The long-term care industry has supported increasing the number of immigrant workers as a solution to the nationwide staffing shortages but has largely ignored the potential exploitative environment of long-term care settings for immigrant workers.
The immigrant population represents more than 15% of the U.S. population but makes up more than 23% of the long-term care workforce. Nearly one in three immigrant healthcare workers (30%) are employed in long-term care settings and among unauthorized immigrant healthcare workers (foreign-born citizens who are not legal residents), 43% were employed in long-term care.
The long-term care industry has historically relied on the immigrant labor force as a strategy to bolster the nursing workforce — for several good reasons. Research shows that the supply of immigrant healthcare workers is associated with positive patient outcomes, such as shorter nursing home stays for residents. In addition, more immigrant workers in nursing homes have also been found to have a positive effect on the number of registered nurse (RN) hours provided to nursing home residents, which ensures high-quality resident care.
Given the persistent workforce staffing shortages and the benefits of immigrants in the long-term care industry, it makes sense to advocate for an increased focus on immigrants as a solution to bridge the gap in the direct care workforce.
The importance of reform & protections
However, this singular perspective fails to consider the moral dilemma of bringing more immigrants into the long-term care workforce: the potential exploitation of immigrants in long-term settings, which currently lack sufficient protection and benefits for immigrant healthcare workers.
Migrant workers, in general, are recognized as the most vulnerable members of society, and immigrant healthcare workers are no exception. Reports about the exploitation of immigrant workers in long-term care are not uncommon, as they tend to receive poverty-level wages and work longer hours in poor working conditions. Unauthorized immigrants are arguably more susceptible to exploitation as they are less likely to report formal complaints of long-term care safety violations for fear of losing their jobs and/or being deported.
I am part of a team of nurses and scholars at the Hartford Institute for Geriatric Nursing at NYU Meyers working to advance healthcare for older adults, and we have long recognized the positive impact that immigrant healthcare workers (documented or not) have on long-term care. We call on policymakers to join us in recognizing the importance of immigration reform that can maximize immigrant workers’ contribution to the long-term care sector while simultaneously protecting them.
The Biden Administration and Congress need to move beyond mere announcements of comprehensive immigration reform plans, which have previously led to no tangible outcomes, and instead take concrete actions.
PHI, the leading national expert on the direct care workforce, released policy recommendations that aim to improve compensation, training, advancement opportunities and working conditions for immigrant healthcare workers.
These include recommendations that Congress enact the U.S Citizenship Act of 2023 to provide pathways to citizenship for undocumented immigrants, the U.S. Department of Health and Human Services should fund immigrant-specific direct-care workforce interventions, and the U.S. Department of Labor should enhance legal services and resources in multiple languages to share fair workplace rights and reduce workplace exploitation by long-term care facilities.
As we look for creative solutions to address the ongoing nursing workforce shortages, we must also be mindful of how we can improve the long-term care environment for immigrant workers. It is time to look past one-dimensional views of how immigrants can solely benefit the long-term care workforce, recognize the plight of immigrant healthcare workers, and embrace policy initiatives that are vital for the growth and sustainability of the United States economy and long-term care industry.
Moroni Fernandez Cajavilca, MS, BSN, RN, is a Ph.D. student at NYU Rory Meyers College of Nursing. His research, affiliated with the Hartford Institute for Geriatric Nursing, focuses on older adults and minority health.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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