When the Caregivers Are Deported: How TPS Removal for Haitians Will Reshape U.S. Healthcare

Marie Shirley Sanon has been a certified nursing assistant in Miami for 22 years. She has held Temporary Protected Status for all 22 of those years, ever since the U.S. government designated Haiti for TPS after the 2010 earthquake. She is one of roughly 37 workers losing their jobs at Miami Jewish Health, which has already cut 120 nursing home beds in anticipation of the staffing loss. Twenty-two years. One designation. One looming deadline. No path to permanency. Across the country in Massachusetts, a nursing assistant named Marie Fleurival cared for Alzheimer's and dementia patients at the Enclave of Franklin. She was laid off twice, once when the administration initially terminated TPS and again after USCIS issued a brief extension. Her employer told her she would not be able to work until further notice. Her patients, many of whom cannot speak for themselves, lost the caregiver who bathed them, fed them, and remembered their life stories. In a Kentucky emergency room, a TPS holder named Harlaine worked through the COVID-19 pandemic as an ER nurse while raising four U.S. citizen children. After the Supreme Court ruling, she prepared her will. She told a reporter, "I just couldn't breathe. They're starving us out. It's like someone saying, hey, do you want to go live in a horror movie? No, I don't." She has no idea how many more shifts she will be allowed to work. These three women are not exceptions. They are the rule. And their loss from the U.S. healthcare system is not a hypothetical future event. It is happening now, bed by bed, shift by shift, nursing home by nursing home. This article examines the scale of the crisis, the workers and patients caught in the middle, and what the data tells us about what comes next. The Scale: 112,000 Healthcare Workers at Risk Roughly 112,000 Haitian TPS holders work in the U.S. healthcare system. That is approximately one out of every three Haitian TPS holders in the workforce. They are not evenly distributed across the medical profession. They are concentrated in the lowest paid but most essential roles: certified nursing assistants, home health aides, personal care aides, dietary workers, housekeepers, and orderlies. These are the workers who provide the majority of direct, hands-on care to elderly and disabled Americans in nursing homes and private residences. The numbers are stark. The American Immigration Council estimates that 112,000 Haitian TPS holders work in healthcare nationally. The Florida Health Care Association, representing 90 percent of the state's approximately 700 nursing homes, estimates that 35,000 are in Florida alone. The Warren/Markey/Pressley report, released in May 2026, found that 13,000 Haitian TPS nursing assistants in Massachusetts care for 65,000 patients every single day. In Everett, Massachusetts, Haitian workers provide care to an estimated 80 percent of older adults in nursing homes and homebound patients receiving home health services. "In Everett, Massachusetts, Haitian workers provide care to an estimated 80 percent of older adults in nursing homes and homebound patients receiving home health services." These workers are not peripheral to the healthcare system. They are its foundation. And the foundation is about to collapse. The Pre-Existing Crisis: A System Already Broken To understand what the loss of 112,000 healthcare workers means, you have to understand how fragile the system already was before this decision. The data paints a dire picture. Forty-seven percent of U.S. nursing homes were already limiting new admissions due to staffing shortages before any TPS changes took effect. Nearly half of nursing homes in the country, pre-TPS termination, could not accept new patients because they did not have enough workers to care for them. Sixty-six percent of hospitals were operating below capacity due to staffing shortages. Only 19 percent of nursing homes met the federal government's minimum staffing levels. The U.S. faces a projected shortage of 3.5 million healthcare workers by 2030, even before accounting for the loss of TPS workers. The nation's 65-plus population is 58 million today and is projected to reach 82 million by 2050, a 42 percent increase. The demand for nursing assistants is projected to grow by 44 percent between 2023 and 2038. Into this gap, Haitian TPS workers stepped. They filled the roles that pay the least, require the most patience, and are the hardest to staff. They worked through COVID-19 when they were called "essential workers," often without hazard pay or adequate protective equipment. They cared for the patients no one else would care for. And now, with the stroke of a Supreme Court opinion, they are being told that their labor is no longer welcome. Dr. Steffie Woolhandler, a physician and researcher at CUNY and Harvard, put it bluntly: "Two-thirds of hospitals have closed beds. About half of nursing homes cannot take new admissions. The loss of Haitian nursing aides will worsen this dramatically." Facility by Facility: What the Data Shows The aggregate numbers are overwhelming, but the facility-level data makes the crisis concrete. These are real institutions, real patients, and real workers. Miami Jewish Health in Florida cut 120 nursing home beds