What role might immigration play in the nation’s caregiving needs and policies? A pretty big one, potentially, according to policy and aging experts.
Researchers joined immigration and healthcare experts for a Tuesday panel discussion on the role of immigration in the nation’s caregiving needs and policies, hosted by the Center on Children and Families at the Brookings Institution.
The expectations — and sheer size — of the population of baby boomers will profoundly affect caregiving needs soon. The problem, according to these experts, is the nation’s aging infrastructure is not ready for them.
Tara Watson, Ph.D., a Brookings economist, conducted research on how immigrants affect the settings where older adults age. She found that the institutionalization of older adults declines — particularly nursing home use — when increasing numbers of immigrants move to a local area.
From 1980 to 2000, a period characterized by an increase in immigration rates in the United States, institutionalization rates for older Americans was 10% lower than it would have been in immigration levels stayed at 1980 levels, she said.
“Immigration is an important factor in considering the future of the healthcare system, and long-term care in particular,” Watson said. “The presence of a robust immigrant workforce is an important component of the decision of Americans to age in place.”
But the United States has not kept up with other countries in terms of immigration policies and protections, according to Kristie De Pena, J.D. vice president of policy and director of immigration at the George Washington University Law School’s Niskanen Center.
De Pena said that how the country uses foreign-born workers is a necessary component of the discussion on the aging services infrastructure.
Most immigrant visa programs, she said, are not geared toward lower-skilled healthcare workers — personal care aides, nursing assistants, home health aides and others in healthcare support roles, even though there is an “incredible” demand for these workers. And the programs in place create major obstacles, with some applicants waiting a decade or more for a visa due to backlogs, she added.
“The pathways that exist now for migrant labor to come to the U.S. are woefully inadequate,” De Pena said. “Compounding that, many of our global equals, other high-income countries experiencing similar needs in the healthcare space — namely the UK, Canada and Australia — are doing an exponentially better job at recruiting and retaining and protecting their foreign talent. That puts the U.S. at an even more distinct disadvantage as we move forward.”
System has issues
“A change in immigration policy, and including immigration policy as part of our national strategy about how we’re going to care for the older adult population going forward, is just table stakes,” ATI Advisory CEO Anne Tumlinson said.
The problem, she added, is a lack of a care system and infrastructure in the United States. The nation also lacks a way to pay for those long-term services and supports, Tumlinson said.
Da Pena said the lack of care system was laid bare during the pandemic as workers — particularly women workers — abandoned the workforce in extraordinary numbers to not only care for young children, but also for their older parents. The rumblings of older adults and their advocates about their needs may be the only impetus to move Congress on immigration, she said.
The other reality, Da Pena said, is there are not enough people in the United States to fill the caregiving labor shortages. This gap provides opportunities to think more about incentives and structures to address immigration policies and bring in more workers from other countries, she said.
“For years, we had a suppressed level of immigration. We’re starting to see the effects of that across the board,” Da Pena said. “Ultimately, if we want to keep up and fill these needs, the answer is in refreshed immigration policy that reflects what people are clamoring for.”
Workforce shortages continue
Howard Gleckman, a senior fellow at the Urban-Brookings Tax Policy Center, spoke on the effects of the long-term care labor shortage on the U.S. labor market and family caregivers.
Gleckman pointed to Bureau of Labor Statistics data showing that 400,000 care workers left their jobs during the pandemic. Although research suggests that other low wage workers returned to work in recent months, the same is not true for healthcare, according to recent PHI research. Non-competitive wages and benefits, few opportunities for advancement and dangerous work all contributed to the loss of healthcare workers.
The effect on providers, he said, is striking. Although occupancy at assisted living communities and nursing homes has rebounded from the pandemic lows of early 2021, the ability of providers to accept residents is constrained by workforce shortages.
“There are not enough workers to care for residents of fully occupied facilities,” Gleckman said.
