Will the end of TPS for Haitians mean a caregiving crisis in US?

On June ۲۵, the United States Supreme Court decision allowed President Donald Trump and his administration to end Temporary Protected Status (TPS) for Haitians, paving the way for their legal immigration status to be removed.

Trump has pushed to end TPS for several groups, as part of his efforts to restrict immigration into the US.

But lawmakers from both political parties have argued that stripping Haitians of their TPS status could create a caregiving crisis, given their presence in key industries like healthcare.

“Of the ۳۵۰,۰۰۰+ lawful Haitian TPS holders, roughly ۱/۳ work in our healthcare system. Immediately shutting off TPS will create a crisis in our hospitals, nursing homes, and in the [intellectual disabilities] community,” Republican Representative Mike Lawler wrote on the social media platform X.

Democratic Representative Ayanna Pressley echoed that sentiment in a statement.

“Seniors will lose their caregivers when we already have a caregiving crisis, and seniors will lose their ability to age in community with much-needed assistance,” she wrote.

The Temporary Protected Status programme allows nationals from countries experiencing crises, such as natural disasters or armed conflict, to live in the United States for up to ۱۸ months. The federal government had previously renewed the designations, making them effectively permanent, before President Trump took office for a second term in ۲۰۲۵.

Lawler’s estimates about how many Haitians with TPS work in the US healthcare system are within the range of what the data show.

The Trump administration decision — and Supreme Court ruling — affect about ۳۳۰,۰۰۰ Haitians whose TPS-related work authorisations expire on July ۱۰. They face deportation unless they qualify for another status. The ruling also applies to Syrians and Venezuelans.

About ۱۵۸,۰۰۰ Haitians in Florida have TPS, the majority of whom are in South Florida. The Sunshine State has the largest population of TPS recipients in the US: nearly ۴۰۴,۰۰۰ people. More than half are from Venezuela and about one-third are from Haiti, according to the nonpartisan Congressional Research Service.

With an ageing population and an existing caregiver shortage, healthcare experts say the end of TPS for Haitians will have a significant effect on the US healthcare industry.

Of the ۳۳۰,۰۰۰ Haitian TPS holders, about ۱۳,۰۰۰ work daily as nursing assistants, caring for ۶۵,۰۰۰ patients, The Boston Globe found. Another ۸,۰۰۰ Haitian caregivers serve ۱۲,۰۰۰ children and ageing people, according to Americans for Immigrant Justice, a Miami-based nonprofit law firm that provides free representation to low-income immigrants.

Experts said the TPS healthcare workforce exodus will be felt most acutely in New York, Massachusetts and Florida.

With its high populations of older people and immigrants, Florida is expected to be particularly hard-hit.

David Grabowski, a Harvard Medical School healthcare policy professor, said the decision will “have a major impact on nursing homes, assisted living facilities and home care agencies”.

What will happen if most Haitians with TPS are deported?

Healthcare researchers say deporting Haitian recipients of Temporary Protected Status will add pressure on a strained system.

Immigrants who have TPS are more likely to work in healthcare, with one ۲۰۲۵ study finding that recipients represent ۱۵ percent of all noncitizen healthcare workers. (TPS recipients make up about ۲.۱ percent of the total immigrant population.)

Immigrants make up a large share of direct care workers — people who are home health aides, personal care aides and nursing assistants.

There is already a national shortage of home health aides, personal care aides, nursing assistants and other long-term care and eldercare workers, but the US will need even more in the future. The US ۶۵-and-up population is expected to rise from ۵۸ million to ۸۲ million by ۲۰۵۰ — a ۴۲ percent increase.

Nearly half of US nursing homes report limiting admissions due to staffing shortages, and ۱۹ percent recently met the minimum staffing levels set by the Centers for Medicare & Medicaid Services. In ۲۰۲۳, shortages of nurses and other employees caused about two-thirds of US hospitals to operate below capacity.

“People who run nursing homes, chronic care hospitals and home care agencies – they are all saying this is a crisis,” said Dr Steffie Woolhandler, a distinguished professor of public health at City University of New York’s Hunter College. “There has long been a shortage of folks who are willing to do direct care work as nursing aides, and there’s still a shortage now, so, of course, if the US deports them all, it’s just going to make it worse.”

Drishti Pillai, the director of immigrant health policy at the research nonprofit KFF, said, “The long-term care industry is already facing shortages prior to these immigration policy changes, so I think it’s accurate to say that this is going to further exacerbate the situation.”

Why do so many Haitians with TPS work in caregiving?

Healthcare experts pointed to several reasons for TPS holders’ high numbers in direct care, including job availability, an easier certification process compared with other healthcare jobs, and prior experience caring for family members.

“We do not have sufficient native-born workers to fill all the caregiving jobs,” Grabowski, the healthcare policy professor, said.

These positions also typically have lower barriers to entry for licensure, or no English language requirements, experts said. Refugee settlement organisations often recommend the work to immigrants for those reasons.

The positions are “extremely difficult to fill” because they’re physically and emotionally demanding, with low pay and with little or no employee benefits, said Priya Chidambaram, senior policy manager with KFF’s programme on Medicaid and the uninsured.

Some Haitians also have experience caring for sick family members in their homes, given the lack of nursing home infrastructure in their home country.

In the end, experts said there will be many more people who need this care than people who will be able to provide it.

“This was true before the ruling,” Chidambaram said. “Now, the impact will only be worse.”