The Trump administration’s revocation of temporary protected status for immigrants from countries including Honduras, Venezuela, Syria, and Haiti has cost US hospitals and nursing homes thousands of nursing assistants, home health aides, and other frontline workers, according to employers and patients interviewed by the Guardian. About one in six hospital workers directly involved in patient care is an immigrant, and an estimated 4% of hospital workers are not naturalized citizens — figures that healthcare executives said cannot be easily replaced.
Among those affected is Janeth, a 50-year-old Honduran nursing assistant who emigrated to the United States in 1998 and worked at a Kaiser Permanente hospital in the San Francisco Bay Area for 23 years, winning a prestigious national nursing award seven times. She lost her job in March after the Department of Homeland Security terminated Honduras’s TPS designation in September 2025, the Guardian reported. Her colleagues raised more than $13,000 in a crowdfunding campaign. On September 8, the day the termination took effect, Michael Fein, a retired Kaiser physician, wrote to US Senator Adam Schiff of California describing Janeth as “reliable, compassionate, dedicated, and knowledgeable” and calling the situation “devastating and so unfair.” Kaiser Permanente, which did not comment directly on Janeth’s case, said it has been “looking for ways to reduce the anxiety and uncertainty for any of our employees who might find themselves in this situation.” Janeth, who asked to be identified only by her middle name because of the sensitivity of her immigration case, has had to move in with her daughter after she could no longer pay her mortgage. “I just want my job back, I just want my life back. I want to take care of my patients again,” she said.
The human cost is visible in the accounts of patients Janeth cared for. John Jacoby, whose mother Dolores was diagnosed with acute myeloid leukemia in 2012, said Janeth “injected life into my mom, into her veins, into the atmosphere, you know, for all of us” at a moment when the family had just received devastating news from the doctor. Dolores was given three months to live; she lived for three years. “They need to take her back for the patients,” Jacoby said. “I just hope I don’t ever end up in a hospital bed without someone like [her] by my side.”
Employers say they are already struggling to replace TPS workers. Amina Dubuisson, vice-president of clinical services at Ventura Services Florida, which operates nine nursing homes across Miami with 200 to 300 staff each, said 20% to 30% of her workers are TPS holders. “They do a lot of the jobs that Americans don’t want to do,” she said, naming nursing assistants who clean and feed patients. Kimberly Pierce Burke, executive director of the Alliance of Independent Academic Medical Centers, a national organization of about 90 independent teaching hospitals, said the loss of immigrant caregivers cannot reduce patient need. “Just because we are stopping immigration pathways and banning people from these countries doesn’t mean we can ban patients, too,” Burke said. “They continue to come to hospitals and nursing homes, except now there is a shortage of people who can attend to their needs.”
FWD.us, a Washington, DC-based immigration advocacy organization, used census and other government data to estimate that nearly 1.3 million people in the US were on TPS as of early 2025, of whom at least 50,000 were working in healthcare. US Citizenship and Immigration Services, part of the Department of Homeland Security, told the Guardian it does not maintain data on TPS holders’ occupations.
The administration has framed the terminations as a return to TPS’s original purpose. “TPS was never designed to be permanent, yet previous administrations have used it as a de facto amnesty program for decades,” a DHS spokesperson said in a statement. Since returning to the presidency in 2025, the Trump administration has ended or attempted to end TPS for 13 of the 17 countries with such designations.
The policy is now entangled in litigation. In December, a federal court ruled that the administration’s decision to end TPS for Honduras, Nepal, and Nicaragua was unlawful because DHS did not consult other government agencies or review country conditions as required. The government appealed, and in February the Ninth Circuit Court of Appeals upheld the revocation; plaintiffs chose not to take the case to the Supreme Court. Separately, the high court is weighing whether the administration can immediately end TPS for Haitians and Syrians; oral arguments were held in April. Last September, 95 House members and 13 senators, all Democrats, wrote to then-DHS Secretary Kristi Noem to warn that “the most vulnerable Americans in need of healthcare will pay the price” of the terminations.
Jhony Silva, who entered the US from Honduras in 1998 at age three and grew up in the Bay Area, worked as a nursing assistant at Stanford Hospital in Palo Alto before last year’s TPS revocation forced him out. He dropped out of nursing school because he could no longer afford it. He has since become a lead plaintiff in a lawsuit challenging the government’s decision. “I’m going to use my voice to speak up about what’s going on, for people that can’t speak like me,” he said.
The terminations extend beyond TPS. In June 2025 the administration also ended a humanitarian parole program launched by the Biden administration in 2023 that had allowed nearly 500,000 people from Cuba, Haiti, Nicaragua, and Venezuela — known as CHNV — to enter the US with work authorization, according to FWD.us. DHS said many of the parole recipients were “very poorly vetted” and described the termination as a “return to commonsense policies.” About 30,000 healthcare workers were working under the program as of September 2024.
Joseph Durandis, a Miami doctor, lost one of his three medical assistants when CHNV ended — a former physician in Cuba whom he described as “not replaceable.” Patient wait times have lengthened and satisfaction is dropping, Durandis said: “Triage takes much longer and that causes annoyance among patients.”
Rachel Blumberg, president and CEO of Sinai Residences, a senior assisted-living and long-term care facility in Boca Raton, Florida, said she went to work the day CHNV expired, pulled aside nine staff members, gave each $2,000, and asked them to leave because they had lost work authorization. “It felt like I had to do the dirty work of the government,” she said.
Haiti’s TPS status remains in limbo. The country was first granted TPS in 2010 after an earthquake that killed thousands and displaced over a million people; the designation has been the subject of multiple rounds of litigation, and a federal judge in Washington ruled that terminating it would cause “irreparable harm” to Haitians who would be forced back to a country that the State Department warns Americans not to visit “for any reason.” According to 1199SEIU, Florida’s largest healthcare union, more than 30% of nursing home workers it represents would have lost legal status overnight had the federal judge not ruled against the termination.
Marie Esther Duval, a 55-year-old Haitian woman who came to the US in 2000, runs an adult family home in Spokane, Washington, for four women with severe mental illness, ages 29 to 34. Three of her patients are themselves Haitian or Haitian-American. “It scares me how much she cares about me,” Demica, one of the residents, said of Duval. “I can see her heart pounding out of her chest when she thinks I am not doing well.” Duval has not told her patients that she could lose her legal status. “These are people with chronic anxiety and depression. They won’t be able to handle this news.”
Maryse Balthazar, who moved from Haiti to the US in 2010 after the earthquake and has worked for years as a home health aide, now cares for Esther Birnbaum, a 96-year-old in Palm Beach County whose elder brother — a Second World War pilot — she cared for until his death in 2024 at age 102. “I can’t imagine my day-to-day life without her. I don’t know how she does it, really. From hooking me on to my lymphatic drainage machine to keeping me active, it’s all her,” Birnbaum said. “There is no plan B. This is where my life is, I wouldn’t know what to do if TPS isn’t protected,” Balthazar said.
In April oral arguments before the Supreme Court, lawyers for Haitian and Syrian TPS holders alleged the administration’s actions reflected “the president’s racial animus towards non-white immigrants and bare dislike of Haitians in particular.” US Solicitor General John Sauer, representing the administration, dismissed the claim, saying the president’s statements referred to “the problems of crime, poverty, welfare dependency.” DHS told the Guardian “these decisions have nothing to do with race” and were taken after “reviewing conditions in the country and consulting with appropriate US government agencies.” It said Haiti’s TPS was granted after an earthquake more than 15 years ago and “now is the right time to conclude what was always intended to be a temporary designation.”