Nursing homes already struggling to recruit staff are now grappling with President Donald Trump’s attack on one of their few reliable sources of workers: immigration.

Facilities for older adults and disabled people are reporting the sporadic loss of employees who have had their legal status revoked by Trump. But they fear even more dramatic impacts are ahead as pipelines of potential workers slow to a trickle with an overall downturn in legal immigration.

“We feel completely beat up right now,” says Deke Cateau, CEO of A.G. Rhodes, which operates three nursing homes in the Atlanta area, with one-third of the staff made up of foreign-born people from about three dozen countries. “The pipeline is getting smaller and smaller.”

Eight of Cateau’s workers are expected to be forced to leave after having their Temporary Protected Status, or TPS, revoked. TPS allows people already living in the U.S. to stay and work legally if their home countries are unsafe due to civil unrest or natural disasters and during the Biden administration, the designation was expanded to cover people from a dozen countries, including large numbers from Venezuela and Haiti.

While those with TPS represent a tiny minority of A.G. Rhodes’ 500 staffers, Cateau says they will be “very difficult, if not impossible, to replace” and he worries what comes next.

“It may be eight today, but who knows what it’s going to be down the road,” says Cateau, an immigrant himself, who arrived from Trinidad and Tobago 25 years ago.

Nearly one in five civilian workers in the U.S. is foreign born, according to the Bureau of Labor Statistics, but as in construction, agriculture and manufacturing, immigrants are overrepresented in caregiving roles. More than a quarter of an estimated 4 million nursing assistants, home health aides, personal care aides and other so-called direct care workers are foreign born, according to PHI, a nonprofit focused on the caregiving workforce.

The aging of the massive Baby Boom generation is poised to fuel even more demand for caregivers, both in institutional settings and in individuals’ homes. BLS projects more growth among home health and personal care aides than any other job, with some 820,000 new positions added by 2032.

Nursing homes, assisted living facilities, home health agencies and other such businesses were counting on immigrants to fill many of those roles, so Trump’s return to the White House and his administration’s attack on nearly all forms of immigration has sent a chill throughout the industry.

Katie Smith Sloan, CEO of LeadingAge, which represents nonprofit care facilities, says homes around the country have been affected by the immigration tumult. Some have reported employees who have stopped coming to work, fearful of a raid, even though they are legally in the country. Others have workers who are staying home with children they have kept out of school because they worry about roundups. Many others see a slowdown of job applicants.

Rachel Blumberg, CEO of the Toby and Leon Cooperman Sinai Residences in Boca Raton, Florida, has already lost 10 workers whose permission to stay in the U.S. came under a program known as humanitarian parole, which had been granted to people from Cuba, Haiti, Nicaragua and Venezuela. She is slated to lose 30 more in the coming weeks with the end of TPS for Haitians.

“I think it’s the tip of the iceberg,” says Blumberg, forecasting further departures of employees who may not themselves be deported, but whose spouse or parent is.

Blumberg got less than 24 hours’ notice when her employees lost their work authorization, setting off a scramble to fill shifts. She has already boosted salaries and referral bonuses but says it will be difficult to replace not just aides, but maintenance workers, dishwashers and servers.

“Unfortunately, Americans are not drawn to applying and working in the positions that we have available,” she says.

Front-line caregivers are overwhelmingly female and a majority are members of minority groups, according to PHI, earning an average of just $16.72 hourly in 2023.

Long-term care homes saw an exodus of workers as COVID made an already-challenging workplace even more so. Some facilities were beginning to see employment normalize to pre-pandemic levels just as the immigration crackdown hit, though industry-wide, there is still a massive shortage of workers.

Some in the industry have watched in frustration as Trump lamented how businesses including farming and hospitality could be hurt by his policies, wondering why those who clean hotel rooms or pick tomatoes deserve more attention than those who care for elders. Beyond rescinded work authorizations for people living in the U.S., care homes are having difficulty getting visas approved for registered nurses and licensed practical nurses they recruit abroad.

What used to be a simple process now stretches so long that candidates reconsider the U.S. altogether, says Mark Sanchez, chief operating officer of United Hebrew, a nursing home in New Rochelle, New York.

“There are lines upon lines upon lines,” says Sanchez, “and now they’re saying, ‘I’m going to go to Canada’ and ‘I’m going to go to Germany and they’re welcoming me with open arms.’”

Looking around a facility with a majority-immigrant staff, the son of Filipino immigrants wonders where his future recruits will come from.

“I don’t have ICE coming in my door and taking my people,” Sanchez says, “but the pipeline that was flowing before is now coming in dribs and drabs.”

Long-term care workers are routinely lured away not just by hospitals and doctors’ offices, but restaurants, stores and factories. Half of the average nursing home’s staff turns over each year, according to federal data, making the attraction and retention of every employee vital to their operation.

