Robert Espinoza

Informed discussion and smart immigration policies are needed as policymakers and leaders in senior living and long-term care increasingly see lawful and undocumented immigrants as a solution to workforce needs, according to a new research brief by PHI Vice President of Policy Robert Espinoza.

Approximately 860,000 immigrants are employed as direct-care workers in home- and community-based settings, assisted living facilities, group homes, intermediate care facilities, nursing care facilities and hospitals, according to the brief. Added to the number of nursing assistants, personal care aides and home health aides hired directly by families, the total becomes 1 million, meaning that immigrants make up about 25% of the direct care workforce, Espinoza said, and in California, Florida, Hawaii, New Jersey and New York, more than 40% of direct care workers are immigrants.

Most immigrants who are direct care workers are women, and their median annual income is $19,000, according to the brief. “Additionally, this segment of the workforce experiences high poverty rates and relies largely on public benefits to survive,” Espinoza wrote.

The study is part of PHI’s #60CaregiverIssues educational campaign focused on the growing workforce shortage in direct care. Espinoza said the research on immigrants is meant to be “a starting point for understanding this sector” and that future research will present ideas for potential policy reforms.

Congressmen weigh in

At least two congressmen appear to be among those open to immigration reform to assist senior living and long-term care providers.

Rep. John K. Delaney (D-MD) and Rep. James B. Renacci (R-OH) discussed the topic at the National Investment Center for Seniors Housing & Care fall meeting in 2015.

“If you go through the various cases for comprehensive immigration reform in this country, which I think is very compelling, certainly this industry and the healthcare industry in general is an industry that would benefit enormously from it,” Delaney said at the time, answering a question from NIC CEO Robert Kramer.

In general, Delaney said, immigrants are good for the healthcare system because they are paying more into the Medicare program than they are taking out, whereas nonimmigrants are taking more out of Medicare than they are putting in. Immigrants could aid Social Security in a similar way, he said. “I think this industry should be big supporters, proponents and cheerleaders for immigration reform, because it makes good financial sense” for the system, Delaney said.

Renacci said that immigrants could play an important role in replacing retiring citizens in the workforce and also in caring for those retired workers. “How are we going to take care of the aging population going forward, when we know that we don’t have growth in that younger workforce?” he said. “Some of it’s going to have to be through immigration.”