Foreign-born staff have long been valuable contributors to the aging services sector’s workforce. As our 2024 white paper, The Immigration Imperative, makes clear, foreign-born caregivers comprise a significant proportion of team members in the long-term services and supports (LTSS) sector compared to other workplaces: immigrants working as direct care professionals come to the U.S. from at least 163 countries and, while they make up 17% of the total U.S. labor force, they comprise 31% of the home care workforce, 21% of the residential care aide workforce, 21% of the nursing assistant workforce, and 30.3% of the nursing home housekeeping and maintenance workforce.

That dependence is colliding with the most recent wave of immigration policy changes that started over a year ago with the Trump administration’s move to cancel Temporary Protected Status (TPS) for several countries. These changes test LeadingAge members’ operational stability, ability to meet compliance standards, long-term workforce planning capacity, and ultimately the ability to serve those for whom they care and serve.

A cascade of policy shifts affects nearly every stage of the immigration process—from how workers receive employment authorization, to how they ultimately secure permanent residence, and a host of compliance steps along the way.

Below is a roundup of the most recent changes. Visit our Pathways for Foreign-Born Workers page for a reverse chronological listing of our coverage of these topics.

Most recently, on May 21, 2026, the U.S. Citizenship and Immigration Service (USCIS) issued a sweeping policy memorandum reframing adjustment of status—the process by which individuals already in the U.S. apply for a green card—as a “matter of discretion and administrative grace” rather than a standard procedure. In short, the memo seems to lay out a policy preference for sending green card applicants in the U.S. back to their home country to go through consular processing. This has caused a great deal of concern and confusion for individuals and employees undergoing or facing this process.

At the extreme end of risks posed by this update, for workers from 75 countries whose immigrant visa processing has been suspended at U.S. embassies and consulates since January 2026, the memo does not redirect them to an alternative pathway—it effectively eliminates the pathway altogether for the duration of that suspension. At the time of this writing, it is unclear how this memo will ultimately be implemented. LeadingAge National is watching this closely and will report when additional information is available.

Compliance pressures within the processes are also mounting. An interim final rule published in May tightens enforcement of signature requirements on immigration benefit requests, meaning USCIS may now reject or deny a filing if it later determines the submission lacks a valid signature—even if the request was initially accepted for processing. A denial can result in loss of the filing fee and a final adverse decision.

The U.S. Immigration and Customs Enforcement (ICE), meanwhile, has narrowed the category of I-9 errors employers can correct after an audit begins, raising the risk of immediate fines for LeadingAge members managing large, diverse workforces. For members navigating EAD renewal delays, we’ve outlined steps you can take now.

On top of these compliance challenges, a Department of Labor (DOL) proposed rule would revise how prevailing wages are calculated for employment-based visa programs, including the EB-3 pathway widely used in aging services recruitment. LeadingAge National raised concerns in May comments that the underlying data does not adequately distinguish between care settings, such as hospitals and skilled nursing, which operate under very different financial constraints, and that the proposal could significantly limit providers’ ability to access international recruitment pathways.

Amid these headwinds, there is also reason for cautious optimism—and proof that our voices matter. In April, LeadingAge members Sinai Residences and LeadingAge Southeast filed an amicus brief in the Supreme Court case Miot v. Trump, asking the Court to maintain TPS for Haitian immigrants and warning that ending TPS would not merely be an administrative inconvenience: it would destabilize care in facilities already operating under strain. A decision is expected by mid-July.

Around the same time, a bipartisan coalition in the House passed legislation that would extend Haiti TPS for three years via a discharge petition; the bill now awaits Senate action. LeadingAge members and care recipients have strongly supported this action.

Policy makers have noticed this advocacy- a new congressional report released in May cites LeadingAge member testimony directly to document how ending Haitian TPS would deepen staffing shortages, disrupt patient care, and further strain providers already navigating significant workforce challenges.

The common thread for LeadingAge members running through all these developments is this: immigration policy is workforce policy. Every change that makes it harder to recruit, retain, or authorize foreign-born workers has a direct impact on the older adults who depend on those workers every day.

Advocacy on these issues is essential. The LeadingAge National team is engaging with Congress and like-minded organizations, and we are asking LeadingAge members to share workforce stories documenting real-world impacts with our advocacy team, to respond to action alerts through our Advocacy Action Center, and to make their voices heard on pending rules and legislation. The more providers speak in their own words, the stronger the case we can make together.

For general guidance related to immigration enforcement preparedness, please see this resource. To learn more about this topic and other immigration compliance issues facing our members, sign up for our upcoming webinar Immigration Compliance for Aging Services Employers, to be held on Thursday, June 4, 2-3:15 p.m. ET.