An immigrant nursing home worker helps a resident
Photo credit: Juanmonino/Getty Images Plus
An immigrant nursing home worker helps a resident
Photo credit: Juanmonino/Getty Images Plus

As workforce challenges continue to hound long-term care providers, sector experts increasingly point to immigration reform as a vital step on the path toward long-awaited stability. 

The healthcare sector’s existing heavy reliance on immigrant nurses only underscores this urgent need, argues labor economist Ron Hetrick.

Hetrick emphasized during a LeadingAge member policy update call Monday that while immigration remains a contentious issue, fixing the broken system must be an elevated priorite in order to alleviate the growing workforce crisis.

In the past, the country saw immigrants as competition for jobs, he said. Today, there aren’t enough people to fill jobs in the service industry, making the nation more dependent on immigrants than ever. That reliance will dramatically increase in the next five to eight years, he added.

Those sentiments were echoed Thursday by long-term care leaders at a McKnight’s VIP Executive Conversation. The issue goes beyond politics, said Andy Carle, adjunct faculty and lead instructor at Georgetown University’s administrator training program.

“Frankly everybody in our industry should be on Capitol Hill screaming about immigration reform,” he said. “Here we are debating this because of politics. To me it’s not politics — it’s business. And it’s about delivering our product. You can automate the auto industry … we can’t automate a lot of what we do yet.”

Last year, Hetrick said, the nation added 3.3 million immigrants — and between 1.8 million and 2.5 million of them entered the workforce. In healthcare, he said, 1 in 4 nurses, 1 in 5 healthcare aides, and 1 in 4 doctors are foreign born. 

While the number of native-born nurse aides has been falling for nearly a decade, the number of immigrant workers in the same jobs have remained remarkably stable across the country.

Unclogging the pipeline

Although immigration is a subject that “gets a lot of people fired up,” Hetrick said, what people need to understand is how antiquated the system is. The average immigration judge has a backlog of 4,500 cases, and immigrants who applied for a visa five to 10 years ago are just now being processed for them. Building a wall and funneling immigrants through a single point of entry means there will be 3.4 million people waiting at that door, he said. 

In the past year and a half, no sector has become more critically dependent on immigration than healthcare, Hetrick said. The country needs to unclog the immigration pipeline and remove the backlog for those looking to enter the country legally and become part of the workforce, he added.

Pointing to the growing needs of the home healthcare workforce, Hetrick said that some states depend more on immigrant labor than others. Failure to address immigration bottlenecks risks exacerbating workforce shortages, with states reliant on immigrant labor facing the prospect of poaching workers from other regions, he explained. 

“It’s everybody’s problem,” Hetrick said, adding that staffing shortages will likely worsen in the next five to seven years as most baby boomers retire and the birth rate falls off a cliff, leaving fewer working-age individuals available. 

No single solution to problems

But the nation’s reliance on immigration also is a concern, Hetrick said, adding that the “faucet won’t run forever” as other countries also are experiencing falling birth rates and will be looking to keep their people to fill their own job openings.

“My concern for the US is we’re starting to see immigration as a path out for a lot of things, which is keeping some industries from doing things to prepare now for the future,” he said. 

Another issue Hetrick sees is a “quit problem,” which is plaguing some states more than others. Across the 2 million healthcare job openings, half were created due to people quitting, he said. 

“It’s a tremendous concern,” he observed, adding that employers with overworked and stressed employees are constantly creating negative experiences and driving people away from the field. 

“Take pressure off people so they stop quitting,” he said.

Overall, Hetrick said that he is optimistic about the future of the healthcare labor market.

“I believe that pain forces change, and once we get through those things, it gets better,” he said. “I believe a lot of healthcare will be pushed to the home over the next five to 10 years — we will see that explode.”