35,000 Caregivers at Risk: How TPS Termination Threatens South Florida's Healthcare System

Introduction: The Call Bell at 2 A.M. South Florida's healthcare system runs on Haitian TPS workers. They are the certified nursing assistants answering the call bell at 2 a.m. They are the home health aides helping Holocaust survivors bathe and dress. They are the dietary staff, the environmental services workers, the hospice aides who provide end-of-life care when families cannot be there. The Florida Health Care Association, representing 90 percent of Florida's roughly 700 nursing homes, estimates that 35,000 healthcare workers statewide could be affected by TPS termination -- roughly one in five Haitian TPS holders in Florida. This is not a future threat. The impact is already visible. Miami Jewish Health has cut 120 beds -- 28 percent of its capacity. Sinai Residences has spent $600,000 on retention efforts. Jackson Health System has confirmed 50 TPS employees at risk. The Fort Lauderdale airport has already dismissed some of its roughly 170 TPS workers. The system is contracting before termination is even fully implemented. This report examines what TPS termination means for South Florida's healthcare system: the workers, the patients, the facilities, and the moral calculus that has led some residents to offer to hide their caregivers in their apartments. Background: The Demographic Tsunami The United States population aged 65 and older is expected to grow by 42 percent by 2050, reaching 82 million. Florida is ground zero for this demographic shift. The state already ranks 50th nationally in home health aide availability -- dead last. Even before the TPS crisis, Florida's long-term care system was stretched thin. Haitian TPS holders have filled the gap. One in five Haitian TPS holders works in healthcare. Nationally, 13,000 Haitian TPS nursing assistants serve 65,000 patients daily. Another 8,000 Haitian TPS caregivers serve 12,000 children and aging people. TPS recipients represent 15 percent of all noncitizen healthcare workers in the United States. In Florida, where approximately 158,000 Haitian TPS holders live, the concentration is even higher. The Florida Health Care Association's July 7, 2026 letter to DHS Secretary Mullin put it bluntly: "Replacing these workers is neither immediate nor easy." The average time to fill a registered nurse vacancy is 86 days. Recruiting and onboarding a single replacement can cost $5,000 to $20,000. Travel nurse premiums remain 40 to 60 percent above pre-2020 baselines. Nearly one quarter of providers in the Ziegler CFO Survey reported TPS-related staffing disruptions. Timeline: The Crisis Unfolds Date Event Jun 25, 2026 Mullin v. Doe -- SCOTUS 6-3 allows termination of TPS for Haiti. LeadingAge CEO Katie Smith Sloan: "This will directly affect many older Americans." Jul 1, 2026 USCIS issues implementation guidance. Work authorization expiration set. Jul 7, 2026 FHCA sends letter to DHS Secretary Mullin requesting exemptions for 35,000 long-term care workers. Jul 10, 2026 USCIS extends work authorization to July 24 after last-minute pressure. Jul 20, 2026 Mother Jones publishes "Florida's Nursing Homes Are Bracing for Life Without Haitian TPS Workers." Jul 24, 2026 Current work authorization expiry date. No DHS response to FHCA letter as of this writing.

