Immigration must be part of the solution to address the shortage of paid caregivers and other long-term care workers in the United States, according to policy recommendations formally released Thursday by LeadingAge in an effort to strengthen the workforce delivering long-term services and supports in assisted living communities, hospices, homes and other settings.

The organization had a “soft” launch of its IMAGINE (International Migration of Aging and Geriatric Workers in Response to the Needs of Elders) Initiative in October.

“The recommendations in our IMAGINE Initiative will ensure that, as the U.S. population ages, our nation will have enough qualified, committed workers to care for people with LTSS needs in all settings,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “The shortage of caregivers is the greatest challenge facing senior care providers and the older adults they serve.”

With unemployment rates at a historically low 3.6% and the number of unpaid family caregivers declining due to lower birth rates, increased geographic mobility, more women in the workforce and changing family dynamics, foreign-born workers are needed to supplement American ones, according to LeadingAge.

The main proposals in the 14-page document, which the organization said could be implemented individually or together:  

  • Enact an “H2Age” time-limited guest worker program for foreign-born home care aides, certified nursing assistants, dietary aides and housekeeping technicians who are qualified and speak English.
  • Expand the EB-3 visa program to allow more foreign-born direct care workers to enter the country. Under the program currently, registered nurses can enter the country to work in healthcare settings, and there are a “very small number” of “other” slots that could be used to allow CNAs to enter, LeadingAge said. “We encourage the government to carve out an explicit category under EB-3 for workers who would be allowed to fill CNA and other professional caregiver positions in assisted living, home care, hospice, and home health settings,” the proposal states.
  • Modify the EB-3 visa to increase the number of visas available specifically to address LTSS needs.
  • Modify the R-1 visa program to provide religious visas to temporary workers in faith-based organizations.
  • Enact “Carer Pairer,” a new authority under the J-1 visa program, to include aging services workers in addition to child care workers. 
  • Amend the North American Free Trade Agreement and the U.S.-Mexico-Canada Agreement (NAFTA’s unratified potential replacement) to include aging services workers.
  • Increase the number of refugees permitted to enter the United States, and take steps to employ those refugees in the LTSS sector. 

LeadingAge said it may have additional policy recommendations in the future.