✨✨General Discussions

  Richmond,

  This is an excellent discussion. Thank you. I accessed the article in McKnight's and read the two summaries of the survey that was done, one about caregiving and one about the lack of discussion among seniors and their family members. I would add two additions, one from NaCCRA and one from VaCCRA.

  We did a webinar on caregiving in dementia. Alzheimer's, the most common form of dementia, is slow in onset and prolonged in its course. A former governor of Wisconsin, Marty Schreiber, describes his twenty-year experience caring for his wife. It is at https://www.youtube.com/@naccra-media. His life was broken into two Elaines: forty years with a loving wife and twenty years providing care to a wife with memory loss. He has written a book and spoken to groups all around the country on caregiving. His insights are valuable.

  Immigrants are providing home care to many seniors as personal care attendants. I submitted this article to the VaCCRA newsletter and have heard it will be published in the current edition. I have copied it here for wider discussion. It addresses the same issue: Who will care for seniors in need of home care?

  In early February 2026, former Secretary of Homeland Security Kristi Noem attempted to end Temporary Protective Status (TPS) for 353,000 Haitian and 6,100 Syrian immigrants. The District Court of Columbia issued an injunction prohibiting the cancellation, citing a State Department advisory warning Americans not to travel to Haiti “due to kidnappings, crime, terrorist activity, civil unrest, and limited healthcare.” Sending these immigrants back to Haiti would be unwise. There was also concern that the national immigration policies were biased against Haitians because they were black.

  The case was appealed to the Supreme Court, and on June 25, 2026, the High Court ruled that the District Court lacked jurisdiction. When TPS was enacted by Congress in 1990, responsibility for determining eligibility was assigned to the Attorney General. Over time, this authority was delegated to the Secretary of Homeland Security. TPS falls exclusively within the domain of homeland security, and the Secretary has sole authority to determine eligibility. Permissions are typically granted for 18 months at a time.

  The Secretary, acting in concert with the Trump administration, may now end TPS protections for Haitian and Syrian nationals and, by implication, for any or all of the 1.3 million immigrants in TPS from 17 countries. Losing TPS makes one illegal. ICE knows where they work and live. This termination will be a tragedy for immigrants and their families, as many are the sole support for young children born in America. Children forced to move to Haiti or abandoned to relatives here in America will suffer.

  The loss also affects communities that lose hardworking, dedicated employees. TPS workers from Haiti, many of whom came here after the 2011 earthquake, have become productive citizens who harvest crops, work in the hospitality industry, and support senior living. Most of the jobs they fill are unattractive to native-born Americans because of long hours, difficult working conditions, and low pay. 24% of direct care workers in residential care are foreign-born. This includes 21% of workers in nursing facilities and 32%-40% of workers in home care, according to the Kaiser Family Foundation. A July 10, 2025, article in the New England Journal of Medicine asks, “Who Will Care for America?” It estimates a shortage of 860,000 healthcare attendants by 2032. The loss of immigrant workers will drive up costs, leading to higher caseloads and accelerated burnout among those who remain. Programs that lose devoted workers with deep institutional knowledge may have to restrict admissions or even close.

  Congress established TPS, and it can assert its authority to protect these foreign workers. A 3-year extension of TPS passed the House on April 16th (H.R.1689). It has been read twice in the Senate (S.4814), with 34 sponsors. Bringing it to the floor will require cooperation from the Senate Republican leadership (who called the bill "dead on arrival"). As seniors who depend on these workers, we can support efforts to keep this workforce intact by contacting our Senators.

  - Chuck Webb, MD, Board Member of NaCCRA and VaCCRA

  McKnight's published an article about aging in place based on an underlying LogicMark survey. Here is a summary. The survey was conducted in April 2026 among 1,000 U.S. adults, and the central finding is the gap between older adults’ desire to age at home and the lack of family planning around that wish.

    This article reports on a new national survey that exposes a troubling contradiction in the way Americans think about aging, independence, family caregiving, and senior living. Nearly nine in ten older adults surveyed said that aging in place is important to them, and almost half said they never expect to leave their current home. Yet only a small minority have had detailed conversations with loved ones about what they actually want if their needs change.

  That gap is the heart of the story. The desire to remain at home is strong, but the planning needed to make that desire realistic is often missing. Families tend to delay the conversation until there is a fall, hospitalization, cognitive decline, caregiver burnout, or some other crisis. By then, choices may be fewer, emotions higher, and the older adult’s own preferences less clearly known.

  The survey also reveals how deeply older adults worry about becoming a burden. Loss of independence ranked as their top fear, but concern about imposing on family was also prominent. Many older adults do not want their children or relatives to become default caregivers, yet they also may not have identified the services, supports, technology, housing changes, or financial resources that would allow them to remain safely at home.

  One especially interesting finding is that moving into a senior living setting does not necessarily eliminate anxiety about burdening family. Some residents in facilities still worry about the effect their needs have on loved ones. That suggests the issue is not simply “home versus senior living.” It is about agency, dignity, communication, and having a plan that everyone understands.

  The article also challenges stereotypes about older adults and technology. Many respondents were comfortable with technology playing a role in safety and support, especially when it supplements rather than replaces human contact. The preference appears to be for quiet, respectful assistance: technology in the background, people still in relationship.

  For senior living communities, resident advocates, families, and policymakers, the lesson is clear. “Aging in place” should not be treated as a slogan. It is not enough to say that people want to stay home. The practical question is whether the home, the family system, the finances, the care network, and the community supports are sufficient to make that possible. When they are not, waiting for a crisis can produce exactly the loss of independence everyone hoped to avoid.

  This article is worth reading because it reframes the aging-in-place conversation. The real contradiction is not that older adults want independence while needing help. That is simply the human condition. The contradiction is that families often know help will someday be needed, but still avoid the conversations that would preserve choice, reduce panic, and honor the older adult’s wishes.

 Richmond Shreve

  NaCCRA Board Member & VP

  Forum Moderator