The Human Stories: Faces Behind the Crisis The statistics are overwhelming, but the crisis is best understood through the people living it. These are their stories, drawn from the reporting of Mother Jones, Marketplace, the Miami Herald, NPR, and other outlets. Marie Shirley Sanon: 22 Years on TPS Marie Shirley Sanon worked as a CNA at Miami Jewish Health for 22 years. She is one of 37 employees at the facility who will lose their jobs. Interviewed by Mother Jones, she described what awaits her in Haiti: "I don't have no place to go in Haiti, I don't have no house... the country is finished, every day, people die, they killing people, they kidnap people, they burn people alive." Twenty-two years of continuous employment in the United States. Twenty-two years of care provided to elderly patients. Twenty-two years of taxes paid, including Social Security contributions she will never collect. And now, at the end of those 22 years, she faces a return to a country that is, by every objective measure, uninhabitable for someone with no home, no family network, and no economic infrastructure. "Nina": The COVID Caregiver "Nina" is a pseudonym used by Mother Jones to protect the identity of a CNA who works at two nursing homes in Florida. She came to the United States after the 2010 earthquake. During the COVID-19 pandemic, when nursing homes were the epicenter of the deadliest phase of the crisis, she stayed. She held the hands of patients on their deathbeds when families could not enter the facilities. "My country is still a war zone. Going back right now is a death sentence." Nina's story captures the profound moral inversion of the TPS termination: the workers who risked their lives to care for Americans during a pandemic are now being told they must return to a country that is still reeling from the earthquake, from gang violence, from political collapse -- a country that was the reason TPS was created in the first place. "Mary": The Mother of Four "Mary" is a pseudonym from Marketplace. She works as a CNA at Sinai Residences in Boca Raton. She supports her father, who has cancer, in Haiti. She also supports four U.S. citizen children. She has lived in the United States for two decades. If TPS ends, she faces an impossible choice: leave her U.S. citizen children behind or take them to a country that cannot safely receive them. "Richard": The Future LPN "Richard" is a 30-year-old Haitian TPS holder who works in maintenance at Sinai Residences. He is studying to become a Licensed Practical Nurse -- an LPN. He fled Haiti after a gang attack. He is paying for LPN school out of his own pocket. If TPS ends, he will have to stop. The LPN that South Florida's healthcare system will need in five years will never complete his training. "R." and "A.J.": The Caregiver and the 91-Year-Old "R." is a home health aide in Sumter County. She cares for "A.J.," a 91-year-old who broke several vertebrae. Three years of trusted care -- morning routines, medication management, the intimate work of helping someone who cannot help themselves -- is at risk. For A.J., losing R. would not be an inconvenience. It would be a catastrophe that the home care system, already operating at capacity, cannot absorb. The Facilities: Ground Zero Miami Jewish Health: 120 Beds Gone Miami Jewish Health, one of the largest senior care facilities in South Florida, has already cut 120 beds -- 28 percent of its 393-bed capacity. CEO Jeffrey Freimark did not sugarcoat the impact: "Devastating on many levels, first of all, I think it is morally and ethically reprehensible. I have the utmost respect for our caregivers, they are the ones that make this organization work, they are the ones answering that call bell at 2 a.m." Thirty-seven TPS employees at Miami Jewish Health are losing their jobs. But the bed cuts mean that even the patients who remain will receive less care. When the call bell rings at 2 a.m., there will be fewer hands to answer it. Sinai Residences: $600,000 and a Hug Sinai Residences in Boca Raton employs 40 Haitian TPS workers, representing approximately 9 percent of its staff. The facility has spent $600,000 on wage adjustments and recruitment to prepare for the loss. Each TPS worker received a $2,000 retention payment from the facility -- plus a hug from residents. Residents also contributed additional