The US Supreme Court ruled in late June that the Trump administration may remove Temporary Protected Status (TPS) for Haitians and Syrians, a decision experts say will worsen America's growing caregiver shortage. The US is experiencing its fastest increase in the aging population in over 100 years, with more than 20% of the population projected to be 65 or older by 2030. However, the caregiver workforce has not kept pace, leading to staffing shortages.
Immigrants Are a Critical Part of the Caregiving Workforce
Immigrants account for about one in six US workers but comprise roughly 30% of caregivers in long-term care settings, according to a report from LeadingAge, the national association of nonprofit and mission-driven providers of aging services. These caregivers, often nurses and aides in hospitals, facilities, and homes, come from at least 163 countries. Haitian immigrants represent 7% of that workforce.
"Foreign-born staff are significant contributors to care and services our members provide, and that older adults and their families rely on," said Lisa Sanders, vice-president of communications and media relations at LeadingAge. "Without staff, there is no care."
Congressional Action on TPS Stalled
The US House passed a Haiti TPS extension in April, but the Senate has not yet acted. Allowing TPS to expire would force Haitians on temporary status to stop working immediately, exacerbating the caregiving crisis. Nixon Pierre-Louis, a Haitian-American licensed practical nurse in Delaware who works two jobs, explained the impact: "That's going to leave the institution or the facility where you work short, and that's going to affect the resident or the client that you're taking care of."
Pierre-Louis works with patients needing assistance with daily living—feeding, toileting, and bathing. "They depend on you. The clients and the residents are also going to suffer because there is no one to take care of them, and that can also lead to illness and infection." He noted that duties would fall on already-stressed colleagues: "It's just a circle. Not only does it affect residents or clients, it also affects co-workers."
Financial and Operational Strain on Care Facilities
The loss of TPS workers puts pressure on long-term care facilities and home health agencies, which may struggle to care for new patients amid staff shortages. Finding, training, and retaining new staff is difficult and expensive. Sanders said facilities in south Florida and parts of Massachusetts and New York will face "significant" challenges.
"In ageing services, a sector that has long navigated workforce challenges, the loss of good workers is a significant blow. These are dependable, valued staff who are having to leave their employer because the government says they must go," Sanders said.
Although the number of immigrant workers has remained relatively stable despite immigration crackdowns, the workforce composition has shifted, according to a recent report from KFF. Non-citizen immigrant workers have left caregiving in greater numbers, while naturalized citizens have joined.
Limited Options for Employers
Ageing service employers are often reimbursed by Medicaid and Medicare Advantage, limiting their ability to respond to financial pressures. "Unlike, say, a pizza restaurant, which raises the cost of a pie when ingredient prices rise, ageing services providers cannot increase the reimbursements they get from Medicaid or MA plans," Sanders said. This makes it harder to recruit nurses and aides. "Our members are also competing with restaurants, hospitality businesses, and retail for servers, housekeepers and maintenance workers."
Retaining experienced workers is a major challenge in home care, with 70% to 80% of new employees leaving after about three months. The Supreme Court decision is "one of many blows to the sector that relies on foreign-born staff, whose ability to work in the US increasingly is limited, because of actions by the current administration," Sanders added.
Human Impact on TPS Holders
Many Haitians on TPS have lived in the US for years or decades and worry about paying mortgages, car payments, and providing for their families. Pierre-Louis described them as "on edge and anxious and concerned." According to Pew Research surveys, most Americans agree that immigrants frequently do jobs Americans do not want.
"There are certain jobs that I've only seen foreigners do," Pierre-Louis said. While white Americans sometimes work alongside him in caregiving, it is often temporary until they find jobs that demand less and pay more. Caregiving can be difficult work—patients with cognitive decline may spit on, curse, or hit caregivers. "You have to assist them with dignity," Pierre-Louis said. "You do it with all your heart, because they need the help. If you don't do it, no one's going to do it for them."
Being a foreigner in the US now means being targeted, Pierre-Louis said. Even citizens worry about backlash. "I just want people to know that we are here to contribute to society. We are here to help," he said. Noting that Donald Trump and JD Vance are both married to first- or second-generation immigrants, as are other top officials, and that many Americans descend from immigrants, Pierre-Louis asked: "Why is it an America for them only, and it cannot be the America for all?"
