Home care providers could lose some Haitian immigrants in their workforce after a Supreme Court ruling cleared the way for Haiti’s Temporary Protected Status (TPS) designation — and the work authorization tied to it — to expire.

These staffing gaps could lead to turned-away referrals, strained hospitals and health systems, disrupted care relationships and an inability to care for the increasing older adult population, industry leaders told Home Health Care News.

“The immigrant enforcement [actions have] been a lose-lose-lose-lose proposition,” Dr. Stephanie Woolhandler, professor of public health at New York City-based Hunter College, told HHCN. “Everybody is losing out when you start deporting all these immigrant workers who’ve been working here and contributing to our healthcare system.”

On June 25, the Supreme Court upheld a Congressional statute barring judicial review of non-constitutional claims on the Department of Homeland Security’s (DHS) decision to terminate TPS designation for certain countries. The move allowed the DHS to proceed in ending TPS status for Haitian and Syrian immigrants, which had been temporarily delayed in district courts. People who lost TPS and lacked another lawful basis to remain in the U.S. could become subject to removal from the country, under federal immigration law.

TPS permits immigrants from certain countries to live and work in the United States if returning to their home country is temporarily unsafe. The Secretary of Homeland Security may designate countries as needing TPS if there are “extraordinary and temporary conditions” such as ongoing armed conflict, environmental disasters or an epidemic, according to the U.S. Citizenship and Immigration Services.

Ending TPS for Haitian TPS holders could have sweeping ramifications for home care providers.

Data from the American Immigration Council shows Haiti is one of the top countries of birth for immigrant health aides. As many as 58,000 American health aides were born in Haiti, comprising 6% of the share of immigrant health aides and 2% of all health aides.

“There’s a reality that the caregiving workforce has a lot of immigrants in it,” Seth Sternberg, founder and CEO of Honor, told HHCN. “We just naturally end up having a lot of immigrants on our workforce, as well as a lot of people who were born in America.”

San Francisco-based Honor is a home care technology and services provider. In 2021, Honor acquired Home Instead, a home care company for older adults, to form an organization bringing in $2.1 billion in home care services revenue.

Sternberg noted that Honor focuses on the caregiver’s best fit for the role, whether they’re an immigrant or not.

“The direct impact will be that our [human resources] team will scan through our workforce and make sure that everyone is still in compliance,” Sternberg said. “If all of a sudden someone’s work authorization is canceled, it means that we would unfortunately have to let them go.”

These ripple effects will also negatively impact access to home care — and therefore the health system more broadly.

Current effects

Research shows that noncitizen immigrants, both documented and undocumented, make up at least 10% of home care agency personnel as of April 2025, according to a research letter Woolhandler co-authored.

The potential loss of Haitian TPS holders will be “very serious” in certain locations with a high concentration of Haitian immigrants, such as Miami, Florida, as well as eastern Massachusetts, Woolhandler told HHCN.

New York City will be among the hardest hit as well, said Mollie Gurian, vice president of policy and government affairs at LeadingAge. Organizations relying on direct worker care will be most impacted out of the health care continuum, Gurian added. These include home health agencies, home care providers, Program of All-Inclusive Care for the Elderly (PACE) providers and Medicare- and Medicaid-funded home- and community-based services.

“Haitian TPS holders are valuable contributors to the aging services workforce in a range of care settings, including home-based care,” Gurian said. “Ending their authorization to work legally in the U.S. will force providers, including our mission-driven and nonprofit members, to make difficult decisions if they do not have sufficient staff to provide care.”

LeadingAge is a nonprofit organization comprised of 5,300 member organizations advocating for better older adult care.

These difficult decisions could include turning away new referrals or reducing visits for current patients, thus lowering access to care, Gurian said. Health systems could feel the ramifications, for example, if a hospital cannot arrange proper home care for a patient set to be discharged.

Ending TPS for Haitian immigrants can also break care continuity, which can leave families with greater caregiving burdens.

“For patients and family caregivers, home care depends heavily on trusted relationships built over time,” Gurian said. “When a caregiver who knows a client’s routines, medical needs and preferences suddenly disappears, families often face gaps in services, schedule disruptions and greater caregiving responsibilities of their own. These workers are not easily replaced because they possess years of experience and knowledge of the people they serve.”

Changes in continuity are particularly troublesome for individuals with dementia, Sternberg said.

“We need more and more people here so that we can find people who are going to rise to this challenge and treat the elderly the way they deserve to be treated when they need care,” John Sneath, CEO of Tribute Home Care, told HHCN. “There’s a lot at stake.”

Framingham, Massachusetts-based Tribute Home Care provides in-home personal care, dementia care and other assistance in Maryland, Massachusetts, Illinois and Virginia.

The future of care

By 2034, there will be more adults over the age of 65 than under 18, according to the United States Census Bureau.

These demographic changes will increase demand for home care. But industry leaders warn that immigration enforcement actions, including the termination of TPS designations, could further constrain an already limited caregiving labor pool.  

“We are, right now, today, short care pros,” Sternberg said. “I have a very large team that is doing nothing other than trying to find more ways to find more care pros. They will hire anyone who is a great care pro. It does not matter if they were born in the United States or if they’re an immigrant, because we simply can’t find enough of either group.”

Potential enforcement actions will have tangible impacts on access to care, Sneath noted.  

“This is about what do we want for our moms and dads and our spouses as we get older,” Sneath said. “What do we want for them? We want somebody who’s going to love them and lift their spirits and be there for them. And so, the more people we have looking to do this [caregiving], the more we’re going to be able to do that.”