump by 47% by 2050, putting even more pressure on an already strained system. Immigrants make up a significant portion of the caregiving workforce—42% of home health aides and nearly a quarter of nursing assistants are foreign-born. Without them, experts warn, the quality of care for seniors could suffer. “Caregivers are the backbone of long-term care, and foreign-born workers are a big part of that backbone,” says David Grabowski, a health care policy professor at Harvard Medical School. “If we lose them, we’ll see staffing shortages and a decline in care quality.” Some in the industry are already brainstorming solutions, like creating special visas for home care workers. Others are reaching out to refugee communities to train newcomers for caregiving roles. But with Trump’s plans still unclear, many are left in limbo. “We don’t know what’s coming next,” says Robin Wolzenburg of LeadingAge Wisconsin. “But one thing’s for sure: we can’t afford to lose these workers.” ---