In the living room of a Randolph apartment, a 3-year-old boy beams as he shows off his electric tricycle. His father, Jacques, smiles, but he has big worries. His boss at a Boston hospital just told him he’ll be let go if he can’t secure a new immigration status.
“I don’t know what I’m going to do, because I have an apartment to pay, I have a car loan, I have my family in Haiti to help,” he said. “So I have a lot of responsibility.”
As a certified nursing assistant, he’s one of many immigrants the state’s health care sector has come to rely on amid staffing shortages. But now the Trump administration is terminating the program that permitted him to live and work in the country.
Jacques’ family is in the U.S. under Temporary Protected Status. It’s a long-standing humanitarian program that allows people who face unsafe circumstances in their home countries to live and work here. As of March 2024, Massachusetts was home to some 28,000 TPS recipients, the majority from Haiti.
WBUR agreed to call Jacques by his nickname because he fears being targeted by immigration police. He worked as a filmmaker in Haiti before coming to the U.S. in 2021. He became a certified nursing assistant — a job that allowed him to enter the industry with roughly two months of training.
Jacques works on a ventilator ward at a state-run hospital, taking vital signs and cleaning bed pans. He earns $21 a hour, feeding patients, helping them bathe, and transferring them between beds and wheelchairs. It’s hard, dirty work, Jacques said, and many Americans don’t want to do it.
Most of his fellow CNAs “are immigrants — two Jamaican, one person from Antigua, and six or seven others” are from Haiti, he said.
State officials say health care facilities, which already struggle to hire enough workers, could be “seriously disrupted” by the termination of TPS and other humanitarian programs, which have allowed thousands of immigrants to enter the workforce.
The change could especially hit the long-term health care sector because of a high reliance on entry level staff, experts say. The Massachusetts Senior Care Association, which represents nearly 400 nursing and rehab facilities, estimates that 2,000 caregivers will be affected.
TPS in the crosshairs
Temporary Protected Status is intended for people who can’t return to their countries because of political or environmental catastrophes. Over a million people from 15 countries have TPS; Haitians were included after a devastating earthquake in 2010.
Despite being designed as temporary, some recipients have been in the U.S. for decades, as presidents from both parties have extended the program to allow them to stay. Others have been here just months. Now the White House appears to be ending TPS one country at a time, including for the two largest groups of recipients, Haitians and Venezuelans.
A federal court case in Washington D.C. aims to stop the White House from terminating TPS for Haitians. Plaintiffs say the move was based on racism rather than on any improvement of conditions in Haiti.
But the administration argues the program is “contrary to the national interest of the United States,” and Haitians will have to leave by Feb. 3. Stephen Miller — one of Trump’s top advisors on immigration — recently took aim at immigrants from Haiti on Fox News.
“Haiti doesn’t work. If you take Haiti and you move it to America, it’s not going to work here,” the controversial homeland security advisor said. “If you move the third world to the first world, eventually we become the third world. And that’s not good for us. It’s not good for anybody who wants to live here in the future.”
Even if the courts ultimately force back the February deadline, Boston-area health care facilities are already seeing workers leave, said Dr. Asif Merchant, a medical director at five nursing homes in the area.
He said home health care and hospice will also be affected — in some cases, providers rely on immigrants for the majority of their workforce. Beyond CNAs, he said, facilities also stand to lose kitchen staff and housekeepers.
“We are quite heavily reliant on these migrant workers,” Merchant said. “And suddenly a large portion of that will just evaporate.”
Merchant said the facilities he works at are bracing to lose between 7% and 20% of their staff. That could translate to serving fewer patients or providing lower quality care. That’s bad for patients, he said, and it’s bad for providers’ bottom line.
“There are many nursing homes that are already on a very thin margin, and it may lead to some additional closures,” he said.
A recent study suggests more than 1 million non-citizens work in health care nationally, and over a third of those currently lack legal status. Co-author Steffie Woolhandler, a physician and health policy researcher at Hunter College in New York who has taught at Harvard Medical School for decades, said the crackdown on TPS will only increase the number of workers in the country without legal status.
And she said that couldn’t come at a worse time.
“Half of nursing homes in the country report that they’ve had to stop admitting people because they just didn’t have the personnel to take care of them,” Woolhandler said. “And that number is going to go way up if we lose all these Haitian nursing aides.”
Wooldhandler said it’s unclear how many people will be affected in Massachusetts, but “anyone who works in health care in this region is aware of how important the Haitians are.”
The economic impact
Under Biden, Massachusetts saw thousands of families arriving from other countries — many from Haiti. Gov. Maura Healey’s administration invested big in the new arrivals, not just paying for shelter beds, but also to help them secure work permits and job training.
Jeff Thielman heads the refugee resettlement agency International Institute of New England. He said many recent immigrants entered the workforce with help from the state. Through nonprofit groups like his, the state provided training in sectors with high demand for workers, including hospitality, construction and health care.
“Many of the people that we have trained over the past five or six years since we’ve had this program have been former health care workers,” he said. “They were nurses — in some cases more than that — in their native countries, and so this is a way to get back into the field.”
Now the termination of TPS and related programs throws a wrench into the works.
Thielman said one workforce preparation program administered by his group had to terminate 600 of the 1,200 participants in Massachusetts and New Hampshire because a humanitarian parole program for citizens of Cuba, Haiti, Nicaragua and Venezuela, known as CHNV, was eliminated.
“We can no longer work with those clients because they’re not eligible to work,” Thielman said.
Another group that offers workforce training to new immigrants is Jewish Vocational Services. The group’s chief executive, Kira Khazatsky, said 10% of their clients receiving advanced job-training have lost work authorization.
“I do hear concerns and worries from the business community about their ability to both do business today and their projections for growth in short and long term, not just in health care, but in multiple other sectors as well,” Khazatsky wrote in an email.
Boston University finance professor Mark Williams has an eye on what this will mean for the larger economy. Before Trump’s reelection, he predicted the state’s investment in recent arrivals would pay off in the long run, as migrants become taxpayers, and their children go on to more lucrative careers.
Instead, Williams said, a “seismic shock” is now in store for the state.
“There are not individuals that are lining up to replace the Haitian community or other immigrants that actually are filling these jobs,” he said. “And we already have a labor shortage in Massachusetts.”
Stay or go?
At their apartment in Randolph, Jacques and his wife, Ivanne, can’t agree on what they’ll do when their status runs out in six months. Either they’ll take their son back to the chaos of Haiti, or remain in the U.S. and risk deportation.
Jacques leans toward staying. Even if he loses his hospital job, he said, he could do food deliveries and work under the table.
“I’m going to do my best to try to take care [of my family], pay my bills,” he said.
For Ivanne, there’s no choice but to go back to Haiti.
“I would like for them to extend TPS and permit us to work until the situation back home really improves,” she said in Haitian Creole. “So we could return home, and give them back their country.”
WBUR’s Martha Bebinger contributed to this report.
This article was originally published on WBUR.org.
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