money from their own pockets. CEO Rachel Blumberg described the bond between the mostly Jewish residents and their Haitian caregivers: "There's a kindred bond between our residents being Jewish and seeing the place that the Haitians have gone through." The bond goes beyond sentiment. When residents learned that their caregivers might be deported, some offered to hide them in their apartments. Blumberg told reporters: "That reminds me of Anne Frank." Jackson Health System: The Public Safety Net Jackson Health System, Miami-Dade County's public hospital network, has confirmed 50 TPS employees at risk. As the safety net provider for the county's most vulnerable patients, Jackson cannot cut beds the way a private facility might. The pressure on its remaining staff will intensify at a moment when the system is already operating at the margins of capacity. The Ripple Effect: Nursing Homes to Hospital ERs The Florida Health Care Association has warned of a cascade effect. When nursing homes reduce capacity because they lack staff, patients who would have been discharged from hospitals to nursing homes cannot be transferred. They remain in hospital beds, contributing to the emergency department boarding crisis that has plagued hospitals since the pandemic. The ERs that are already overcrowded become more so. The ambulances that are already on diversion stay on diversion longer. The whole system tightens. The Holocaust Survivor Connection Perhaps the most poignant dimension of the TPS termination crisis is the relationship between Jewish seniors and their Haitian caregivers. Miriam Singer, CEO of Jewish Community Services, which serves more than 400 Holocaust survivors annually, wrote in the Miami Herald: "Haitian caregivers with TPS status provide essential in-home care for hundreds of Holocaust survivors throughout Miami-Dade County... For many clients, these caregivers are not just employees -- they are trusted companions and, in many cases, family." The connection between Holocaust survivors and Haitian TPS workers is not sentimental. It is structural. Both groups know what it means to be displaced. Both know what it means to need protection. As one resident at Sinai Residences put it, "They can relate to not being wanted, to being kicked out and coming to America for salvage and freedom and safety and shelter." Murray Rubin, 92, a resident at Sinai, described his caregivers: "Everyone that works here, they've got a smile on their face. They're like family. We were married for 69 years, and the warmth and the empathy that the people showed... you can't put dollars on that." The residents launched a letter-writing campaign to Washington. Only Representative Jared Moskowitz responded. The disconnect between the moral urgency felt by the residents who live with their caregivers every day and the policy distance of the federal government could not be starker. Fun Facts: Surprising Details What You Might Not Know Sinai residents offered to hide Haitian staff in their apartments. CEO Rachel Blumberg: "That reminds me of Anne Frank." Residents mounted a letter-writing campaign to Washington; only Rep. Jared Moskowitz responded. Every Sinai worker facing TPS loss received $2,000 from the facility and a hug. Residents contributed more from their own pockets. Holocaust survivors care for their caregivers. At Sinai, many residents are Holocaust survivors. They see themselves in the Haitian workers. Miami Jewish Health cut 28 percent of its beds -- 120 beds out of 393. Not a rounding error but a business model collapse and a care crisis rolled into one. Immigrants account for 64 percent of all home health aides in Florida. Not just TPS holders but all immigrants. But TPS holders are a significant share, and the pipeline of future immigrant workers is damaged by policy chaos. Thirteen thousand Haitian TPS nursing assistants nationally serve 65,000 patients daily. The Boston Globe's analysis puts it in stark terms: every nursing assistant cares for five patients, every day. One Florida home health provider will have to dismiss six nurses providing at-home care to children. "You don't want the kids to go to a higher level of care," said Denise Bellville of HCAF. "So now, what happens?" Nearly half of U.S. nursing homes already limit admissions because of staffing shortages. TPS termination will