Could immigrants fill the gaps in the long-term care staffing crisis?

When Margarette Nerette arrived in the United States from Haiti, she sought safety and a fresh start.

The former human rights activist feared for her life in the political turmoil following the military coup that toppled President Jean-Bertrand Aristide in 1991. Leaving her two young children with her sister in Port- au-Prince, Nerette, then 29, came to Miami a few years later on a three-month visa and never returned. Over time, she was granted political asylum.

She eventually studied to become a nursing assistant, passed her certification exam, and got a job at a nursing home. The work was hard and cheap, she says, but “as an immigrant, those are the jobs for you.”

A few years later, her family joined her, but her children did not want to follow her professional path. When she was a teenager, Nerette’s daughter, now 25, would ask, “Mom, why are you doing this? Nerette said. Her daughter considered the work underpaid and too physical.

After many years, Nerette, now 57, quit working at a nursing home for a job with the Florida local of the SEIU1199 union, which represents more than 25,000 healthcare workers. As the local’s vice president for long-term care, she’s acutely aware of the staffing issues that have plagued the industry for decades and will worsen as aging baby boomers push the boundaries. long-term care services.

The United States faces a growing crisis of unfilled job openings and high employee turnover that puts the safety of elderly and frail residents at risk. In a tight labor market with plenty of work opportunities, low-paying and physically demanding long-term care jobs are a tough sell. Experts say opening up immigration pathways for social workers would help, but policymakers have not budged.

In the decade to 2031, employment in health care support jobs is expected to grow by 1.3 million, a growth rate of nearly 18% that exceeds that of all other major occupational groups, according to the Federal Bureau of Labor Statistics. These direct care workers include nurses of various types, home health aides, and physical and occupational therapy assistants, among others.

Certified nursing assistants, who help people with daily tasks like bathing, dressing and eating, make up the largest proportion of workers in nursing homes. In the decade to 2029, nearly 562,000 nursing assistant jobs will need to be filled in the United States, according to a high-profile report on nursing home quality released last year by the National Academies of Sciences. , Engineering, and Medicine.

But as the US population ages, fewer workers will be available to fill those vacancies in nursing homes, assisted living facilities and private residences. While the number of adults aged 65 and over will nearly double to 94.7 million between 2016 and 2060, the number of working-age adults will only increase by 15%, according to an analysis of census data by PHI, a research and advocacy organization for older people and people with disabilities that conducts workforce research.

Immigrants can play a crucial role in bridging these gaps, experts say. Already, about 1 in 4 direct care workers are foreign-born, according to a 2018 PHI analysis.

“We believe immigrants are critical to this workforce and to the future of the long-term care industry,” said Robert Espinoza, executive vice president of policy at PHI. “We think the industry would probably collapse without them.”

Nursing homes and other long-term care facilities have long struggled to maintain adequate staffing. The problem worsened significantly during the pandemic, when these facilities became hotbeds of covid-19 infections and deaths. More than 200,000 residents and staff died in the first two years of the pandemic, representing about a quarter of all covid deaths during that time. Since March 2020, the long-term care industry has lost more than 300,000 jobs, bringing employment to a 13-year low of just over 3 million, according to an analysis of payrolls data. of the BLS by the American Health Care Association and the National Center for Assisted Living.

Immigration policies that aim to identify potential workers from overseas to fill long-term care positions could help ease the pressure. But unlike other countries that face similar long-term care challenges, the United States has generally not made attracting direct care workers from abroad a priority.

“Immigration policy is long-term care policy,” said David Grabowski, a professor of health care policy at Harvard Medical School, whose research focuses on the economics of aging and long-term care. . “If we really want to encourage a strong workforce, we need to make immigration more accessible to individuals.” Most of the roughly 1 million immigrants to the United States each year are family members of citizens, although some arrive on work visas, often for high-skilled jobs.

On his first day in office, President Joe Biden proposed comprehensive immigration reform that would have created a pathway to citizenship for undocumented workers and revised employment-based visa rules, among other things. but it came to nothing.

“There hasn’t been a lot of interest or political will behind opening up more immigration opportunities for mid to lower level caregivers such as home health aides, personal caregivers and certified caregivers,” said Kristie De Peña, vice president. chairman for policy and director of immigration policy at the Niskanen Center, a think tank.

The Biden administration did not respond to requests for comment.

Some local and regional organizations are working to link immigrants to health care jobs. Ascentria Care Alliance provides social services, refugee resettlement and long-term care services in five New England states. Through public and private philanthropic funding, the organization is beginning to help refugees from Ukraine, Haiti, Venezuela and Afghanistan get the support services they need – language, housing, childcare – to enable them to work in Ascentria’s long-term health sector. healthcare establishments and those of healthcare partners.

The group has a long history of helping refugees resettle and find jobs in traditional settings such as warehouses or retailers, said Angela Bovill, president and CEO of Worcester, Mass.-based Ascentria. “Now we’re looking at what it would take to move them into health care jobs,” she said.

The alliance is applying to the Department of Labor for a grant to expand the program. “If we are successful, we will build a pathway and pipeline to move at the fastest pace from immigrant to effective healthcare worker,” Bovill said.

Some long-term care experts say the United States cannot afford to drag its feet in implementing policies to attract immigrants.

“We’re competing with the rest of the world, other countries that also want these workers,” said Howard Gleckman, senior fellow at the Urban Institute.

Canada, for example, relies on immigration. In 2022, it welcomed more than 430,000 new permanent residents, the most in its history. Immigration accounts for almost 100% of Canada’s labor force growth, and by 2036 immigrants are expected to make up 30% of the population, the government has said. In the United States, immigrants make up about 14% of the population, according to an analysis of census data by the Migration Policy Institute. Canada’s Economic Mobility Pathways pilot program aims to identify and recruit refugees who have the skills Canadian employers need. In January, after visiting a refugee camp in Kenya, recruiters offered jobs in Nova Scotia to 65 continuing care assistants.

In a December survey of 500 nursing homes in the United States, more than half said staffing shortages had forced them to turn away new residents.

These staffing challenges, industry officials said, are likely to become even more onerous, with more closed facilities, units or wings, after the Biden administration announced last year that it would establish minimum staffing requirements for retirement homes.

A government mandate alone will not solve long-standing problems with inadequate training, pay, benefits or career progression, experts said.

“Young people aren’t going to clean 10 to 15 patients for $15 an hour,” Nerette said. “They will go to McDonald’s. We need to face this reality and come up with a plan.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.