When patients started cancelling appointments out of fear that Immigration and Customs Enforcement might arrest them on the street, St. John’s Community Health in Los Angeles adapted.
The clinic began sending nurse practitioners, like Gabriella Oloye, to patients’ homes.
“It felt like I was in a movie,” Oloye said. “Like I was meeting patients in secrecy.”
As the months passed, the home visitation program became more familiar to staff, who packed a van with fresh food and hygiene supplies to deliver through the clinic’s Healthcare Without Fear program.
Oloye estimates 40% of her patients are over age 50 and often behind on screenings like mammograms or colonoscopies.
One patient in his 50’s with a chronic condition was too scared to leave home, even for a walk or to go to work. “I can’t even go out to the park,” he told her. “This is no way to live.”
Another patient waited too long to seek help for cellulitis in an infected toe.
“That could mean losing limbs or appendages,” Oloye said.
Since President Donald Trump took office, the U.S. Department of Homeland Security has deported over 527,000 people, with another 1.5 million who have self-deported, according to a recent announcement by the agency. And one of the administration’s first orders was to rescind a Biden-era rule that protected “sensitive locations” — places of worship, schools, hospitals and clinics — from immigration operations.
Advocates who coordinate care for immigrant patients have reported seeing this hesitancy to access healthcare.
“We had over a thousand cases a few years ago,” said Laszlo Maderas, the chief medical officer of the Migrant Clinicians Network. “Now, we’re down to a few dozen.”
According to polling conducted by NPR with PBS and Marist, support for these mass deportations is split across party lines; a majority of polled Republicans believe these policies are making the country safer.
But health care and service providers in California who work with immigrants said they are concerned about the toll the Trump administration’s immigration policy is having on their patients — many of whom are avoiding medical treatment and social programs because they fear immigration arrests or raids. Clinicians and social workers said they are particularly concerned for older immigrants and those with chronic conditions, for whom routine medical care is more critical.
For older patients, often dealing with cancer or chronic conditions such as diabetes and heart disease, avoiding care can mean greater severity for someone already holding more disease.
While telehealth offers an alternative to a routine appointment, services like lab tests and vaccines require in-person visits.
“That fear will outweigh the need to actually get care,” Wang said. “That’s the real human impact.”
While Alameda County did not provide data tracking the relation between immigrants avoiding care and adverse health outcomes, research suggests the two are correlated: studies and literature reviews show that fear of detainment leads to exacerbated stress and reluctance to obtain health services amongst both undocumented and legal migrant populations. Wang speculated that missed care may have already contributed to premature deaths, noting chronic disease — prevalent in older populations — is the leading cause of death in Alameda County.
“If you don’t pay attention to it,” Wang warned, “you’re going to die early from something totally preventable.”
Staff at the Mission Neighborhood Centers’ Health Aging and Disability Program in San Francisco said that patient fears have led to a noticeable drop in attendance. The center is located at the corner of 19th and Capp Street in the Mission District, the heart of San Francisco’s Latino community, which has attracted generations of immigrant families and more recent migrants.
Fear for themselves or undocumented family and friends, combined with rumors, has pushed many into isolation. Claudia Perez-Vaughan, who leads senior activities for the program, said the current situation reminds her of what many seniors were forced to endure during the COVID-19 lockdown. Studies have shown a correlation between isolation and increased risk of mortality, dementia, and disability in older results.
“They have this community center that is their second house, their second home,” she said. “We are like a family.”
The atmosphere has changed recently. Some seniors have limited their visits to once a month, said Cinthia Torres, the community services coordinator. Others come only for to-go meals. A few have disappeared entirely. She remembers clients who used to drop by to say hello or play bingo.
“They don’t come anymore,” Torres said.
José Sequaira, 77, and a naturalized citizen, still comes to the center for community activities like bingo, but it isn’t without trepidation. He’s upset by stories of people being ambushed by ICE officers and deported after building lives here. “I’m afraid because people with power, they treat them like nothing,” he said. “I don’t have any power, and how are they going to treat me?”
Much of the fear stems from language barriers, Torres noted.
“Let’s say someone stops them and asks them something. They’re afraid they won’t be able to answer, and they’re going to be taken away.”
Torres reminds clients that Mission Neighborhood Centers isn’t a sanctuary, but staff will do everything they can to protect them — “even if we have to sleep here.”
Citizenship can offer some protection against the threat. Jake Simons, associate director and naturalization program manager at Centro Latino de San Francisco, said there’s a push among clients to enroll in classes.
Naturalization class enrollment applications have jumped from 250 to 400 in the past year at Centro Latino, a community center for older adults and people with disabilities. It’s normal to be nervous before citizenship exams, Simons said. Now he’s seeing students break down crying during one-on-one conversations with him, others are being prescribed anxiety medication. A few ask staff to accompany them to their citizenship exams, a service the center doesn’t officially offer.
“They think going through this process, something bad is going to happen to them when in reality it should be a positive thing,” Simons said.
Julio Sifuentes, 67, who attends the naturalization classes, said a friend had a heart attack brought on by fear and stress.
The man, undocumented, was rushed to the ER and now won’t leave his house.
“I was scared,” Sifuentes said. “I also thought it could happen to me.”
Beyond medical appointments and social activities, some seniors are also choosing not to apply or recertify for CalFresh food benefits or Medi-Cal health insurance, said Centro Latino social worker Veronica Lacayo. She said the seniors worry that their information could be accessed by ICE — which had access to Medicaid data before being blocked in California.
“Part of [their] well-being is food, it’s medical assistance. If they won’t get those services, it’s devastating,” Lacayo said.
Centro Latino distributes hot meals, often drawing long lines. Now, it’s not unusual for clients to ask to wait indoors, afraid of being seen by immigration agents, Lacayo said.
Others hide at home. Meal-delivery drivers have reported seniors not answering their doors. When Lacayo calls to follow up with clients, they tell her they thought ICE was knocking.
“For most, it’s the only meal they get all day,” she said. Now, she instructs drivers to loudly say “la comida,” announcing the meal, and to identify themselves.
Some clients have asked Lacayo for virtual programming, she said, and she urges them to return in person.
“But this situation is really challenging,” she said. “Encourage them how, when they feel fear?”
Hussain Khan is a reporter and Matthew Busch is a photographer with the Investigative Reporting Program at the UC Berkeley Graduate School of Journalism. They covered this story through a grant from The SCAN Foundation.
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