The immigration squeeze on your workforce, and the cost that follows each goodbye
If your building feels harder to staff this year, you're not imagining it, and a big piece of it is happening in Washington, not in your market.
What changed
Over the last several months, a series of federal immigration actions has reshaped the pipeline that nursing homes have long relied on. New H-1B petitions filed on or after September 21, 2025 may carry a $100,000 fee, a cost larger hospitals can absorb more easily than skilled nursing can. The H-1B lottery is also moving to a wage-weighted system, which tends to favor higher-paid hospital roles over long-term care. Separately, terminations of Temporary Protected Status for workers from countries including Haiti, Cuba, Nicaragua, and Venezuela have, in some cases, revoked work authorization with very little notice. And in January 2026, the State Department announced an indefinite pause on immigrant-visa processing for applicants from 75 countries, closing a pathway some operators had used to recruit foreign-trained nurses.
The details are technical and still shifting. The effect on the floor is not.
Why it lands so hard on nursing homes
Immigrants make up roughly 21% of the nursing-facility workforce and about 28% of the overall direct-care long-term-care workforce (more than 820,000 workers), with an even higher share among aides and in housekeeping and dietary roles, according to a KFF analysis of Census data. These aren't edge-case hires. They are, in many buildings, the people doing the hands-on work every shift.
Layer that onto a sector that was already stretched. By the industry's own count, 99% of nursing homes have open positions and the vast majority say recruiting is difficult, even as the Bureau of Labor Statistics projects hundreds of thousands of additional caregiving jobs will be needed by 2032. Notably, industry groups across the spectrum, from AHCA/NCAL to LeadingAge, have called for immigration reform as part of the workforce solution, not against it.
The part that's easy to miss
The headline is headcount. The quieter story is continuity. Research has found that immigrant direct-care workers tend to stay in their roles longer than U.S.-born workers, and that facilities with more immigrant staff held their staffing more steadily, with lower turnover, through the pandemic. A separate line of economic research has linked higher immigrant staffing to better resident outcomes, including lower rates of depression and anxiety.
In other words, the workers most affected are often the steady, experienced ones. When they go, a building doesn't just lose a warm body on the schedule. It loses the person who knew this resident's routine, who'd seen a survey before, who remembered why the policy was written the way it was.
What operators are doing
There's no tidy fix, and most of the real work is unglamorous: retaining who you have. Operators are hiring immigration counsel, helping staff navigate documentation changes, and leaning hard into the retention levers they actually control, like scheduling, recognition, and leadership stability. The common thread is a shift in mindset from recruit your way out to don't lose what you've got.
The knowledge that walks out the door
Software doesn't solve a staffing shortage, and we won't pretend otherwise. But every departure carries a hidden cost beyond the open shift: the institutional knowledge that leaves with the person. Some of that is irreplaceable. Some of it (the compliance knowledge, the survey memory, the "how we handle this tag here") doesn't have to walk out at all.
That's the part Tactis is built to keep: the regulations, your policies, and the way your building responds, held in one place so a new hire or a new administrator starts closer to a veteran than a stranger. When the workforce is this fragile, the knowledge you can hold onto matters more, not less.
Sources & further reading