before the TPS termination even took effect, anticipating the loss of staff. The beds are empty. The patients who would have occupied them were transferred or turned away. Sinai Residences in Orlando is losing 40 TPS workers. The facility filed an amicus brief with the Supreme Court urging the Court to preserve TPS. The Supreme Court ruled against them anyway. President and CEO Rachel Blumberg described the workers' roles as "some of the most demanding in our health care system." Laurel Ridge, a nursing home in Boston, lost 13 key Haitian staff members for 115 residents. Director Colin O'Leary said, "You lose very caring caregivers that have established relationships with our seniors." Relationships built over years, gone in weeks. Road to Responsibility in Massachusetts is losing 28 workers on top of 130 already lost. They had 150 existing vacancies before the TPS termination was announced. They are now expected to lose more workers than they currently employ in some departments. Hebrew SeniorLife in Boston is losing 37 employees. They had already lost 60 more through attrition and other staffing pressures. One facility, hemorrhaging workers from every direction. Arc Rockland in New York has already lost 20 TPS workers and expects to lose 19 more. They had 60 vacancies before the terminations began. Frank Romano in Massachusetts operates five facilities that could lose 8 percent of their workforce, roughly 20 nursing assistants. One provider reported spending an extra $24,000 per pay period after losing 101 Haitian employees, forced to hire expensive temporary agency staff at three times the cost of direct employment. These are not projections. These are current realities, documented in congressional testimony, industry reports, and local news coverage from Florida to Massachusetts to Ohio to New York. "Miami Jewish Health cut 120 nursing home beds. Laurel Ridge lost 13 staff for 115 residents. Sinai Residences is losing 40 workers who filed an amicus brief with the Supreme Court. The Court ruled against them anyway." The Workers: Lives Interrupted, Careers Frozen Behind every statistic is a person who made choices, built skills, and invested in a career in American healthcare. Their stories do not fit the political narratives on either side. In Massachusetts, a medical assistant named Tina was placed on unpaid leave while one English exam stood between her and her registered nursing license. She had spent months studying, taking classes, and preparing for the exam. The exam would have doubled her income and moved her into a profession with more stability and respect. Instead, she cannot work at all. Her license is unreachable. Her career is frozen at the moment of its greatest potential. In New York, a home health aide named Fred keeps getting calls from his elderly client, asking when he will come back. Fred has no answer to give. The client, who depends on Fred for bathing, dressing, and meals, cannot understand why the person who cared for her is not allowed to care for her anymore. Genevieve Artamin has spent 38 years in the United States as a certified nursing assistant. She is a delegate for 1199SEIU, the healthcare workers union. She has cared for American seniors for nearly four decades. She has no path to citizenship. She now faces deportation to a country she barely knows. Thirty-eight years. One status. No permanency. In Florida, a travel nurse named Harlaine Dominique was featured in a New York Times video. Her mother needs a kidney transplant. When TPS was terminated, her mother lost access to Medicare. The family is now facing an impossible choice: leave the country where her mother can receive treatment, or stay without legal status and lose access to the healthcare system her daughter has worked in for years. Vilbrun Dorsainvil was a doctor in Haiti before becoming a registered nurse in Springfield, Ohio. He is a TPS holder, a plaintiff in the litigation that reached the Supreme Court, and the co-founder of the Haitian Support Center in Springfield. He works at Springfield Regional Hospital, caring for cardiac patients. He is also a pastor. After the Supreme Court decision, he told Democracy Now, "Knowing that you can be picked up anytime, anywhere, is not something easy to deal with." "Genevieve Artamin has spent 38 years in the United States as a CNA and a union delegate. She has no path to citizenship. She now faces deportation to a country she barely knows." The Patients: Who Will Care for Mom? The story of TPS termination in healthcare is not just about the workers. It is about the people they care for, the families who depend on them, and the communities that will be left to manage the aftermath. Rita Siebenaler is 82 years old and lives in Virginia. She was featured on NPR in April 2026 advocating for TPS caregivers. She understands that the person who helps her bathe, dress, and move through her day may not be allowed to stay in the country. She asked a question that no policymaker has been able to answer: "Who is going to care for them?" referring to the seniors who depend on Haitian TPS workers. Sabine French's 91-year-old mother lives in New York and depends on a Haitian home health aide named Murtha, who has cared for her for years. Sabine described her mother as "terrified" of losing Murtha. Not of dying. Of losing the person