Across the country, an estimated 350,000 Haitians could soon lose legal status. That could have a big impact on health care in places like Massachusetts, where many recent arrivals work in low-wage long-term care jobs. 

Now they face deportation.

“I can't continue to work, so now I don't know what I'm going to do,” said Jacques, a certified nurse assistant who recently learned he’d lose his job at a Boston hospital if he can’t fix his immigration status by February. 

“I have an apartment to pay, I have a car loan, I have my family in Haiti to help,” he said.

We agreed to call Jacques by his nickname because he fears being targeted by ICE.

His family is in the U.S. under a program called Temporary Protected Status, and the Trump administration is ending it for Haitians. Now they have to decide whether to return to Haiti voluntarily or be undocumented and work under the table.

Jacques works on a ventilator ward, cleaning bed pans and taking vital signs. He’s one of roughly 50,000 certified nurse aides in Massachusetts — and a lot of them have legal status that could soon expire. 

“Mostly people [who] did this job are immigrants — many from Haiti,” he said, estimating that half of colleagues are about to become undocumented with the expiration of Temporary Protected Status.

TPS is for people who can’t return to their countries because of political or environmental catastrophes. Seventeen nations are on the list, and slightly over a million people now have TPS. The White House has eliminated TPS for countries including Haiti and Venezuela — that could make hundreds of thousands of people deportable and unable to work.

The healthcare industry could face a much larger threat with President Trump’s promise to carry out mass deportations, said Dr. Steffie Woolhandler, a physician and health policy researcher at Hunter College in New York. Particularly at risk, she said, are nursing homes and other long-term care providers.

“You cannot subtract a huge share of the nursing aides from a nursing home and still have the quality care we need to keep our elder and disabled people comfortable and safe,” she said.

Woolhandler recently wrote for the Journal of the American Medical Association that more than a million non-citizens now work in health care — over a third of them are already undocumented. She said the immigration crackdown couldn’t come at a worse time for an industry with existing staffing shortages.

“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.

People travel from around the world to receive healthcare in Boston, and geriatricians here are well aware of the need for foreign workers. Dr. Asif Merchant is a medical director at five nursing homes in the area. He said hospices and home health care providers also rely on immigrants, sometimes for the majority of the workforce. 

“And suddenly a large portion of that will just evaporate,” Merchant said.

Several court cases around the country aim to stop the White House from ending TPS and similar programs. But Merchant said his facilities are already seeing people leave voluntarily — some are bracing to lose up to 20% of their staff.

“There are many nursing homes that are already on a very thin margin, and it may lead to some additional closures of nursing homes,” he said.

Aside from the workers themselves, Merchant said, it could be the patients who pay the ultimate price.