Just weeks ago, long-term care providers were rallying behind the Dignity Act, a bipartisan, wide-ranging piece of immigration reform that would add opportunities for guest workers while also tackling border security.

But after that bill failed to drum up much excitement among lawmakers (or even a single new co-sponsor), long-term care advocates are looking for a new angle that might still lead to workforce changes this year.

“I think comprehensive immigration reform is off the table for this Congress, but we’re working on a more refined version,” Mark Parkinson, president and CEO of the National Health Care Association/National Center for Assisted Living told McKnight’s Long-Term Care News Tuesday.

“We’ve got to go back to the drawing board and develop a smaller, niche kind of proposal that could be effective for healthcare, but maybe less controversial to the partisans that want to turn comprehensive immigration reform into a huge debate,” he added. “What we’re focusing on is a visa program specific to healthcare workers.”

Currently, the number of immigrant nurses is strictly limited, with American providers quickly filling their allotments for permanent and temporary healthcare workers visas each year. A procedural time limit this spring made those quotas even more painful for some long-term care providers who had planned to patch open shifts with foreign-born staff.

The options for non-licensed healthcare workers, such as nurse aides, are even more limited. Opening avenues to registered nurses and other types of qualified workers is a strategy endorsed by AHCA in conjunction with the American Hospital Association.

“Currently, 1 in 4 direct care workers are from abroad and more are badly needed,” the two organizations told the Centers for Medicare & Medicaid Services in an April letter. “We are advocating for Congressional action to create a temporary visa option specifically for registered nurses. Ideally, the visa option would include some other much-needed health care occupations such as certified nurse assistants, respiratory therapists, and others. We also strongly support the expedition of visas for foreign-trained nurses.”

Others also continuing visa push

Ruth Katz, senior vice president of public policy and advocacy for LeadingAge said Wednesday that her team still backs the Dignity Act’s workforce measures, but it is also considering other avenues for more limited reform.

“For a variety of reasons, immigration reform is complex,” she said in an email to McKnight’s. “We need to push on many fronts for any hope of progress.” 

“We need to pull every lever available to us to find solutions; immigration reform is one critical initiative,” added Katz, who also noted that immigrants comprise 20% of RNs and 15% of LPNs in nursing homes.

LeadingAge also supports approaches that would expand pathways for foreign-born workers to enter the US to join aging services. Those include: citizenship and permanent residency status for aging services workers deemed “essential” during the COVID-19 public health emergency; the ability to recapture unused employment-based immigrant visas for foreign nurses and doctors; a new visa system that allow hiring non-agricultural essential workers for positions that have remained open for significant time; and a new H-2 temporary work visa category for aging services and organizations serving people with disabilities.

Parkinson told McKnight’s Tuesday that AHCA is “spending some time really drilling down” on what its proposal might look like and “coming up with language.” The association may float a draft within “a few weeks,” he added.

While the association had earlier lobbied hard on the immigration front, it directed members in Washington, DC, for its Congressional Briefing this week to instead promote other workforce legislation when they met with their representatives.

Despite that turn, Parkinson still insisted at a press conference on a soon-to-be-published staffing minimum that comprehensive immigration reform would be “the very best and most immediate solution.”

As it stands, a State Department visa freeze for 2023 is hitting hard those who already had contracted nurses in the immigration pipeline. Among those is the Good Samaritan Society, the nation’s largest skilled nursing provider, which said it will lose about 45% of 300 immigrant nurses it was working toward hiring.