The Care Workers Who Keep America's Elders Alive
Sarah Longwell, Tim Miller, Bill Kristol have written something that cuts through the noise of immigration politics and lands on a question most Americans never think about: who will care for your grandmother when she can't bathe herself? The piece follows Maryse, a 56-year-old Haitian home care worker in Miami, and uses her story to expose the brittle infrastructure of American elder care—an infrastructure built on immigrant labor that federal policy now threatens to dismantle.
A Journalist Who Became a Caregiver
Maryse did not plan to spend sixteen years lifting strangers out of bathtubs. She was a journalist in Haiti before the 2010 earthquake killed an estimated quarter million people and collapsed the island's infrastructure. When the Obama administration granted Haitians temporary protected status—a designation for foreigners whose home countries become dangerous due to natural disaster or armed violence—Maryse stayed in the United States with her children and enrolled in nursing assistant classes.
"I really like helping these people and it reminds me how vulnerable we all are," Sarah Longwell, Tim Miller, Bill Kristol writes, quoting Maryse. "I do it with as much heart as I can."
Her clients have included a Purple Heart recipient from the Army, a World War II pilot who flew missions over France and Africa, a young man with cerebral palsy, another with severe head trauma from a car accident. The work involves cooking, driving, bathing, toilet assistance, and sometimes just sitting in front of the television to watch Wheel of Fortune. It is physically demanding and emotionally draining. Maryse says she does not mind the difficult parts.
The Workforce Americans Don't Want
Here is the arithmetic that immigration enforcement often ignores: foreign-born citizens and noncitizens make up just 17 percent of the adult workforce but 28 percent of the direct care workforce. This is not immigrants taking jobs from Americans. It is immigrants taking jobs Americans do not want—jobs with unpredictable hours, physical strain, and pay that fast food can match with less emotional toll.
Robert Espinoza of the National Academy of Social Insurance told the authors that better pay and conditions would help, but that requires legislation and financial commitment unlikely from a Congress that has spent the last year cutting Medicaid, the nation's largest financier of long-term care. Even if substantial new investment arrived, it would not meet existing demand, let alone future demand from America's aging population.
"There are literally millions of people who rely on immigrants for their basic care needs every single day," Ai-jen Poo, president of the National Domestic Workers Alliance, says. "With the growth and demand for care work, particularly in the home and community where most people want to age . . . I don't see how we meet anywhere near the demand without a really strong presence of immigrant care workers."
"We become their mother, their grandmother, their sister, their brother. We feed them, we clean them, we put them in the chair, we put them in the chair, we put them in bed. That's awesome. When they are happy, we know it. When they're not happy, we know it too. Because we are there for them."
Cultural Values as Care Infrastructure
What makes Haitian caregivers indispensable is not just their availability but their cultural orientation toward elder care. Thomas Wenski, Miami's archbishop who supervises Catholic Health Services, told the authors that Haitian workers come from "a very traditional society in which grandparents and elders are very much respected." Tessa Petit of the Florida Immigrant Coalition cited a Haitian proverb: Bourik fè pitit pou do l poze—"the donkey has little ones to rest her back"—conveying the expectation that children care for their elders.
"Everywhere around the country, people will tell you that Haitian workers are very empathetic, they're supportive," Petit says. "No job is too belittling when it comes to taking care of sick people, and taking care of their elders. Why? Because it comes from a culture where our older folks stay home and care for them. It's normal to care for your loved ones."
This cultural norm is not unique to Haitians. Filipinos have a similar reputation, with a well-known nursing pipeline from the Philippines. Ai-jen Poo notes that "different cultures around the world treat aging and caregiving differently, and some cultures really uphold and uplift older populations . . . That is a cultural norm that we do not have in our country."
The Political Battle Over Temporary Protection
A federal judge blocked the administration's order to revoke TPS for roughly 330,000 Haitians, determining that Homeland Security Secretary Kristi Noem acted "at least in part" out of "racial animus" and failed to conduct necessary analysis about whether Haiti's conditions had improved enough for safe return. The administration plans to appeal. Advocates treat the ruling as a reprieve, not a victory, and are rallying political support—including a discharge petition in the House filed by Massachusetts Democrat Ayanna Pressley that would force leadership to bring TPS extension legislation to the floor.
As of Saturday evening, 127 Democrats and one Republican had signed. Organizers hope to flip additional Republicans in vulnerable districts with large Haitian populations. A bill passing the House would still need Senate approval and presidential signature—hard to fathom given the administration's stated desire to expel immigrants from countries like Haiti. The only path may be attaching TPS extension to must-pass legislation and convincing the administration that alienating voters in Florida, New York, and Ohio is not worth the political cost.
The Human Cost of Enforcement
Luis Zaldivar of the American Business Immigration Coalition cited a Palm Beach County nursing home director who said many Jewish residents were distraught at losing their Haitian caregivers and asked if they could hide them, as some gentiles had done for Jews during the Holocaust. "There are many others who would like to speak up, but are afraid of retaliation," Zaldivar said.
Critics might note that temporary protected status was never meant to be permanent—that it is, by definition, temporary, and that Haiti's conditions have improved since 2010. They might argue that reliance on immigrant labor at low wages is a market distortion that better pay would fix. They might point out that TPS recipients are not refugees but economic migrants who have stayed for sixteen years.
These arguments are legally coherent. They are also morally blind to the reality that 28 percent of direct care workers are foreign-born, that America's population is aging faster than its caregiving infrastructure can adapt, and that cultural norms around elder care cannot be legislated into existence.
Bottom Line
The administration's immigration policy treats Haitian TPS holders as removable aliens. The elder care industry treats them as indispensable infrastructure. When policy and infrastructure collide, the people in wheelchairs and hospital beds lose first. Maryse's sixteen years of lifting strangers out of bathtubs have built a care network that cannot be replaced by legislation or rhetoric. The question is not whether Haitians deserve to stay. It is whether America's elders deserve to be cared for.