who makes her daily life possible. Colin O'Leary, the director of Laurel Ridge in Boston, described residents who have lost caregivers they had known for years. "They have established relationships with our seniors," he said. In long-term care, relationship is not a luxury. It is a medical intervention. A patient whose caregiver knows their history, their preferences, their medication schedule, and their family is a patient who receives better care. When that caregiver disappears, the patient does not just lose a helper. They lose a piece of their safety and their dignity. The Bipartisan Response: When Healthcare Overrides Politics One of the most striking features of this crisis is the bipartisan nature of the opposition to TPS termination for healthcare workers. Republican governors, Republican members of Congress, and industry associations representing nursing homes and senior care facilities have all broken with the administration on this issue. Governor Mike DeWine of Ohio, a Republican, called the removal of Haitians "a mistake." He said, "It's Haitians who, many times, are taking care of your mom or your dad who has Alzheimer's." He was not speaking in abstract terms. Springfield, Ohio, is home to a significant Haitian TPS community, and the healthcare system there depends on their labor. Representative Mike Lawler of New York, a Republican, co-led the House bill to extend TPS for Haiti. He warned, "Of the 350,000 plus lawful Haitian TPS holders, roughly one-third work in our healthcare system. Immediately shutting off TPS will create a crisis in our hospitals, nursing homes, and in the intellectual disabilities community." Representative Carlos Gimenez of Florida, a Republican and a Cuban American whose district includes a large Haitian population, called the deportation of Haitian TPS holders "a huge mistake." He rarely breaks with the administration. On this issue, he did. The Florida Health Care Association, representing the nursing home industry in a state that voted for Trump by a wide margin, sent a formal letter to DHS Secretary Mullin on July 7, 2026, asking for exemptions for healthcare workers. The letter warned that the loss of even a small percentage of Haitian TPS healthcare workers "would be detrimental" to the state's long-term care system. LeadingAge, the national association representing nonprofit aging services providers, warned that TPS workers represent 8 percent or more of the entire workforce in some communities. Their CEO Katie Smith Sloan said, "Staff who support older adults every day, legal employees who in some communities represent 8 percent or more of the entire workforce, can now lose their jobs overnight." Even 1199SEIU, the healthcare workers union representing approximately 50,000 TPS healthcare members nationally, and the Florida Health Care Association, a nursing home industry group, found themselves on the same side of this issue. That does not happen often. It is happening now. "Governor Mike DeWine (R-OH): 'The policy to remove these individuals from this country is a mistake. It's Haitians who, many times, are taking care of your mom or your dad who has Alzheimer's.'" The Broader Contradiction: Essential Then, Deportable Now Perhaps the most painful dimension of this crisis for Haitian healthcare workers is the whiplash between how they were treated during the COVID-19 pandemic and how they are being treated now. In 2020 and 2021, they were designated "essential workers." They were celebrated, in theory, for showing up to work in nursing homes and hospitals while much of the country stayed home. They cared for COVID patients. They contracted the virus themselves. Some of them died. Now, the same government that called them essential is deporting them. The same government that urged them to keep working during a global health emergency is stripping their work authorization and telling them to leave. The same government that needs them to staff the nursing homes that will care for the Baby Boom generation is eliminating their legal status with a 14-day placeholder extension. The contradiction is not lost on the workers themselves. Harlaine, the ER nurse in Kentucky, said it plainly: "They're starving us out." She did not mean food. She meant the slow, grinding removal of every form of stability, every legal protection, every right to exist in the place she has called home for years. What Many People Get Wrong • These Workers Can Just Get Green Cards Through Their Jobs The PERM labor certification process for employer-sponsored green cards takes 500 days or more. Even if every nursing home wanted to sponsor every Haitian CNA, the immigration system is not equipped to process them in time. TPS termination happens in weeks. The system is designed to fail them. • They Can Be Replaced by Other Workers Nursing homes in Florida, Massachusetts, and Ohio have been trying to fill the same vacancies for years. The U.S. faces a projected shortage of 3.5 million healthcare workers by 2030. There are no replacement workers waiting in the wings. Temp agencies charge three times the cost of direct employment. • TPS Was Only Supposed to Be Temporary It is true that TPS was designed as a short-term status. But when the U.S. government repeatedly extended it for 16 years, tens of thousands of people built careers, obtained