push this number higher. The U.S. 65+ population is expected to grow by 42 percent by 2050. The demographic tsunami was coming regardless of TPS. TPS termination makes it impossible to prepare. The Statistics: Quantifying the Crisis 35,000 Haitian TPS healthcare workers at risk in FL (FHCA) 120 Beds cut at Miami Jewish Health (28% of capacity) 13,000 Haitian TPS nursing assistants nationally 65,000 Patients served daily by those nursing assistants Facility-Level Impacts Facility Impact Miami Jewish Health 37 TPS employees lost, 120 beds cut (28% of capacity) Sinai Residences (Boca Raton) 40 TPS workers (~9% of staff), $600K retention cost Jackson Health System 50 TPS employees at risk Catholic Health Services 44 TPS employees at risk Fort Lauderdale Airport ~170 TPS workers (some already dismissed) Unnamed South Florida senior care provider ~100 TPS employees One unnamed nursing home (1199SEIU) ~30 of 100 employees are TPS holders

Statewide and National Context Metric Value Haitian TPS holders in Florida ~158,000 Haitian TPS healthcare workers at risk (FHCA) 35,000 Florida nursing homes 695 (FHCA represents 90%) Florida rank for home health aide availability 50th (last) Haitian TPS nursing assistants nationally 13,000 (serving 65,000 patients daily) One in five Haitian TPS holders works in healthcare ~20% U.S. nursing homes limiting admissions due to staffing ~50% U.S. 65+ population by 2050 82 million (42% increase)

Replacement Costs The financial burden of replacing TPS workers is staggering for facilities already operating on thin margins: Cost Item Value Sinai Residences annual retention/recruitment costs $600,000 Per-worker retention payment at Sinai $2,000 + resident contributions Average time to fill RN vacancy 86 days Recruiting/onboarding cost per hire $5,000 to $20,000 Travel nurse premium 40-60% above pre-2020 baseline Providers reporting TPS-related staffing disruptions Nearly 25% (Ziegler CFO Survey)

Why This Matters: The System Cannot Absorb the Shock Florida's long-term care system was fragile before TPS termination. The state ranks 50th in home health aide availability. Nearly half of U.S. nursing homes already limit admissions because of staffing shortages. The demographic wave of 82 million older Americans by 2050 is approaching. TPS termination does not create a staffing problem -- it deepens an existing one past the point of recovery. The moral dimension is equally urgent. The Holocaust survivors who offered to hide their Haitian caregivers understand something that the policy process has not yet grasped: these are not temporary workers. They are family. They have been in the United States for decades. They have paid taxes, cared for the most vulnerable Americans, and built lives that cannot be uprooted without causing profound harm. As Margarette Nerette, Vice President of 1199SEIU Florida, told reporters: "I don't know how we're going to survive this. The workers are suffering, but the patients are going to suffer more." For organizations tracking the impact of TPS termination on healthcare systems, tools like PROVEN help coordinate data across facilities, workforce agencies, and policymakers to ensure that the human and operational stakes remain visible in the public record. When 35,000 workers are at risk across 700 nursing homes, coordinated data is not a luxury. It is a necessity for understanding the full scope of the unfolding crisis. Sources "Revoking TPS Would Create Crisis for South Florida Health Care." NBC Miami, 2 Feb. 2026, www.nbcmiami.com/news/local/revoking-tps-for-haitians-would-create-crisis-for-south-florida-health-care-industry/3758754/. "State Nursing Homes Push Back on TPS Decision." Skilled Nursing News, 13 Jul. 2026, skillednursingnews.com/2026/07/state-nursing-homes-push-back-on-tps-decision-seek-exemptions-for-35000-haitian-workers/. "Hobbled End of TPS for 1.3M Workers." Skilled Nursing News, 26 Jun. 2026, skillednursingnews.com/2026/06/hobbled-end-of-temporary-protected-status-for-1-3m-workers-will-exacerbate-nursing-home-access/. "Florida's Nursing Homes Are Bracing for Life Without Haitian TPS Workers." Mother Jones, 20 Jul. 2026, www.motherjones.com/politics/2026/07/floridas-nursing-homes-are-bracing-for-life-without-haitian-tps-workers/. "Without TPS, Elder Care Industry Will Lose Critical Haitian Staff." Marketplace, 