As long-term care workforce crisis worsens, immigrants can fill the gaps – Orange County Register

By Michelle Andrews

Kaiser Health News

When Margarette Nerette came to the United States from Haiti, she was looking for security and a fresh start.

The former human rights activist feared for her life in the political turmoil that followed the military coup that toppled President Jean-Bertrand Aristide in 1991. A few years later, the then 29-year-old Nerette left her two small children with her sister in Port-au-Prince, came to Miami on a three-month visa – and never returned.

After some time, she was granted political asylum.

Eventually she trained as a nursing assistant, passed her master’s examination and got a job in a nursing home. The work is hard and doesn’t pay well, she said, but “those are the jobs that are open to you as an immigrant.”

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

After many years, Nerette, now 57, left working at a nursing home to take a job with the Florida branch of union SEIU1199, which represents more than 25,000 healthcare workers. As local vice president of long-term care, she is aware of the workforce challenges that have plagued the industry for decades and will get worse as aging baby boomers push the boundaries of long-term care services.

The US faces a growing vacancy crisis and high staff turnover, which threatens the safety of elderly, frail residents. In a tight labor market with many job opportunities, low-paying and physically demanding nursing jobs are hard to sell. Experts say it would help open avenues for care workers to immigrate, but policymakers have not budged.

Over the decade to 2031, employment in supportive healthcare jobs is projected to increase by 1.3 million, a growth rate of nearly 18% that outpaced all other major occupational groups, according to the Federal Bureau of Labor Statistics. These direct care workers include, but are not limited to, nurses of various types, home nurses, and physical and occupational therapy assistants.

The largest proportion of employees in nursing homes are qualified nursing assistants who help people with everyday tasks such as bathing, dressing and eating. According to a wide-ranging report on nursing home quality released last year by the National Academies of Sciences, Engineering and Medicine, there are nearly 562,000 nursing assistant positions in the United States to fill.

But as the US population ages, fewer workers will be available to fill those vacancies in nursing homes, assisted living facilities, and private homes. 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 grow by just 15, according to an analysis of census data by PHI, a research and advocacy organization for older people % increase and people with disabilities.

Immigrants can play a crucial role in filling those gaps, experts say. According to a 2018 PHI analysis, around 1 in 4 direct care workers was born abroad.

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

Nursing homes and other long-term care facilities have long struggled to retain sufficient staff. The problem worsened dramatically during the pandemic as these facilities became hotbeds for coronavirus infections and deaths. More than 200,000 residents and employees died in the first two years of the pandemic, accounting for about a quarter of all coronavirus-related deaths during that period.

The long-term care industry has lost more than 300,000 jobs since March 2020, taking employment to a 13-year low of just over 3 million for assisted living, according to an analysis of BLS payroll data from the American Health Care Association and the National Center.

Immigration policies aimed at finding potential overseas workers to fill long-term care positions could help ease the burden. But unlike other countries facing similar challenges, the US has generally not made recruiting direct caregivers from abroad a priority.

“Immigration policy is long-term care policy,” said David Grabowski, a professor of health policy at Harvard Medical School whose research focuses on the economics of aging and long-term care. “If we’re really going to foster a strong workforce, we need to make immigration more accessible to individuals.”

Most of the roughly 1 million immigrants to the US each year are family members of citizens, although some come on work visas, often for highly skilled jobs.

On his first day in office, President Joe Biden proposed sweeping immigration reform that would have included creating a path to citizenship for undocumented workers and revising the rules on employment-based visas, but it came to nothing.

“There wasn’t much interest or political will to open up more immigration opportunities for mid- to lower-level care workers, such as home health nurses, personal health workers and certified care assistants,” said Kristie De Peña, vice president of policy and director of immigration policy at the think tank of the Niskanen Center.

The Biden administration did not respond to requests for comment.

However, some local and regional organizations are working to match immigrants with healthcare jobs.

Ascentria Care Alliance provides community services, refugee resettlement, and long-term care services in five New England states. With government and private philanthropic funding, the organization is beginning to help refugees from Ukraine, Haiti, Venezuela and Afghanistan get the supportive services they need—language, housing, childcare—to take up healthcare jobs at Ascentria’s long-term care can facilities and those of healthcare partners.

The group has a long history of helping refugees relocate and find jobs in traditional settings like warehouses or retailers, said Angela Bovill, president and CEO of Worcester, Massachusetts-based Ascentria. “Now let’s look at what it would take to get them into healthcare jobs.”

The Alliance applies to the Department of Labor for a grant to expand the program.

“If we get it right,” Bovill said, “we will build a path and a pipeline to go from immigrant to effective healthcare worker as quickly as possible.”

Some long-term care experts say the US cannot afford to delay introducing policies to target immigrants.

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

Canada, for example, is going all out when it comes to immigration. In 2022, it welcomed more than 430,000 new permanent residents, the most in its history. Immigration accounts for nearly 100% of Canada’s labor force growth, and by 2036 immigrants are expected to make up 30% of the population, the government 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 aims to identify and recruit refugees who have skills that Canadian employers need. After visiting a refugee camp in Kenya, recruiters offered 65 nursing assistants a position in Nova Scotia in January.

Meanwhile, in a December survey of 500 US nursing homes, more than half said staff shortages had forced them to turn away new residents.

Those staffing challenges, industry officials said, are likely to get more severe with more closed facilities, units or wings after the Biden administration announced last year that it would establish minimum staffing requirements for nursing homes.

A government mandate alone will not solve long-standing problems of inadequate education, pay, welfare benefits or career advancement, experts said.

“Young people are not going to clean 10 to 15 patients for $15 an hour,” Nerette said. “You will go to McDonald’s. We have to face this reality and develop a plan.”

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 the Kaiser Family Foundation. KFF is a donated non-profit organization that provides information on health issues to the nation.