Following the Supreme Court ruling allowing the Trump administration to end Temporary Protected Status (TPS) for Haitians, Syrians and possibly more than 1.3 million immigrants from multiple countries, nursing home leaders say major access issues are on the horizon.

Immigrants who have legally lived and worked in the country for years, including those in the nursing home sector, may lose their work permits and face deportation as a result of the ruling.

“The residents will be losing caregivers that they really have become attached to,” Colin O’Leary, executive director at Laurel Ridge Rehabilitation & Skilled Care Center in Boston, told the Washington Post. “That’s a lot for our residents to handle.”

The exact timeline for the end of TPS depends on lower court rulings – lower court judges must issue orders to implement the decisions.

Regardless, some nursing homes are bracing for workforce departures.

Managers at Laurel Ridge are preparing to say goodbye to dietary aides and certified nursing assistants (CNAs) who care for about 115 residents, according to the report. Miami Jewish Health, meanwhile, cut 120 nursing home beds months ago due to staffing issues stemming from the pending TPS cancellation for Haitians.

“We are disheartened by the Supreme Court decision to end TPS and what it means for those individuals and their families who are part of our workforce here at A.G. Rhodes.

“The care partners affected by this decision fill some of the most direct care and critical roles in our homes and serve as trusted surrogate family to many of our elders,” Deke Cateau, CEO of Georgia nonprofit operator A.G. Rhodes, told Skilled Nursing News. “The sudden loss of these valued team members will have an immediate impact on our nursing home communities, and any interruption in consistent care will be deeply felt by our elders.”

Katie Smith Sloan, president and CEO of LeadingAge, said the Supreme Court’s decision puts older adults and the providers who care for them in an untenable position.

“Though there is no quick fix, we do have a Senate that can act,” Sloan said in a press release. “We urge the Senate to take up the House-passed Haiti TPS extension immediately, because the alternative is an unnecessary hobbling of our country’s care system – at a time when our population is aging rapidly and demand for care and services is growing.”

The sector relies heavily on immigrant workers, and deeper workforce shortages are expected if these immigrant caregivers are forced to leave.

“We are grateful for the contributions of all our care partners, over a third of whom are immigrants,” said Cateau. “As an immigrant myself, the matter is also very personal to me. We will continue to support those affected by this decision however we can and advocate for the strong, stable caregiving workforce our elders need and deserve.”

The TPS decision is the latest setback to staffing in nursing homes, with exorbitant visa fees also creating headaches for providers.

“Staff and caregivers who support older adults every day – legal employees who in some of our communities represent 8% or more of the entire workforce—can now lose their jobs overnight,” said Sloan. “There is no workforce waiting in the wings capable of replacing the long-standing relationships, in some cases built over years and even decades, that are so vital to quality care.”

According to KFF, that percentage of immigrant workers in long-term care is even higher, with immigrants making up 21% of workers in nursing facilities and 24% of workers in residential care settings.

The Trump administration argued TPS lasted well beyond the emergencies that justified the program’s presence.

The 6-3 decision in Mullin v. Doe reversed lower court rulings that prevented the Department of Homeland Security from implementing terminations while litigation was still pending. SCOTUS noted that the Immigration and Nationality Act generally bars judicial review of non-constitutional challenges to TPS termination decisions.

TPS was created in 1990, granting work permits and deportation reprieves to immigrants for up to 18 months if their nations are dealing with war, natural disasters or other emergencies; the government has renewed such protections multiple times, and TPS applicants can’t have serious criminal records.

Immigrants from other countries may be affected by the ruling down the line, with TPS designations in other countries set to expire in the coming months, including El Salvador on Sept. 9. But future DHS actions are subject to separate agency determinations.

Nursing home employers and employees should monitor the U.S. Citizenship and Immigration Services (USCIS) for effective dates and procedures, according to a blog post from the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). Those directly affected are urged to consult with a qualified immigration attorney to explore remaining options or alternative pathways to lawful status.

“[The] Supreme Court decision underscores the critical need to develop sustainable and stable workforce development solutions to help the profession build and retain our workforce,” said Dana Ritchie, associate vice president of workforce and constituency services at AHCA/NCAL. “We will continue to work with policymakers to pursue practical solutions through our Caregivers for Tomorrow initiative that strengthen the caregiving workforce and create clear, streamlined legal pathways for qualified international caregivers to continue serving America’s seniors and individuals with disabilities.”

Meanwhile, LeadingAge’s Sloan expects nursing home operators will have to make tough choices as a result of the ruling, including limiting admissions, closing units or turning away requests for home health and home care until the vacant jobs are filled.

For now, there are potential TPS extensions being floated in Congress as well.

Some House Republicans joined Democrats to pass legislation to extend Haitian TPS protections through April 2029. It was introduced in the Senate that same month, but there hasn’t been movement on the legislation since then.