The Unintended Consequence of Stringent Immigration Enforcement on Staffing Levels in Nursing Homes: Evidence from Secure Communities

The provision of healthcare in the United States is increasingly reliant on immigrant workers. In this paper, I examine the impact of Secure Communities, a major immigration enforcement program designed to check the immigration status of all individuals arrested by local police, on staffing levels in nursing homes. Using a difference‐in‐differences strategy that exploits the staggered activation of Secure Communities across US counties, I found that the program reduced directcare staff hours per resident day by 0.073, an approximately 2% decline relative to the mean of treatment counties in the baseline period. This finding suggests that stringent immigration enforcement may exacerbate the healthcare worker shortage in the United States.