Ending Haitian TPS Is Already Straining America’s Caregiving Workforce
MIAMI, FL — MAY 18, 2017: Parishioners pray during a Haitian Flag Day service at Notre Dame d’Haiti Catholic Church in Miami’s Little Haiti neighborhood. That day, worshippers were awaiting a decision from the first Trump administration on whether to extend Temporary Protected Status for Haitians living in the United States. Nearly a decade later, the future of Haitian TPS is again at the center of a national debate — this time with potential consequences for America’s already strained healthcare workforce. (Photo by Joe Raedle/Getty Images)
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Throughout the United States, home health aides and nursing assistants care for some of our most vulnerable neighbors. They help people get out of bed, bathe, eat, take their medications and use the bathroom.
So what happens when the person fulfilling this role suddenly loses authorization to work?
For a lawyer-turned-certified nursing assistant who fled Haiti after members of a criminal group attacked her home in 2022, that question is no longer hypothetical.
“They stole everything from us and raped me,” the Haitian woman, a Temporary Protected Status designee, told Human Rights Watch in an interview. “I had no choice but to leave the neighborhood, but I knew that wherever I went, it could happen to me again.”
Haiti’s Temporary Protected Status designation, also known as TPS, dates back to the catastrophic 7.0-magnitude earthquake that struck the country on January 12, 2010, killing and displacing hundreds of thousands of people and devastating much of the country’s infrastructure. Nine days later, the Obama administration designated Haiti for TPS, allowing eligible Haitians already living in the United States to temporarily remain in the country and obtain authorization to work because conditions made returning safely to Haiti difficult.
The designation was subsequently extended and, in 2011, expanded to cover additional Haitians who had arrived in the United States as Haiti struggled to recover. Over the years, TPS for Haiti has been extended, terminated, restored and redesignated by successive administrations as Haiti has confronted natural disasters, political instability, economic turmoil and, more recently, escalating gang violence.
Under international human rights law, governments should not return people to places where they face serious risks to their lives, freedom, or physical integrity. However, the Trump administration’s move to deport Haitians to Haiti would mean returning them to one of the world’s most severe human rights and humanitarian crises.
The consequences won’t be felt by Haitian workers alone. In Florida, where Haitian immigrants make up an important part of the healthcare workforce, nursing homes and home-care providers are warning that losing these workers could deepen an existing labor shortage and disrupt care for elderly and disabled Americans.
Put more simply: Washington may be making an immigration decision, but nursing homes, healthcare workers and the patients who depend on them could be left dealing with the consequences.
“The loss of this significant part of the workforce means that people with disabilities [and] older folks are going to lose people that they rely on for some of their most basic functions, whether it’s bathing, helping feed themselves, or even helping take their medicines,” said Dr. Giridhar Mallya, a senior policy officer at the Robert Wood Johnson Foundation.
NEW YORK, NEW YORK – JULY 10: People hold signs during a press conference on the end of the Temporary Protected Status (TPS) at the 199SEIU Headquarters on July 10, 2026 in New York City. Healthcare employers, frontline workers, and patient advocates held a press conference on the upcoming end of TPS for thousands of Haitian and Syrian nationals, after last month’s Supreme Court ruling siding with the Trump administration in Mullin v. Doe allowing it to move forward in terminating TPS. (Photo by Michael M. Santiago/Getty Images)
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Mallya argues that the potential loss of Haitian workers comes at a particularly difficult moment for the nation’s long-term care system.
“I think that the healthcare industry is somewhat paralyzed,” Mallya said. “They don’t know how they’re going to be able to fill these positions, which were already hard to fill prior to this decision.”
It is a paralysis the industry warned the Trump administration about before the policy changes took effect. In a July letter to the Department of Homeland Security, the Florida Health Care Association urged the administration to consider the consequences for the state’s already strained healthcare workforce.
“We ask DHS to work with federal and state healthcare agencies to evaluate the impact on long term care providers before implementing actions that could further reduce the healthcare workforce,” the association wrote.
The potential impact in Florida is significant. “If roughly one-in-five Haitian TPS holders works in healthcare occupations, as national workforce analyses indicate, as many as 35,000 healthcare workers in Florida could be affected by recent policy changes,” the letter states.
While only a portion of those workers are employed in skilled nursing facilities and other long-term care settings, the association warned that losing even a fraction of them could affect patients.
“The loss of even a small percentage of these experienced caregivers would be detrimental to residents’ continuity of care as well as providers who are already struggling to fill essential positions,” the association wrote.
Those warnings, no longer hypothetical, extend beyond Florida.Even across New York, Massachusetts and Ohio, health care providers have already begun confronting the loss of Haitian workers.
For an industry that has struggled for years to recruit and retain enough caregivers, the challenge isn’t simply replacing one worker with another. Home health aides and nursing assistants often develop relationships with patients over months or years, learning their routines, medications and individual care needs.
That makes the loss of a caregiver more than a staffing problem. For an older or disabled American who depends on that worker to get dressed, eat a meal or safely move around their home, a disruption in the healthcare workforce can quickly become a disruption in daily life.
NEW YORK, NEW YORK – JULY 28: Haitian immigrants and community members attend an immigrant resource fair and Know Your Rights event in Brooklyn’s Little Haiti neighborhood on July 28, 2026, following the Trump administration’s move to end Temporary Protected Status for hundreds of thousands of Haitians. (Photo by Spencer Platt/Getty Images)
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For 91-year-old Solange French, it could mean losing Martha Nelson.
After French fell and broke her hip, Nelson, a 69-year-old Haitian home health aide, has cared for French nearly every weekday for the past three years, according to reporting from the Associated Press (AP). Nelson, who arrived in the United States after Haiti’s devastating 2010 earthquake, prepares meals, helps with household chores, accompanies French to medical appointments and provides the kind of companionship that has transformed their caregiver-patient relationship into something resembling family.
“On my days off, I think about her,” Nelson told the AP.
French is equally clear about what losing Nelson would mean.
“She’s with me all the time,” French told the AP. “Life would be impossible.”
For now, Nelson reportedly carries a copy of her work authorization with her wherever she goes and worries that each shift caring for French could be her last. Her uncertainty illustrates the larger problem confronting the long-term care industry: replacing a caregiver isn’t simply about filling an open shift. It can mean replacing years of trust, familiarity and knowledge about the daily needs of the person receiving care.
Today, America’s healthcare system is confronting a collision of immigration and healthcare policy, where decisions about who can live and work in this country increasingly determine who is available to care for the people who need it most.
“This is one among many immigration policies that are squeezing the healthcare system.” Mallya said.
While the debate over TPS will continue to play itself out in the political arena, families who depend on home health aides, nursing assistants and other caregivers aren’t debating their truths.
America is getting older, and the need for workers willing and able to care for aging and disabled Americans is not going away. Neither are the workforce shortages that nursing homes, assisted living facilities and home care agencies were confronting long before the latest changes to immigration policy.
The question, then, isn’t simply what happens to Haitian workers when they lose their authorization to work. It is also what happens to the people they were caring for.
For Solange French, that question has a name: Martha Nelson.
And across the country, thousands of other families may soon be facing a similar situation.