The Case for Immigration: Engaging American Workers to Solve the Labor Crisis SNF
The intersection of nursing home staffing and immigration has long been a conversation between operators before and during the pandemic, becoming even more pressing as industry leaders clamor to provide solutions to a historical labor shortage.
According to Kristie De Peña, vice president of policy and director of immigration policy at the Niskanen Center, a nonpartisan think tank based in Washington, D.C.
De Peña was a panelist at a webinar on Tuesday, hosted by the Brookings Institution, a DC-based nonprofit public policy organization Researchers and industry leaders explored the link between long-term care duration and immigration.
“The questions that follow here are whether we can meet these growing needs, given our current immigration infrastructure, and if not, what do we really need to do to get there,” De Peña said. “At this point, I can say unequivocally that the avenues that currently exist for migrant labor to come to the United States are woefully inadequate.”
American Health Care Association (AHCA) President and CEO Mark Parkinson said the aging services organization will begin to “beat” and “sow the seeds” for more comprehensive health care reform. immigration to bring care home workers overseas.
The AHCA has pushed lawmakers to change the country’s current immigration visa prioritization to consider prioritizing the entry of internationally trained nurses and healthcare workers into the United States before the end of 2021.
However, Parkinson admitted that immediate reforms are unlikely, given the current partisan divide in Congress.
Nursing specific visas
Visas are almost entirely reserved for doctors and surgeons, De Peña said. A program motivated by the nursing shortage created the H1C visa to temporarily bring registered nurses to the United States, but that route expired in 2009, she added.
“There’s not a lot of political will behind increasing opportunities for migrants and many of these lower-skilled healthcare sectors, even though there is incredible demand,” De Peña added. “There are really no single employment-based visa categories available to home health aides, personal aides, [CNAs].”
Still, about 28% of long-term care aides are immigrants, according to panelist Howard Gleckman, senior tax policy researcher at Urban-Brookings.
For Anne Tumlinson, CEO of ATI Advisory, a more open immigration policy is just “table stakes” for nursing home staffing shortages.
“It’s not even really a question of if, for me it’s more a question of how,” Tumlinson said, referring to immigrants helping to stem the labor shortage. “I’m really struck by the fact that we’re going to be competing for this workforce… [other countries are] ahead of us in terms of immigration policy, but they are also ahead of us in terms of care delivery systems and funding for these services and supports.
More traditional work visas like the H1B visa are still incredibly difficult to obtain for most of these workers, De Peña said; the United States has approximately 1 million employment-based green card applicants in its backlog and distributes only 140,000 each year.
Immigrant doctors, surgeons and clinicians with advanced degrees must overcome obstacles ranging from opaque licensing requirements to rigid visa mandates to practice in the United States, De Peña said during the webinar.
The UK, Canada and Australia are doing an “exponentially better” job of recruiting and retaining overseas talent, which puts the US at a more marked disadvantage as the industry continues with worsening labor crisis, said De Peña.
Immigration and quality of care
Delia Furtado, an associate professor in the Department of Economics at the University of Connecticut, provided a notable data point from her research on immigrants in the nursing home workforce – SNFs have seen a decrease in 4% of resident falls as the number of immigrants in local labor markets increased between 2000 and 2010.
Furtado also saw a 33% decrease in the number of residents retained and a 20% drop in pressure ulcers related to this influx of immigrants into local labor markets.
“All of this suggests that a more open immigration policy could lead to improvements in the quality of care provided in nursing homes,” Furtado said. “It seems reasonable to believe that a more open immigration policy is a cheaper way to increase staffing compared to other policy tools like maintaining minimum staffing standards and policies to raise the salaries of nurses.”
Furtado’s research paper, currently under review in the Journal of Human Resources and originally published by the IZA Institute of Labor Economics in July 2020, explores the possibility that immigration improves the quality of care in homes of retirement.
An open immigration policy is all the more important as baby boomers begin to approach the age when they will need more acute institutional care, and as nursing homes become increasingly part of that care, she said.
About $172 billion was spent on nursing home care in 2019, and Furtado expects that number to grow further.
Meanwhile, the quality of care has been affected as clinicians struggle to treat Covid among an elderly and frail population, Furtado added. Residents of nursing homes make up less than 1% of the US population, but accounted for 19% of all Covid deaths, she added.
Furtado referred to the National Academy of Sciences, Engineering, and Medicine’s (NASEM) report on home nursing, including its description of the industry as “inefficient, inefficient, inequitable, fragmented, and unsustainable. “.
“The report specifically mentions understaffing as one of the main issues to be addressed in our document,” Furtado said. “We examine whether increasing the availability of migrant workers could lead to improvements in the quality of care in care homes, even without the use of policy tools, such as increasing minimum staffing standards .”