Reimbursement limits constrain wages as facilities lose workers
The Supreme Court ruled in late June that the Trump administration may end Temporary Protected Status for Haitians and Syrians, a decision that experts say could worsen a growing caregiver shortage of nurses, aides, and home care workers in the United States. The U.S. is now experiencing its fastest increase in the aging population in more than a hundred years, with more than 20% of the population projected to be 65 or older by 2030.
Immigrants account for about one in six workers in the U.S. overall, but they comprise about 30% of caregivers in long-term care settings, according to a report from LeadingAge, the national association of nonprofit and mission-driven providers of aging services. Haitian immigrants are strongly represented in that workforce, at 7% of the long-term care labor pool, the report found.
“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.”
Allowing the TPS status of Haitians to expire will force those on temporary status to stop working as soon as the designation lapses, said Nixon Pierre-Louis, a Haitian-American citizen who works two jobs as a licensed practical nurse in Delaware. Pierre-Louis said patients who need assistance with daily living — feeding, toileting, bathing — will be directly affected.
“They depend on you,” he said. “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 leave their jobs, their duties will fall on already-stressed colleagues, Pierre-Louis said. “It’s just a circle. Not only does it affect residents or clients, it also affects co-workers.”
Care facilities — for instance, in south Florida and parts of Massachusetts and New York state — will face “significant” challenges, Sanders said. “In aging 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.”
The recent 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 said.
Aging services employers are often reimbursed by Medicaid and Medicare Advantage, which limits their ability to raise wages to attract replacements, Sanders noted. “Unlike, say, a pizza restaurant, which raises the cost of a pie when ingredient prices rise, aging services providers cannot increase the reimbursements they get from Medicaid or MA plans,” she said. Retaining experienced workers is already among the biggest challenges in home care, where 70% to 80% of new employees leave after about three months.
The U.S. House passed a bill in April to extend Haiti TPS, but the Senate has not taken action. Without legislative relief, the administration can proceed with revocations under the Supreme Court’s ruling.
Many Haitians on TPS have lived in the U.S. for years or decades, Pierre-Louis said, and are “on edge and anxious and concerned” about paying mortgages, car payments, and providing for their families.
“I just want people to know that we are here to contribute to society,” he said. “We are here to help.”