| An upcoming event, and a recap of last week’s webinar

| I. Virtual Convening on Immigration, Aging & Cross-Sector Collaboration

| Wednesday, April 15. 1:00–4:00 p.m. ET
| Thursday, April 16. 1:00–4:00 p.m. ET
Please join the American Bar Association, Acacia Center for Justice, and the Children’s Immigration Law Academy for a two-afternoon virtual convening, bringing together advocates, attorneys, social service providers, and community-based organizations that work with older adults, immigrant families, and caregivers. Explore how immigration enforcement impacts caregiving networks, how multigenerational families prepare for emergencies, and how to better connect the fragmented systems serving older adults—including immigration, aging services, and homelessness providers. Register now.

| II. Highlights from the March 25 Positive Aging Community webinar Hosted by Steve Gurney and Mark Swartz with:

Leah E. Masselink, Milken Institute School of Public Health
Jennifer A. Minear, McCandlish Holton
Lindsay Hutter, Goodwin Living

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Hutter: I will say on a personal note, having been with Goodwin Living at the beginning of the pandemic, our care partners in nursing, they’re serving the most frail and vulnerable older adults. They as immigrants were the one who would approach our leaders of our healthcare centers and say, ‘When we get the first residents that have COVID, you send me in. I will care for them. I will pull double shifts when team members need to be out or they themselves are sick.’ And you only need to see that once in your life to recognize the devotion and the dedication of the immigrants who serve in our organization and in our field. And so it’s on behalf of them that I’m honored to be a voice on this panel. Thank you. 

Gurney: Jennifer, could you tell us about the H1B visas, which are basically the non-immigrant work visas for foreign workers, and give us an update on what’s happening with that?

Minear: The H1B visa category is the most commonly used temporary work visa in the country, not just for healthcare workers, but for all workers. We honestly don’t have that many temporary work visa categories that are available. The H1B is available for any job that requires at least a bachelor’s degree to do the job and where the person has a degree that is related to the work. So if you are a physician with a medical degree, then you can qualify for an H1B visa. If you are a medical technologist with a music degree, you can’t qualify for an H1B visa because you don’t have a degree that’s related to your occupation. So the H1B category is by far the most commonly used visa available to healthcare workers and all workers. It is capped annually at 85,000 each fiscal year, 85,000 new H1B workers who can come in. Because there are well more than that number who seek H1B visas each year, generally more than 400,000 people vying for those 85,000 slots every fiscal year. We have an annual lottery, literally a lottery that chooses who gets the 85,000. The Trump administration has made some changes to how that lottery is administered this year, which will have an impact toward ensuring that people who are paid higher wages have a greater shot at winning the lottery. So if you think about the kind of lower wage and workers who might be entry level workers who are going to be earning less because they’re entry level, they’re going to have a decreased chance at winning an H1B visa this year because of the new role that the administration has put into place. Unfortunately, that rule, though I think it is subject to legal challenge, has not been legally challenged. 

This year, the administration has imposed some additional hurdles as well that impact not just healthcare workers, but all workers seeking to come to the United States in H1B status. For those people who are outside the US and their employers are filing H1B petitions to bring them into the country, the administration has imposed an additional $100,000 fee for every person seeking entry in H1B status, which is pretty much a deal breaker for most employers who cannot afford to pay that kind of money to bring H1B workers to the country. So that’s been very much an impediment to the use of the H1B program. That is also the subject of litigation that’s outstanding, hasn’t been decided yet. 

Swartz: I’d love to hear more about the Philippines from Leah, and also about Haiti. I know that in some cities there are large numbers of Haitians that work in elder care and their status is sort of up in the air. 

