HEBREW SENIORLIFE lost 35 employees in a single day this summer. It was the largest one-day staffing hit in the history of the senior care and housing organization, which has shed about 100 employees over the past year amid shifting federal immigration policy.

The president and CEO says the losses compound a MassHealth financing squeeze he calls unsustainable for the long-term care sector.

Adam Scott, one year into the top job at New England’s largest nonprofit senior care and housing provider, joined hosts John McDonough of the Harvard T.H. Chan School of Public Health and Paul Hattis of the Lown Institute on a Health or Consequences edition of The Codcast.

The 35 employees, all Haitian nationals, lost their jobs after the US Supreme Court’s June ruling cleared the way for the Trump administration to end Temporary Protected Status for Haitians and Syrians. Massachusetts is home to 45,000 Haitian TPS holders, and the state estimates at least 2,000 work in nursing facilities and home care roles.

The terminated workers had averaged 13 years at Hebrew SeniorLife, with most working there since the devastating 2010 earthquake in Haiti.

“These are important jobs and they’re meaningful jobs,” Scott said. “And people make a difference in people’s lives. And what’s hard is replacing that loyalty.”

The federal travails facing the sector include changes to MassHealth, the state Medicaid system, which covers 75 percent of Hebrew SeniorLife’s long-term care patients. Scott said the 2025 federal reconciliation law, known as the One Big Beautiful Bill Act, could cost Massachusetts $2 billion a year in MassHealth funding once fully phased in. Long-term care already consumes 10 percent of the state’s $22.7 billion MassHealth budget, he said.

“We can’t raise prices,” Scott said, describing rising health benefit and labor costs colliding with flat MassHealth reimbursement rates.

“And so that means we have to look at ways to cut our costs and cut our costs more,” he said. “And that’s in the face of affordability challenges for every resident of the Commonwealth. We can’t cut our nursing salaries. We have to increase them because our nurses are facing rising heat costs and rent costs. And so, the rubber has to meet the road somewhere.”

Scott placed his organization’s struggles in the context of a shrinking statewide sector: Massachusetts has lost 34 skilled nursing facilities and 3,500 nursing beds since 2020, even as demand climbs among residents over 85. About 1,200 hospital patients a day are stuck waiting for discharge because of limited space at skilled nursing facilities, he said.

On top of the looming Medicaid cuts and sudden staffing challenges brought by the stripping of TPS status for a group that makes up a vital share of the long-term care workforce, there is a growing cost crisis facing those who rely on the sector.

Scott pointed to Washington state’s new payroll-tax-funded long-term care benefit as one model worth watching, while cautioning that its $36,000 lifetime payout covers only a couple of months of care.

“The middle class really has no way to pay for care except by impoverishing themselves,” Scott said of the country’s long-term care financing gap.

On the episode, Hattis, McDonough, and Scott discuss the Hebrew SeniorLife workforce losses (6:10), the MassHealth financing outlook (14:15), and the future of dementia care at the Wolk Center for Memory Health (27:00).