22 Jan. 2026, www.marketplace.org/story/2026/01/22/without-tps-elder-care-industry-will-lose-critical-haitian-staff. "End of TPS for Haitians Could Devastate Elder Care." Marketplace, 15 Jan. 2026, www.marketplace.org/story/2026/01/15/end-of-tps-for-haitians-could-devastate-elder-care. "Will the End of TPS for Haitians Lead to a Caregiving Crisis?" PolitiFact Florida / WUSF, 2 Jul. 2026, www.politifact.com/article/2026/jul/02/TPS-Haitians-florida-caregiving-crisis-seniors/. "Terminating Protections for Haitians Could Deal a Blow to Elder Care." WUSF, 31 Mar. 2026, www.wusf.org/politics-issues/2026-03-31/terminating-protections-haitians-could-deal-blow-florida-elder-care. "Jewish Seniors Rally Behind Their Caregivers." JTA / Jerusalem Post, 30 Jan. 2026, www.jta.org/2026/01/30/united-states/jewish-seniors-rally-behind-their-caregivers-as-350000-haitians-are-set-to-lose-legal-status. "Reminds Me of Anne Frank." Forward, forward.com/fast-forward/802069/reminds-me-of-anne-frank-jewish-seniors-and-holocaust-survivors-are-offering-to-hide-their-haitian-caregivers. "Jewish Seniors Offer to Hide Carers." Times of Israel, www.timesofisrael.com/jewish-seniors-offer-to-hide-carers-as-350000-haitians-face-deportation-from-us/. Singer, Miriam. "Op-ed." Miami Herald, 17 Jul. 2026, www.miamiherald.com/opinion/op-ed/article316541795.html. "End of Haitian TPS Will Create a Humanitarian Storm." Tampa Bay Times, 20 Jul. 2026, www.tampabay.com/viewpoints/2026/07/20/haitian-tps-temporary-protected-status-miami-florida/. "Florida Could Lose 35,000 Caregivers Under TPS Ruling." USA Today Network-Florida, 10 Jul. 2026, www.usatoday.com/story/news/healthcare/2026/07/10/health-official-warns-loss-of-haitian-tps-workers-will-hurt-florida-seniors/90879329007/. "Florida Healthcare Providers Brace for Haitian Workforce Losses." Florida Phoenix / Islander News, 11 Jul. 2026, www.islandernews.com/lifestyle/health/florida-healthcare-providers-brace-for-haitian-workforce-losses-as-tps-lapses/article_fa705862-d6cb-4e1c-81c5-e8e8fd72d963.html. "Nursing Home Group Asks for Exemptions." WLRN, 13 Jul. 2026, www.wlrn.org/immigration/2026-07-13/nursing-home-group-asks-for-exemptions-for-haitians-working-in-florida-facilities. "TPS Expirations Spark Fears About Healthcare Worker Shortage." Healthcare Brew, 15 Jul. 2026, www.healthcare-brew.com/stories/tps-expirations-spark-fears-about-healthcare-worker-shortage. "Haitian TPS: Employers Brace for Economic Impact." CNN, 28 Apr. 2026, www.cnn.com/2026/04/28/economy/haitian-tps-immigrants-economy-supreme-court. "South Florida Officials Concerned Over TPS Impact." Local 10 News, 27 Jan. 2026, www.local10.com/news/local/2026/01/27/south-florida-officials-concerned-over-looming-impact-of-revoking-tps-from-haitians/. "Fort Lauderdale Airport TPS Workers." Miami Herald, 11 Jul. 2026, www.miamiherald.com/news/local/immigration/article316418251.html. Sinai Residences and LeadingAge Southeast. "Amicus Brief." Supreme Court, 16 Apr. 2026, www.supremecourt.gov/DocketPDF/25/25-1083/404204/20260416163804454_25-1083%20and%201084%20Sinai%20Residences%20et%20al.%20ACB%20Corrected.pdf. FHCA. "Letter to DHS Secretary Mullin." 7 Jul. 2026, floridaphoenix.com/wp-content/uploads/2026/07/FHCA-TPS-DHL-7.26.pdf. LeadingAge. "Statement on SCOTUS Ruling." 25 Jun. 2026, leadingage.org/leadingage-reax-supreme-court-ruling-on-haiti-syria-tps/. Home Care Association of Florida. "TPS Impact Statement." HomeCareFLA.org, members.homecarefla.org/news/Details/hcaf-urges-congress-to-act-as-haiti-tps-termination-threatens-florida-s-home-care-workforce-307900. "Senior Citizens Join Immigration Fight to Protect Caregivers." NPR, 29 Apr. 2026, www.npr.org/2026/04/29/nx-s1-5804448/tps-seniors-long-term-care-supreme-court. "Haitian TPS Healthcare Immigration." NPR, 2 Jul. 2026, www.npr.org/2026/07/02/nx-s1-5878415/haitian-tps-healthcare-immigration-supreme-court. FWD.us. "Haiti TPS Fact Sheet." Jan. 2026, www.fwd.us/wp-content/uploads/2026/01/Haiti-TPS-Fact-Sheet_January-2026.pdf. Ziegler CFO Survey. Skilled Nursing News, 15 Jul. 2026, skillednursingnews.com/2026/07/workforce-costs-remain-a-top-operating-pressure-for-nursing-homes-and-long-term-care-providers-ziegler-cfo-survey-states/. Healthcare Brew / Stealth Agents. "Staffing Cost Data 2026." stealthagents.com/research/healthcare-staffing-costs-2026.