Masselink: In preparing for this, I put together just a couple top-line statistics that I thought might be helpful for people in the audience that might be trying to just get general context for this presence of internationally trained workers in the healthcare workforce in the U.S.: 25% of physicians, active physicians are international medical graduates as they’re called. Usually they need to complete residency training in the U.S. to practice. There’s starting to be some exceptions in certain states. They fill important gaps. In underserved areas, sometimes they have visa waivers and sort of faster paths to being able to stay if they’re willing to practice in an underserved area. About one in six or about 16% of US nurses are internationally educated. As we mentioned, the Philippines is the biggest source country for a variety of reasons that I could talk about at length, essentially sort of an outgrowth of the Philippines colonial experience as a colony of the United States, but that’s been a longstanding source country. Nurses also need to take the nursing licensure exam before they practice in the U.S. There have been other visa mechanisms, small visa mechanisms in the past for nurses, but at this point it is mostly employment based visas, but hospitals are still hiring them to some degree, at least as of a couple years ago, the proportion had actually increased. And then of course, there are a lot of immigrants in the direct care workforce who in a lot of cases are here anyway and then are working in those fields. I’m not sure if you want me to talk about some of the different statuses now or if we want to maybe fill in some of the details about the physician gap filling and so forth. 

Minear: I will play off that data because it characterizes what are the challenges, how difficult it is for immigrants to migrate into the United States of America and do so legally. A few statistics: 96% of senior living organizations in the United States of America report staffing shortages, 96%. The most acute shortages are in the higher levels of living, assisted living, and particularly nursing care and skilled nursing. That is not a want- based situation. If you’re the older adult or a loved one over an older adult, when you need it, you need it now.

Hutter: What’s significant is that we are still short as a field, 130,000 workers to reach our pre-pandemic levels. However, the bar has risen because there are more older adults, about 10 or 11,000 a day turning 65. And so the number of workers needed in senior living and healthcare between now and 2040 is three million. [Furthermore], of working age individuals, the immigrant workforce has a higher rate, the immigrant population, excuse me, has a higher rate of workforce participation than Native-born Americans. The workforce participation rate among immigrants of working age is 66.5%, and that’s higher than 61.7% for the U.S.-born population. So there’s a whole other set of data which is very compelling about Why immigrants are contributing in so many ways, and particularly economically to the United States of America. 

Masselink: I think it was the Cato Institute that published that immigrants every year individually, as well as overall, were a net benefit to the U.S. economy and debt and so forth, year by year, and then also in aggregate. 

Minear: I’ve been a lot of doom and gloom so far in the conversation, and I don’t mean to be completely hopeless sounding. I think that if there is a silver lining in this moment, it’s that I think the extremes to which the administration has taken its current immigration policies and its enforcement mechanisms in particular have really spotlighted, I think, the need for immigration reform in our country. And I think that most people are not necessarily on board with the levels of restriction that are currently being imposed. And I think most Americans aren’t even aware of most of the levels of restriction that are currently being imposed. And if they were, I don’t suspect they would be happy about it. So the more that the administration kind of doubles down on pushing the envelope to the extreme in terms of restrictionist policies, in terms of its removal policies and techniques that it’s using that are extremely unpopular with the American people, I do think that it offers an opportunity for us to talk about how we can make things better, how we can fix this. 

In the healthcare sector, one thing I would love to see happen is that we would have, first of all, an H1B, an exemption from that quota I was talking about for all healthcare workers. So that no matter who your employer is, if you’re a healthcare worker coming to the United States in a job that would otherwise qualify for H1B status, you don’t have to play the lottery. Your employer can sponsor you for H1B status. That would be one huge step forward. Reinstituting, we used to have a temporary visa category for nurses. It would be great to start that up again. We already have a model to use. We used to have that category and it sunsetted and we didn’t have the political will to keep it going. It seems to me that our government recognizes the national shortage that we have in nurses. The Department of Labor recognizes that it is a national shortage. Why not create expanded pathways for people to come here temporarily to work as nurses while they’re waiting for their green cards to be processed rather than making them wait outside the country until an immigrant visa can be issued? That would be huge. 