licenses, gained expertise, and became irreplaceable members of the healthcare workforce. The system encouraged their integration and is now punishing them for it. • The $2,600 Voluntary Departure Bonus Is a Solution DHS is offering TPS holders $2,600 and a free flight to leave the country voluntarily. The average CNA salary in Florida is approximately $32,000 per year. The "bonus" amounts to about two to three weeks of wages for workers who have cared for American seniors for decades. It is not a solution. It is an insult. By the Numbers 112,000 Haitian TPS holders in U.S. healthcare 35,000 In Florida healthcare alone 13,000 Nursing assistants serving 65,000 patients daily (MA) 47% Of nursing homes limiting admissions pre-TPS loss 1 in 3 Haitian TPS workers in the workforce is in healthcare 3.5M Projected healthcare worker shortage by 2030 Timeline January 12, 2010. Haiti earthquake. DHS designates Haiti for TPS. Haitians begin filling essential healthcare roles across the country. 2020 to 2021. COVID-19 pandemic. Haitian TPS healthcare workers are designated "essential." They work the front lines while much of the country stays home. Many contract the virus. Some die. November 28, 2025. DHS Secretary Noem publishes the Haiti TPS termination notice. April 16, 2026. The House passes H.R. 1689 with bipartisan support, extending TPS for Haiti through 2029. The Senate does not act. May 19, 2026. Senators Warren and Markey and Representative Pressley release the "Care in Crisis" report documenting the Massachusetts healthcare impact. June 25, 2026. The Supreme Court rules 6-3 in Mullin v. Doe that TPS termination decisions are not reviewable by federal courts. July 7, 2026. The Florida Health Care Association sends a letter to DHS asking for healthcare worker exemptions. July 10, 2026. USCIS issues a 14-day EAD extension through July 24. Some employers preemptively lay off Haitian workers anyway. July 24, 2026. Work authorization deadline. Approximately 350,000 Haitians face the loss of legal status. Why This Matters The loss of 112,000 Haitian TPS healthcare workers is not a future hypothetical. It is a present reality. Nursing homes are cutting beds. Hospitals are losing staff. Home health agencies are telling patients they can no longer serve them. The workers who spent years building careers, obtaining licenses, and forming relationships with patients are being told that their labor is no longer needed, even as the demand for their labor has never been higher. For the patients, the impact is direct and personal. A patient with Alzheimer's who has had the same certified nursing assistant for three years does not easily adjust to a new face. A family that depends on a home health aide to bathe and feed their elderly mother does not have a backup plan when that aide is deported. A nursing home that has already cut 120 beds and turned away dozens of seniors does not have unused staff waiting to be deployed. For organizations tracking the healthcare workforce impact and coordinating support for affected communities, tools like PROVEN help map where TPS healthcare workers are concentrated, which facilities are most vulnerable to staffing losses, and how patient access is being affected in real time. When 112,000 workers face simultaneous termination, data informed coordination is essential for anticipating where the next crisis will hit and directing resources accordingly. For Haitian TPS healthcare workers, the message from advocates is clear: document everything, get a legal screening, prepare emergency guardianship plans for your children, and do not give up. Your labor built this system. Seniors fought for you during COVID. Republican governors are speaking up for you. The healthcare industry is begging the administration to keep you. You are not alone, even if it feels that way right now. Senator Elizabeth Warren put it in terms that cut through the policy jargon. She said, "This is about who we are as a nation. Do we deport the people who care for our parents and grandparents? Or do we honor their contributions and give them the stability they have earned?" The answer, in July 2026, remains unfinished.

Works Cited American Immigration Council. "Temporary Protected Status: An Overview." AmericanImmigrationCouncil.org, americanimmigrationcouncil.org/fact-sheet/temporary-protected-status-tps-overview. Warren, Elizabeth, Edward Markey, and Ayanna Pressley. "Care in Crisis: The Impact of Terminating TPS for Haitians on Massachusetts' Health Care System." May 19, 2026, warren.senate.gov. KFF. "Recent Changes to TPS Designations: Potential Impacts on Health and Health Care." May 1, 2026, kff.org. Florida Health Care Association. Letter to DHS Secretary Mullin. Jul 7, 2026, floridaphoenix.com. Mullin v. Doe, No. 25-1083 (U.S. Jun 25, 2026), supremecourt.gov. NPR. "Seniors fight for TPS caregivers." Apr 29, 2026, npr.org. New York Times. "Loss of TPS for Haitians Threatens Health Care Jobs." Jan 29, 2026, nytimes.com. WGBH Boston. "Mass health care faces crisis after Supreme Court ruling ends TPS for Haitians." Jul 8, 2026, wgbh.org. LeadingAge. "Senior care providers warn of devastating health care impact if SCOTUS ends TPS for Haitians." Apr 13, 2026, leadingage.org. Penn Wharton Budget Model. "TPS Impact Analysis." Nov 19, 2025, budgetmodel.wharton.upenn.edu.