For skilled nursing operators facing minimum staffing mandates and Five Star quality pressures, the research identifies immigration policy reform, including new visa pathways for direct care workers, as a key lever for closing persistent workforce gaps
The number of native-born CNAs has been declining rapidly since the mid-2010s, whereas the number of foreign-born CNAs has remained relatively constant. During the first two years of the COVID-19 pandemic, the share of immigrant CNAs employed by nursing homes surged, which can be explained by a simultaneous drop in the share of native-born staff. Staffing shortages observed during the pandemic would have been worse if not for foreign-born CNAs remaining in the workforce. In an analysis of prepandemic data, we found that nursing homes in regions with a higher share of immigrant CNAs were associated with more direct care staff hours per resident day and better nursing home quality performance. With the growing demand for long-term care, creating pathways for job-seeking immigrants to fill the gaps in direct care will be crucial to meeting future staffing needs.
Jun, Hankyung, and David C. Grabowski. “Nursing Home Staffing: Share Of Immigrant Certified Nursing Assistants Grew As US-Born Staff Numbers Fell, 2010–21.” Health Affairs, vol. 43, no. 1, 8 Jan. 2024, https://doi.org/10.1377/hlthaff.2023.00881.
Immigration to Address the Caregiving Shortfall
In sum, America’s rapidly aging population, coupled with an acute shortage of direct care workers, threatens to exacerbate an ongoing crisis in long-term elder care.
Immigrant caregivers offer a partial solution to this crisis by simultaneously making long-term care more accessible, effective, and affordable for older Americans.
— Brookings Institution, April 2, 2024
Study Finds Immigrant Caregivers Essential for a Growing Population in Need of Care
Nursing homes in regions with a higher share of immigrant CNAs were associated with better patient care; high percentages of immigrant CNAs resulted in more direct care staff hours per resident day and better overall nursing home quality performance.
Such findings advocate for immigration policy reform that would retain and attract foreign-born workers.
— Harvard Medical School, Department of Health Care Policy, February 5, 2024
Why Immigrant CNAs Are Crucial as the Nursing Home Space Faces A Staffing Mandate, Quality Measures
The share of immigrant CNAs increased in most states between 2000 and 2021, Jun said, but there was a wide variation across states. During pandemic years, this increase was largely due to foreign born CNAs remaining in the workforce while native born CNAs left their positions.
More immigrant CNAs were also associated with more direct care staff hours per resident and better nursing home quality performance, something to keep in mind especially considering the looming CMS minimum staffing mandate and changes slated for the value-based purchasing program. Staffing shortages observed during the pandemic would have been worse if not for foreign-born CNAs remaining in the workforce.
— Skilled Nursing News, January 16, 2024
Researchers Dissect LTC’s Immigrant Workforce, Push for Even More
As the demands of an aging population and new staffing regulations put increasing pressure on nursing homes, immigrants must be a vital part of the sector’s future, said study co-author Hankyung Jun, PhD, a research fellow at Harvard Medical School.
“I believe immigrant workers are going to be one of the key factors in addressing the staffing crisis. Unless we see major improvements in working conditions and wage/benefit levels, hiring non-immigrant staff is going to stay difficult. However, the increasing immigrant population indicates there will be more job-seeking immigrant workers in the future, and many will help fill direct care positions in nursing facilities.”
— McKnight’s Long-Term Care News, January 9, 2024
Researchers urged nursing home operators to consider the potential benefits of immigrant CNAs in improving overall quality measures.
“Having more immigrant CNAs was correlated with lesser resident depressive symptoms and a lower probability of resident falls, weight loss, pressure sores, or inappropriate use of antipsychotics,” researchers wrote. The study suggests that creating pathways for job-seeking immigrants to fill these gaps will be crucial for meeting future staffing needs.
— Skilled Nursing News, January 8, 2024
