The Trump administration's potential removal of Temporary Protected Status (TPS) for Haitians and Syrians, upheld by the US Supreme Court in late June, is expected to worsen America's growing caregiver shortage, experts say. The US is experiencing its fastest increase in the aging population in over a century, 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.
Immigrant Workforce in Caregiving
Immigrants account for about one in six US workers but comprise approximately 30% of caregivers in long-term settings. These caregivers, often nurses and aides in hospitals, facilities, and homes, come from at least 163 countries. Haitian immigrants represent 7% of this workforce, according to a report from LeadingAge, the national association of nonprofit aging services providers.
"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."
Impact of TPS Expiration
The US House passed a Haiti TPS extension in April, but the Senate has not yet acted. Allowing TPS to expire will force Haitians on temporary status to stop working immediately, exacerbating the caregiving crisis, said Nixon Pierre-Louis, a Haitian-American licensed practical nurse in Delaware who works two jobs.
"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 said. He works with patients needing assistance with daily living—feeding, toileting, 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."
As Haitians on TPS are forced to stop working, their duties will fall on already-stressed colleagues, Pierre-Louis noted. "It’s just a circle. Not only does it affect residents or clients, it also affects co-workers." This 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.
Challenges for Care Facilities
Care facilities in areas like south Florida, parts of Massachusetts, and New York state will face "significant" challenges, Sanders said. "In ageing services, a sector that has, for a number of reasons, 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."
According to a recent report from the nonpartisan health policy nonprofit KFF, the number of immigrant workers has stayed relatively stable despite immigration crackdowns, but the workforce composition has changed. Non-citizen immigrant workers have left the caregiving workforce in greater numbers, while naturalized citizens have joined.
Employers in aging services are often reimbursed by Medicaid and Medicare Advantage, limiting their financial flexibility. "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; 70% to 80% of new employees leave after about three months in home care. 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
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. They are "on edge and anxious and concerned," Pierre-Louis said. According to Pew Research surveys, most Americans agree that immigrants often 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; patients with cognitive decline may spit, 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. He noted that Donald Trump and JD Vance are both married to first- or second-generation immigrants, as are other top officials, and many Americans descend from immigrants. "Why is it an America for them only, and it cannot be the America for all?"
