Colin O'Leary, executive director at Laurel Ridge Rehabilitation & Skilled Care Center in Boston, recently confronted one of the most difficult moments of his career. He informed 13 of his most valued employees—all Haitian nationals holding Temporary Protected Status (TPS)—that their employment would end due to the termination of TPS protections for Haitians effective February 3. This decision is part of a broader immigration policy alteration initiated by the current administration.
The departing employees play critical roles in caring for approximately 115 residents at the Boston facility. These seasoned certified nursing assistants and dietary aides possess crucial institutional knowledge, from individual residents' meal preferences to subtle health indicators requiring attention. Their departure not only disrupts patient care continuity but also demands a prolonged and challenging recruitment process to fill these specialized roles.
This development signals wider concerns across elder care sectors nationwide, where many Haitians with TPS serve as frontline staff. Nearly 350,000 Haitians stand to lose their immigration protections imminently, directly influencing elder care staffing in nursing homes, rehabilitation centers, assisted living facilities, and private home care roles. Their positions encompass a range of functions including care aides, culinary staff, and facility maintenance workers.
The elder care industry was already grappling with substantial labor shortages, estimated at 350,000 vacancies in care positions, a figure predicted to escalate with the aging U.S. population. Immigrants constitute over 25% of direct care workers in long-term settings, with their representation nearing one-third in home care environments, as reported by the Kaiser Family Foundation.
Katie Smith Sloan, CEO of LeadingAge, an association representing nonprofit aging service providers, stressed that halting immigration inflows aggravates workforce challenges already confronting the sector. Some providers resort to costly temporary staffing agencies, while others must decline service to potential clients due to insufficient personnel to maintain quality care standards.
In Boston, the situation is especially acute given the city's sizable Haitian community. O'Leary's facility operates within tight financial constraints, restricting opportunities to increase wages competitively or engage staffing agencies. Consequently, remaining employees face extended overtime to cover gaps while efforts to reconstruct the team progress, a process expected to require several years. Despite operational challenges, O'Leary expressed profound personal disappointment in his inability to retain valued staff.
The termination of TPS reflects a deliberate policy shift aimed at reversing prior immigration extensions. The Department of Homeland Security (DHS) announced cessation of TPS for nationals from several countries, including Haiti, Honduras, Nepal, and South Sudan. Legal actions have complicated enforcement, with federal courts temporarily blocking some terminations.
TPS was originally designated for those who would endure extreme hardship if deported to countries afflicted by conflict or disaster. Haitian TPS was first granted following the devastating 2010 earthquake and renewed multiple times amidst subsequent crises including escalated gang violence, food shortages, displacement, and political instability following the 2021 assassination of Haiti's president.
Several Haitian TPS holders have litigated against DHS, asserting insufficient assessments of the risks involved in returning to Haiti. These suits contend that policy decisions are influenced by discriminatory motives targeting Haitians based on race, ethnicity, and national origin. DHS maintains that TPS was never intended as a substitute for asylum and critiques prior administrations' extension practices.
Haitian immigrant caregivers express fears of returning to an unstable and dangerous environment, compounded by uncertainty over their livelihoods in the U.S. One care worker based in New York, who wishes to remain anonymous for fear of government reprisals, described the anxiety of potentially losing employment and being forced to return to a country plagued by rampant gang violence. She emphasized the strong relationship developed with her elderly client over nearly two years, underscoring the personal and emotional dimensions integral to caregiving roles.
Labor representatives highlight the profound impact on elder care recipients who face losing caregivers with whom they share intimate bonds formed through assistance with feeding, bathing, and daily living activities. The anticipated departure of Haitian TPS holders intensifies distress among patients, caregivers, and employers alike.
Goodwin Living, a faith-based nonprofit serving approximately 4,000 seniors in the Washington, D.C. region, experienced notable personnel losses last summer when several Haitian workers lost their humanitarian parole statuses. Replacing even one cook required six months amid the competitive labor market. Further attrition is expected as TPS for workers from El Salvador and other nations also approaches expiration, complicating recruitment efforts.
Goodwin Living currently struggles to meet demand for home hospice and health services due to workforce shortages, prompting considerations to pivot towards expanding independent living options over assisted living, which necessitates a clinical staff presence. This strategic reassessment reflects concerns about the sustainability of service models in the context of persistent staffing constraints.
The impending challenges underscore the elder care sector's vulnerability to immigration policy shifts and the critical role immigrant labor holds in sustaining quality care for the aging population. Operational limitations imposed by workforce reductions compel providers to reconsider service offerings and intensify pressures on remaining staff, with significant implications for care delivery across the country.