There are all kinds of things we can do to streamline the green card process for healthcare workers as well. I referenced earlier the quotas that we have in our system. We could exempt healthcare workers from those quotas that would significantly increase the speed with which they can become permanent residents in the country. We already have incentives in our healthcare system, sorry, in our immigration system to attract international medical graduates, physicians who got their medical degrees overseas, but have received residency training and fellowship training in the United States. We’ve already got incentives built into our system to attract those doctors to underserved areas of the country, [areas that] the Health and Human Services Administration agency has designated as not having enough doctors. Why don’t we do that for nurses and physical therapists and all kinds of other healthcare providers as well, provide additional incentives from an immigration perspective to get workers into those areas? 

There are all kinds of things we could be doing to incentivize healthcare workers who want to come here and who, as Lindsay so eloquently stated, are really hardworking, motivated, compassionate, driven people to come and provide the kind of care that’s currently absent. There’s so much we could do. And I do think that this moment, as dire as it is in many respects, is also an opportunity for us to really reimagine our immigration system and to make it better for everyone. 

Hutter: I have two words for you. One, sustain your wellness and two, advocate. Sustain your wellness. Engage in brain health activities, such as a stronger memory. It’s a curriculum you can download at strongermemory.org. Be mobile, be social. Do everything you can to really, I’m going to visually compress that period of physical and cognitive decline to a minimal portion of your later years in life rather than kind of a slow downhill trajectory. The more you can do to sustain your health, the further off you are pushing the need for care and the cost for care. Second piece of advice I had, and it’s actually a call, I’m inviting you, please advocate. Please share with family and friends the role that immigrants play in senior living and healthcare, their contributions to the United States economy above and beyond what they’re doing for older adults. Write letters to lawmakers that every single one of the measures that is in the United States Congress right now, live active legislation, the Dignity Act and others. 

Masselink: I actually wanted to share something that when I was preparing for this webinar that I came across that probably won’t happen soon, but I was pleased to see it. And that relates to the temporary protected status. I thought we might just mention a little bit more about that since we’ve named it a couple times. So essentially, temporary protected status is granted to people from certain countries on behalf of the Department of Homeland Security because of natural disasters, war and similar. And it’s a little bit lower bar for people that people have to meet to be able to stay as long as they were here and they’re from that country and they essentially don’t have a felony on their record. They can stay, but it’s temporary by design and renewed every, it can be either 6-month to up to an 18-month renewal period. And so it’s a very uncertain status and people don’t have a clear pathway toward citizenship. 

[Senator Alex Padilla has] a proposal for essential workers who are on that status to support them to shift status and actually have a path to citizenship because one of the things that’s very difficult about that situation is that people don’t typically have a pathway. They may be here for decades and they’re allowed to work. And I know that you’ve had that experience, Lindsay, but they don’t really have a pathway to citizenship themselves unless they have it through another avenue. I think it may be a difficult environment for legislation like that at this moment, but it looks like people are still thinking about longer-term solutions and realizing that temporary status for decades is not really a status that is helping anyone, and that these people are making important contributions in healthcare and then of some of our other essential occupations.

Minear: And just one more beat on that Temporary Protected Status note, Leah, that just to give everyone an idea of what’s going on with temporary protected status right now, in March 2025, so a year ago, there were 1.3 million people in the country who were under TPS. And as of March 2026, now a year later, the administration has either canceled or announced the cancellation of one million of those TPS. 

Masselink: The whole U.S. Citizenship and Immigration Services (USCIS) website for that is just cancellation notification country by country. 

Minear: There’s no way to have any predictability or visibility into how to staff your facility if you just don’t know what’s happening with your workers. And obviously it’s hugely impactful for the immigrants themselves, but also for the employers that they work for and the patients that they’re expecting to be able to provide care for. When you just don’t know from day-to-day or week to week what’s going to change in terms of whether that person is legally authorized to be here or not, it’s a huge liability for the immigrants and also for the employers.