U.S. Citizenship and Immigration Services placed an immediate adjudicative hold on all pending benefit applications from 39 designated “high-risk” countries on January 1, 2026, a step nursing home operators and advocates say is worsening staff shortages that already threaten day-to-day care.
Facilities that rely on immigrant workers said the hold, issued in a memorandum numbered PM-602-0194, has added uncertainty for employees and prospective hires at a time when nursing homes across the country are struggling to keep shifts covered.
Federal enforcement framing and official rationale
USCIS and the Department of Homeland Security have framed a series of 2025 and early 2026 moves as enforcement-driven changes meant to tighten screening and restrict access to work authorization, even as the long-term care industry points to rising vacancy rates and workforce churn.
“Unchecked mass migration floods the American labor market, depressing wages and taking jobs away from hardworking Americans, while straining healthcare, education, and housing systems. The Trump administration continues to execute policies to ensure legal immigration advances American interests first,”
— USCIS Spokesman Matthew Tragesser, November 13, 2025 (statement published in the USCIS newsroom).
USCIS Director Joseph Edlow justified shortened work-authorization validity by emphasizing frequent vetting:
“Reducing the maximum validity period for employment authorization will ensure that those seeking to work in the United States do not threaten public safety or promote harmful anti-American ideologies. . It’s even more clear that USCIS must conduct frequent vetting of aliens,”
— Joseph Edlow, December 4, 2025 (official policy memorandum).
DHS Secretary Kristi Noem signaled a broad enforcement posture on December 11, 2025:
“Under President Trump’s leadership, DHS is securing our borders, we’re restoring the rule of law, and we’re protecting the homeland. We have sent a strong message to criminal illegal aliens that we will find you, we will arrest you, we will deport you.”
Impact on the long-term care workforce
Immigrant workers account for a large share of the labor pool that supports older Americans, and the staffing gap has been widening as immigration crackdowns ripple through hiring pipelines and retention.
- KFF (April 2025): immigrants comprise 28% of the total direct care workforce for long-term care services and 30% of all nursing and home health aides.
- Advocates say the January 1 adjudicative hold applies to pending benefit applications from 39 countries and includes a re-review of cases approved as far back as January 2021 (memorandum language).
Advocates and industry groups report that these changes:
– Add delays to hiring and renewals.
– Discourage workers from staying in or entering already hard-to-fill frontline roles.
– Increase scheduling gaps and job interruptions that complicate consistent delivery of medication, bathing, meals, and other daily care tasks.
“The loss of experienced immigrant staff directly compromises the quality of care and safety for residents,” the Center for Medicare Advocacy said, linking reduced staffing to increased hospitalizations and management issues for chronic conditions.
Policy changes and timeline (2025–early 2026)
A compact timeline helps show how multiple changes compounded staffing pressures:
| Date | Policy change | Immediate effect on long-term care hiring/staffing |
|---|---|---|
| January 2025 | Rescission of 2021 policy protecting healthcare facilities from ICE raids | Increased fear in immigrant-heavy workplaces; potential preemptive departures |
| Throughout 2025 | DHS terminations of Temporary Protected Status for nations including Ethiopia, Burma, South Sudan, Afghanistan, Haiti | Terminations slated to take effect Jan–Feb 2026; prompted preemptive job departures and loss of work permission |
| August 22, 2025 | USCIS resumed “neighborhood investigations” for naturalization applicants | Created a chilling effect where shared housing/commuting networks deter engagement with immigration system |
| September 19, 2025 | Presidential Proclamation imposed $100,000 “supplemental payment” for new H-1B petitions outside the U.S. | Made international hiring prohibitively expensive for many nursing homes |
| October 21, 2025 | USCIS described the fee as a “tariff on the importation of labor” | Reinforced cost hurdle for recruiting abroad |
| December 29, 2025 | Federal Register: “Weighted Selection H1B” rulemaking entry | Added uncertainty for employers planning staffing and budgets |
| December 4, 2025 | USCIS reduced EAD (employment authorization document) maximum validity from 5 years to 18 months | More frequent renewals → greater chance of processing gaps and job interruptions |
| December 2025 | CMS and HHS rescinded federal minimum staffing requirements for nursing homes | Acknowledged hiring realities but removed a federal pressure point to maintain staffing |
| January 1, 2026 | USCIS adjudicative hold on pending applications from 39 countries (PM-602-0194) | Immediate freeze and re-review of pending and some previously approved cases |
| Jan–Feb 2026 | Terminations of TPS take effect for listed nations | Expect intensifying staffing pressures as work permissions lapse |
Financial and regulatory barriers to recruiting abroad
- The $100,000 H-1B fee (supplemental payment) imposed in 2025 has been described by USCIS as a “tariff on the importation of labor.”
- Long-term care operators used H-1B to recruit nurses and other skilled workers; the supplemental payment made most such hires prohibitively expensive.
- Ongoing rulemaking and Federal Register activity (e.g., “Weighted Selection H1B”) increased uncertainty around cost and availability of international hires.
Operational consequences for nursing homes
- Facilities report that combined changes—shortened work-authorization cycles, pending-application holds, terminations of legal protections and statuses, increased fees—have created a more fragile staffing pipeline.
- Staffing shortages are now shaping decisions about:
- Admissions
- Unit openings
- Ability to provide consistent care
Public-facing quality metrics reflect the operational strain:
– U.S. News 2026 Rankings reported that approximately 12,000 out of 15,000 nursing homes fell short of quality-care honors in late 2025, primarily due to staffing vacancies.
Industry response and advocacy
- Organizations including LeadingAge (representing non-profit aging services) urged DHS to reconsider policies, emphasizing reliance on immigrant workers for essential daily care.
- Advocates warn that rollback of federal minimum staffing requirements does not solve the underlying shortage and may remove accountability levers without addressing workforce supply.
Government reporting and source materials
- DHS summarized its work in Year in Review 2025 (published at dhs.gov/news/2025/12/31/dhs-year-in-review).
- USCIS posts announcements and statements at uscis.gov/newsroom.
- CMS posted its announcement about rescinding staffing requirements in the CMS newsroom.
- Federal Register entry: “Weighted Selection H1B” (December 29, 2025) at https://www.federalregister.gov/documents/2025/12/29/weighted-selection-h1b.
- USCIS newsroom statement quoted above: https://www.uscis.gov/newsroom.
Near-term outlook
As TPS terminations take full effect between January and February 2026 and the January 1 adjudicative hold continues, long-term care operators and advocates expect staffing pressures to intensify in the coming weeks.
- Residents are most exposed to disruption when experienced aides and nurses leave and cannot be quickly replaced.
- Industry groups warn that without adjustments to policy or targeted workforce supports, the staffing squeeze will continue to hinder safe, consistent care delivery for older Americans.
U.S. nursing homes are struggling with unprecedented personnel vacancies due to new 2026 immigration restrictions. These include an immediate hold on applications from 39 nations and a $100,000 fee for H-1B visas. Industry leaders argue these measures, intended to tighten screening, are instead destabilizing the long-term care workforce. Consequently, resident safety and the quality of daily care are now at significant risk as facilities lose experienced immigrant staff.
