With only an English proficiency test left to complete before getting her nursing license, a 38-year old Haitian medical assistant cried as she described not being able to join the state’s nursing workforce she knows desperately needs her.
Tina who gave only her nickname, has temporary protected status, or TPS, which had allowed her to live and work here legally. But following last month’s U.S. Supreme Court ruling that cleared the way for the Trump administration to end TPS for Haitian nationals, her employer informed her that she’d be placed on unpaid leave because her work permit — tied to TPS — would no longer be valid.
“Most of the time, we are short,” she said, “But you need to manage. You double yourself to help people.”
Immigrant workers in Massachusetts — including foreign-born Haitians, about a third of whom work in health care, according to state data — have become an essential part of filling jobs ranging from maintenance to certified nursing assistants.
Healthcare leaders warn the court’s ruling on TPS could mean thousands of those immigrants are no longer eligible to work, worsening staffing shortages with consequences that will hit seniors hard and reverberate across the state’s healthcare system.
“If we wipe them [the foreign-born workforce] all out and they go back to where they came from, we will have a crisis in post-acute care this country hasn’t seen since COVID,” said Frank Romano, who owns care facilities across the state.
Romano’s Essex Group operates six skilled nursing facilities, as well as assisted living communities, adult day health programs and home care services.
Even before the Supreme Court decision, he grappled with the constant battle to recruit and retain the staff to care for the roughly 1,000 people his company serves.
Immigrants, he said, make up half of his workforce with about 25% Haitian TPS holders. If they lose work permits, he warned his facilities might have to return to COVID-era limits on patients and residents.
“That means they’re going to stay in the acute care hospitals longer because there’s no place to put them, and that’s going to jam the ER’s up and cause a major problem there,” Romano said.
State data show the number of Massachusetts residents age 60 and older has grown by 13%, far faster than the state’s overall 2% population growth over the past five years. Romano said the demographic pressure will compound staffing shortages.
“We have the senior population growing every single year … that are going to need some kind of senior care. If it’s home care, adult daycare, assisted living, supportive housing - there’s going to be the need,” he said.
The state’s Center for Health Information and Analysis found the need for nurses is highest in nursing homes, with a 26% nursing vacancy rate.
Allison Cohn helps run the “Welcome Back Center” at Bunker Hill Community College, guiding foreign nurses through the process of getting Massachusetts nursing licensure.
Since the start of the program, she said, nearly 1,000 nurses have joined the state’s workforce. That includes more than 200 Haitian immigrants, many of them TPS holders.
“If folks do lose their work permission, there will be a huge loss to long-term care, home care, hospitals. We have nurses working in school health — every healthcare setting you can imagine: community health centers, hospice,” Cohen said.
Cohn said nearly all students work as personal care assistants, and certified nursing assistants in hospitals and nursing homes across the state while going through their certification studies and on completion get “multiple offers.”
The Massachusetts Senior Care Association, which represents more than 400 facilities including nursing homes and assisted living residences, estimates that as many as 2,000 staff members will lose work authorization as a result of the Supreme Curt’s decision.
“This ruling will exacerbate an already severe workforce shortage and further jeopardize our ability to ensure consistent access to high‑quality resident care across the state. At a time when nursing facilities are struggling to recruit and retain qualified caregivers, the loss of this vital segment of our workforce is not just harmful, it is unsustainable,” said the Association’s President Tara Gregorio, in a statement.
The Haitian TPS ruling may not be the last of its kind affecting Massachusetts caregivers. TPS for El Salvador — another country whose immigrants help staff the state’s healthcare workforce — is set to expire soon.
The U.S. Department of Labor responded to GBH News’ questions about potential contingency plans to fill the gap in healthcare workers by pointing to the Trump administration’s broader workforce agenda.
“The Labor Department is committed to supporting American workers and strengthening the U.S. workforce, including long-term and home health care, by increasing labor force participation, advancing apprenticeship opportunities, and expanding access to training in partnership with states, employers, and worker organizations,” wrote a Labor department spokesperson in an email.
The potential loss of TPS is not the only threat to the legal status of immigrants powering the state’s healthcare workforce.
A Haitian nurse who completed the Bunker Hill program, who declined to be identified out of immigration concerns, lost her work permit after the Trump administration canceled the CHNV parole program, a Biden-era initiative that had allowed Cubans, Haitians, Nicaraguans and Venezuelans to live and work legally in the U.S. She holds out hope that she will be allowed to legally stay and work in the U.S.
“And then we can have access to work,” she said, ”and help people, because we want to. I love to take care of people.”