Robin Wolzenburg of LeadingAge in Wisconsin began working to place an influx of people from Afghanistan after the U.S. pulled out its final troops four years ago and thousands of refugees arrived in her state. Care homes began hiring the refugees and were so delighted with them, some facilities began hiring refugees who arrived from Ukraine, Somalia and Congo. Though many homes had employee retention rates around 30%, Wolzenburg said the figure was above 90% with refugees.

The Supreme Court left in place Friday two Biden administration environmental regulations aimed at reducing industry emissions of planet-warming methane and toxic mercury.

The justices did not detail their reasoning in the orders, which came after a flurry of emergency applications to block the rules from industry groups and Republican-leaning states. There were no noted dissents.

The high court is still considering challenges to a third Environmental Protection Agency rule aimed at curbing planet-warming pollution from coal-fired power plants.

The regulations are part of a broader effort by the Biden administration aimed at curbing climate change that includes financial incentives to buy electric vehicles and upgrade infrastructure, and rules tightening tailpipe pollution standards for cars and trucks.

The industry groups and states had argued the EPA overstepped its authority and set unattainable standards with the new regulations. The EPA, though, said the rules are squarely within its legal responsibilities and would protect the public.

An EPA spokesperson said Friday the agency is pleased that the Supreme Court denied applications to stay the final methane and mercury rules. EPA believes the rule tightening methane emissions from oil and gas drilling will deliver major climate and health benefits for all Americans, while the mercury rule will limit hazardous pollution from coal-fired power plants, spokesperson Remmington Belford said.

The methane rule will build on innovative technologies and solutions that many oil- and gas-producing states and companies are already using or have committed to use, while the mercury and air toxics rule “will ensure that the nation’s coal-fired power plants meet up-to-date standards for hazardous air pollutants,” Belford said.

Both rules are firmly grounded in the EPA’s authority under the Clean Air Act, he said. The Supreme Court has shot down other environmental regulations in recent years, including a landmark decision that limited the EPA’s authority to regulate carbon dioxide emissions from power plants in 2022, and another that halted the agency’s air-pollution-fighting “good neighbor” rule.

The methane rule puts new requirements on the oil and gas industry, which is the largest emitter of the gas that’s a key contributor to climate change. A lower court previously refused to halt the regulation.

Methane is the main component in natural gas and is far more potent than carbon dioxide in the short term. Sharp cuts in methane emissions are a global priority — including the United States — to slow the rate of climate change.

The methane rule targets emissions from existing oil and gas wells nationwide, rather than focusing only on new wells. It also regulates smaller wells that will be required to find and plug methane leaks.

Studies have found that smaller wells produce just 6% of the nation’s oil and gas but account for up to half the methane emissions from well sites. The plan also calls for a phased-in requirement for energy companies to eliminate routine flaring, or burning of natural gas that is produced by new oil wells.

The states challenging the rule called the new standards “impossible to meet” and said they amounted to an “attack” on the industry.

The mercury rule, meanwhile, came after a reversal of a move by the Trump administration. It updated regulations that were more than a decade old for emissions of mercury and other harmful pollutants that can affect the nervous system, kidneys and fetal development.

Industry groups and conservative-leaning states argued emissions were already low enough, and the new standards could force the shuttering coal-fired power plants.

A North Carolina appeals court on Friday blocked students and employees at the state's flagship public university from providing a digital identification produced by the school when voting to comply with a new photo ID mandate.

The decision by a three-judge panel of the intermediate-level Court of Appeals reverses at least temporarily last month's decision by the State Board of Elections that the mobile ID generated by the University of North Carolina at Chapel Hill met security and photo requirements in the law and could be used.

The Republican National Committee and state Republican Party sued to overturn the decision by the Democratic-majority board earlier this month, saying the law allows only physical ID cards to be approved. Superior Court Judge Keith Gregory last week denied a temporary restraining order to halt its use. The Republicans appealed.

Friday's order didn't include the names of the three judges who considered the Republicans' requests and who unanimously ordered the elections board not to accept the mobile UNC One Card for casting a ballot this fall. The court releases the judges' names later. Eleven of the court's 15 judges are registered Republicans.

The order also didn't give the legal reasoning to grant the GOP's requests, although it mentioned a board memo that otherwise prohibits other images of physical IDs — like those copied or photographed — from qualifying.

In court briefs, lawyers for the RNC and N.C. GOP said refusing to block the ID's use temporarily would upend the status quo for the November election — in which otherwise only physical cards are accepted — and could result in ineligible voters casting ballots through manipulating the electronic card.

North Carolina GOP spokesperson Matt Mercer said Friday's decision "will ensure election integrity and adherence to state law."

The Democratic National Committee and a UNC student group who joined the case said the board rightly determined that the digital ID met the requirements set in state law. The DNC attorneys wrote that preventing its use could confuse or even disenfranchise up to 40,000 people who work or attend the school so close to the election.

North Carolina is considered a presidential battleground state where statewide races are often close.

Friday's ruling could be appealed to the state Supreme Court. A lawyer for the DNC referred questions to a spokesperson for Kamala Harris' campaign who didn't immediately respond to a request for comment. A state board spokesperson also didn't immediately respond to a similar request.

