LTC needs a game plan on immigration

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Elizabeth Newman
Elizabeth Newman

Less than a year ago, it seems as if the long-term care sector was making positive strides in its workforce shortage issue by supporting a bill that would have brought in foreign semi-skilled workers, such as registered nurses, to the United States.

At the time, the American Health Care Association supported the measure because it realistically realized the four million new workers needed by 2050 were not going to appear out of the ether. Rural nursing homes in particular often struggle to fill vacancies.

There also are challenges in low unemployment areas, with LPNs and RNs in especially high demand, Clifton J. Porter II,  senior vice president of government relations for the American Health Care Association, said in April.

“It's becoming an increasing challenge. In Louisiana, in particular, there's a big need for nursing assistants. There's competition from other industries, such as shrimp. It's a squeeze on operators and a real problem,” he said.

Suffice it to say, I don't see that bill resurfacing anytime soon.

For a nation built on the back of immigrants, we have entered an odd time. President Donald Trump's executive order blocking refugees (and originally green card holders) was frozen by multiple judges, but there remains a lengthy court battle ahead.

Perhaps you believe the ban will keep you safer, or that you believe children with cancer should be able to come to the United States as they had planned. My argument is that, political beliefs aside, long-term care must figure out how the order and its consequences, as well as rumors of plans to rescind Deferred Action for Childhood Arrivals (DACA), will impact the workforce.

All aspects of healthcare rely on foreign workers. As many as 25% of practicing physicians were born in another country. A lot of those physicians work in public hospitals, rural areas — and with seniors either in nursing homes or other settings. While no one knows yet how many healthcare workers arrived in the U.S. from the seven countries in Trump's ban, experts said they were worried. 

“If you go to almost any hospital, a community hospital or a teaching hospital, you will find a very substantial number of people from the Middle East,”  J.B. Silvers, a trustee of The MetroHealth System and a professor of healthcare finance at Case Western Reserve University, told Stat News, which is produced by Boston Globe media. “This is just mind-blowing.”

Understanding this is a problem, the American Geriatrics Society came out this week noting its opposition to discrimination against healthcare professionals and the impact the order will have on the industry.

“We oppose any federal order or legislation that unfairly singles out or targets health professionals and other members of the healthcare workforce because of race, color, religion, gender (including gender identity, sexual orientation, and pregnancy), disability, age, or national origin,” it said. The Gerontological Society of America noted its members' concern with regard to the “chilling effect on science” stemming from the order.

There will be people in the industry — including some commenters on McKnight's articles — who will continue to chime in with rhetoric similar to what Trump advisor Steve Bannon said two years ago about refugees (“Why even let ‘em in?”) or to mock contributions of other countries. Given the response from other industries, the silence on the ban from groups such as AHCA and LeadingAge speaks volumes.

But apart from the larger philosophical question of whether or not we have begun a religious litmus test for people entering our country, there's a practical question for long-term care: Who is going to fill those open spots in your facility, now, 10 years from now, 20 years from now? Maybe you have a line-up of young citizens ready to fill slots ranging from laundry to nursing aides.

Or perhaps you believe the administration has a plan. I wouldn't count on it. I suspect we can all agree that filling open slots in long-term care doesn't appear on a priority list of the administration or anyone in Congress.

So that means it falls to you to ask questions of your leaders about what's ahead, and fight for what's right for your facility and industry. Ban or no ban, the workforce shortage issue is not going to disappear, and in fact could worsen.

Follow Elizabeth Newman @TigerELN.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.