Long-term care facilities brace for staffing losses after Supreme Court ruling
The Supreme Court’s decision, handed down last week, removes a legal barrier that had blocked the Trump administration from canceling Temporary Protected Status for Haitians and Syrians. Department of Homeland Security officials have said little about how the withdrawal will be implemented beyond announcing that existing Employment Authorization Documents will expire on July 10, effectively ending the legal ability of those recipients to work.
Health experts said the impact on the healthcare system would be immediate and severe. Steffie Woolhandler, a co-author of a 2025 report on the effects of mass deportation plans, said the loss of Haitian TPS holders will be especially damaging in regions where they make up a large share of the long-term care workforce. Massachusetts, which has the third-largest population of Haitians with TPS at roughly 19,000, will see major disruptions in nursing homes and home care, she said.
“It’s going to be a disaster in the Boston area, where a lot of our nursing home and home care aides are Haitian,” Woolhandler told NPR. “If the United States becomes inhospitable to noncitizens, which I think Trump is doing, we’re going to have a lot of problems staffing our entire healthcare system.”
Nationwide, Woolhandler’s research team found that roughly 50,000 physicians are noncitizens — about 9% of all U.S. doctors — and another 145,000 are registered nurses. The advocacy group FWD.us estimated that 21,000 Haitian TPS holders are employed in hard-to-fill roles such as nursing assistants and caregivers.
Katie Smith Sloan, president and CEO of LeadingAge, which represents more than 5,300 aging-service providers, called the ruling a “direct threat” to care delivery. In a statement, she said it “puts older adults and the providers who care for them in an untenable position,” noting that immigrant workers make up as much as 8% or more of the workforce in some of her member communities.
Woolhandler said the staffing shortfall will create bottlenecks across the continuum of care. If families cannot find nursing home beds or home care aides, patients may remain stuck in hospitals or emergency rooms, further straining acute-care facilities that already lack staff.
“The thing that has to be said is that the healthcare of everybody is going to be compromised by this,” she said. “If you start throwing out workers that play a key role in the whole continuum of care … it tends to create a bottleneck or a backup.”
In Springfield, Ohio, where about one in four residents is of Haitian descent, the ruling has caused widespread worry. Viles Dorsainvil, co-founder and executive director of the Haitian Support Center, said his organization received dozens of calls from TPS holders within hours of the ruling.
“They’re wondering if they can still keep their assets or money at the bank, if they can still go to work because TPS came with the work permit, and with the driver’s license privilege,” Dorsainvil told NPR. “The community is devastated.”
Dorsainvil, himself a TPS recipient who came to the United States from Haiti in 2020, said he is advising people to sign a power of attorney to someone they trust. Parents with American-born children should also plan to sign over guardianship of their children in case federal officials pursue family separations, he said.
With work authorizations set to expire in just over a week and no clear guidance from the administration, Dorsainvil said the people calling have little to rely on but hope. “There was no way I could go home,” he said of the political instability and gang violence that made Haiti unsafe for his return. He and his brother, a former doctor in Haiti now working as a nurse in Chicago, have applied for asylum, but their cases remain unresolved.