Voters can still show photo IDs from several broad categories, including their driver's license, passport and military IDs. The board also has approved over 130 types of traditional student and employee IDs.

The mobile UNC One Card marked the first such ID posted from someone's smartphone that the board has approved. Only the mobile ID credentials on Apple phones qualified.

The mobile UNC One Card is now the default ID card issued on campus, although students and permanent employees can still obtain a physical card instead for a small fee. The school said recently it would create physical cards at no charge for those who received a digital ID but want the physical card for voting.

The Republican-dominated North Carolina legislature enacted a voter ID law in late 2018, but legal challenges prevented the mandate's implementation until municipal elections in 2023. Infrequent voters will meet the qualifications for the first time this fall. Voters who lack an ID can fill out an exception form.

Early in-person voting begins Oct. 17, and absentee ballots are now being distributed to those requesting them. Absentee voters also must provide a copy of an ID or fill out the exception form.

The Arizona Supreme Court unanimously ruled Friday that nearly 98,000 people whose citizenship documents hadn’t been confirmed can vote in state and local races, a significant decision that could influence ballot measures and tight legislative races.

The court’s decision comes after officials uncovered a database error that for two decades mistakenly designated the voters as having access to the full ballot. The voters already were entitled to cast ballots in federal races, including for president and Congress, regardless of how the court ruled.

Secretary of State Adrian Fontes, a Democrat, and Stephen Richer, the Republican Maricopa County recorder, had disagreed on what status the voters should hold. Richer asked the high court to weigh in, saying Fontes ignored state law by advising county officials to let affected voters cast full ballots.

Fontes said not allowing the voters who believed they had satisfied voting requirements access to the full ballot would raise equal protection and due process concerns.

The high court, which leans Republican, agreed with Fontes. It said county officials lack the authority to change the voters’ statuses because those voters registered long ago and had attested under the penalty of law that they are citizens. The justices also said the voters were not at fault for the database error and also mentioned the little time that’s left before the Nov. 5 general election.

“We are unwilling on these facts to disenfranchise voters en masse from participating in state contests,” Chief Justice Ann Scott Timmer wrote in the ruling.

Of the nearly 98,000 affected voters, most of them reside in Maricopa County, which is home to Phoenix, and are longtime state residents who range in age from 45 to 60. About 37% of them are registered Republicans, about 27% are registered Democrats and the rest are independents or affiliated with minor parties.

Arizona is unique among states in that it requires voters to prove their citizenship to participate in local and state races. Voters can demonstrate citizenship by providing a driver’s license or tribal ID number, or they can attach a copy of a birth certificate, passport or naturalization documents.

Arizona considers drivers’ licenses issued after October 1996 to be valid proof of citizenship. However, a system coding error marked nearly 98,000 voters who obtained licenses before 1996 — roughly 2.5% of all registered voters — as full-ballot voters, state officials said.

After approximately five weeks, 19 witnesses, reams of documents and a dash of salacious testimony, the prosecution against Donald Trump rested its case Monday, handing over to the defense before closing arguments expected next week.

Trump’s team immediately sought to undermine key testimony against the former president, who is accused of covering up hush money paid to a porn star over an alleged encounter that could have derailed his successful 2016 White House bid.

His attorneys called lawyer Robert Costello — who once advised star prosecution witness Michael Cohen before falling out with him — in an apparent attempt to puncture Cohen’s credibility.

But Costello’s start on the stand was shaky at best, as his dismissive tone provoked an angry response from Judge Juan Merchan.

Merchan chided Costello for remarking “jeez” when he was cut off by a sustained objection and, at another point, “strike it.” Merchan told him: “I’m the only one that can strike testimony in the courtroom. Do you understand that?”

"And then if you don’t like my ruling, you don’t give me side eye and you don’t roll your eyes.”

Merchan was about to bring the jury back in when he asked Costello, “Are you staring me down right now?” and then kicked out the press to further admonish him.

"I’m putting you on notice that your conduct is contemptuous,” Merchan said, according to the transcript of the conversation that occurred when the press was out of the room. ”If you try to stare me down one more time, I will remove you from the stand.”

Costello didn’t return a message seeking comment Monday night.

Trump, speaking to reporters afterward, called the episode “an incredible display,” branding the proceedings “a show trial” and the judge “a tyrant.”

Extended quibbling among the two legal teams, along with the upcoming holiday weekend, means closing arguments that the judge had hoped could start Tuesday are now anticipated for next week.

It’s unlikely and risky, but the door remains open for Trump to take the stand in the criminal trial, the first ever of a former US president.

Experts doubt he will, as it would expose him to unnecessary legal jeopardy and forensic cross-examination by prosecutors — but his lawyer Todd Blanche has raised the prospect.

On Monday, Blanche finished his third day of questioning Cohen after hours of at times digressive, at other times bruising, exchanges.