Immigration reform won't solve long-term care's fundamental staffing challenge

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John O'Connor
John O'Connor

Long-term care operators are understandably giddy about the sudden prospect of immigration reform.

Such a change holds the promise of a larger labor pool at a time of rampant worker shortages. Add in the possibility that a new labor law might also drive down wages and undermine union strength, and it's not hard to see why many operators are amped up.

Lawmakers in both Congressional chambers are getting ready to roll out legislation, possibly next week. While details are still being finalized, it appears the Senate bill will present a single, difficult path to citizenship. The House version will likely offer three options, according to published reports.

This is all heady stuff. But long-term care operators might want to curb their enthusiasm.

First, keep in mind that the “deal” is being worked out by members of Congress. These are the same people who put a sequestration barrier in place to prevent irresponsible behavior. That was before they plowed through the same barrier, “Dukes of Hazard” style. If there's one organization that can treat a no-brainer as an excuse to go into a coma, Congress is it.

Second, it's worth noting that the depth of the industry's staffing problem extends beyond supply side challenges. That's not to say the sector's labor shortage is not impressive on its own merits. By some estimates, there are now 100,000 unfilled positions in nursing homes. Worse, the number is projected to climb.

But the 100,000 figure is even less scary — if that's possible — than this one: 74.5%.

That's because 74.5% is the annual turnover rate for certified nursing assistants. Put another way, hundreds of thousands of people take jobs as frontline caregivers each year, only to quit them in less than 12 months.

When it comes to staffing, the nursing home sector's problem is not that the bucket is leaky. In fact, the bucket is pouring out.

Immigration reform is going to be of dubious benefit if it only succeeds in creating millions of people who never want to work in long-term care again.

New hires in this field need more than a job. They need better reasons to stick around.


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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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