Immigrant care workers make up an increasingly large share of the nursing home workforce — largely because US-born certified nursing assistants have fled the sector, a new study in Health Affairs confirmed Monday.
As the demands of an aging population and new staffing regulations put increasing pressure on nursing homes, immigrants must be a vital part of the sector’s future, said study co-author Hankyung Jun, PhD, a research fellow at Harvard Medical School.
“I believe immigrant workers are going to be one of the key factors in addressing the staffing crisis,” Jun told McKnight’s Long-Term Care News. “Unless we see major improvements in working conditions and wage/benefit levels, hiring non-immigrant staff is going to stay difficult. However, the increasing immigrant population indicates there will be more job-seeking immigrant workers in the future, and many will help fill direct care positions in nursing facilities.”
With burnout impacting care workers across the nation, the number of native-born CNAs has been on the decline for nearly a decade, according to the researchers. The number of immigrant CNAs, in contrast, has remained remarkably stable and has been a crucial support for the sector, especially during the pandemic. Immigrants now make up 19.1% of the US nursing home workforce — an increase of 40% since the early 2000s when they only made up 13.6% of the workforce.
“During the first two years of the COVID-19 pandemic, the share of immigrant CNAs employed
by nursing homes surged, which can be explained by a simultaneous drop in the share of native-born staff,” study authors noted. “Staffing shortages observed during the pandemic would have been worse if not for foreign-born CNAs remaining in the workforce.”
Incentives drive stability with immigrants
Foreign-born CNAs are more likely to stay on the job for a variety of reasons, according to the study. Latin American workers, for example, can expect to receive four to 10 times more pay in the US even after accounting for the cost of living.
However, immigrant workers are also often more reliant on their jobs. They may find it more difficult to find a new job due to language and cultural barriers and leaving work could threaten their immigration status. This puts them at risk of being stuck in the same high-stress environments that plague all care workers.
“There are studies noting that immigrant workers are less likely to join unions or to speak up for themselves,” Jun added. “I do believe foreign-born workers could experience the same, or even worse, burnout-inducing conditions as native-born workers face, which will do more harm in the long term. There need to be more policies focused on improving working conditions.”
She outlined the implications this dynamic has for nursing homes that might want to attract immigrant workers to address their staffing levels.
“I do believe immigrant workers will be mostly attracted to facilities that sponsor green cards and provide higher wages, but providing a welcoming atmosphere to foreign-workers and establishing a healthy working environment will also be attractive,” Jun said. “Facilities need to monitor whether immigrant workers are receiving equal pay and compensation as native-born workers are receiving, and they should regularly check in with immigrant workers to understand their main concerns while at work.
Policy implications
Having more immigrant workers at a facility was correlated with higher quality of care despite any language or cultural barriers, noted Jun and co-author David C. Grabowski, PhD, professor of health care policy at Harvard Medical School.
The researchers recommended that the US open new immigration pathways to encourage workers to fill urgent staffing needs.
“Some visas are available for ‘less-skilled’ workers,” Jun said, “but none are for direct care workers, which is why most immigrant care workers enter the country through a family visa. If there was a national-level visa category just for direct care workers or certified nursing assistants, I believe it could encourage more care workers to enter the industry.”
She noted that such new visas could be used to target regions and facilities with the most severe staffing needs. States with low immigrant worker populations (often rural in nature, such as West Virginia or Montana) could also sponsor green cards as an added incentive.
Regardless of what measures are actually taken, the study highlights the importance of immigrant workers for the near future of the long-term care sector. Adding incentives to attract these workers may be necessary simply to offset the departure of so many native-born care workers.
