How cracking down on immigrants could strain post-acute care

Modern Healthcare – Tuesday, December 17, 2024
By Diane Eastabrook

Anxiety over President-elect Donald Trump’s potential immigration policies is rippling through the nursing home and home health industries, where more than one-third of workers are foreign-born.

Providers and trade groups fear the possibility of mass deportations and tougher visa requirements could make it harder for nursing homes and home care companies to recruit and retain nurses and nurse aides from outside the U.S. They are urging the incoming administration and Congress not to cut off access to foreign-born workers at a time when the demand for direct care far outpaces the supply of available workers.

“In the national conversation, immigration tends to be a polarizing issue — when it really could be leveraged to help the U.S. solve our long-term care workforce crisis,” Dave Totaro, chief government affairs officer for Bayada Home Health Care, said in an email.

Moorestown, New Jersey-based Bayada provides home health services across 22 states and estimated about 8% of its staff are foreign-born.

Immigrants are integral to the direct care workforce. Approximately 1.5 million of the nation’s 5 million direct care workers who provide medical and nonmedical services to patients in their homes and in long-term care facilities are foreign-born, according to nonprofit research firm PHI National. While PHI says those workers have legal status in the U.S., many may also share their homes with family members who do not.

President-elect Donald Trump said he favored deporting anyone who is in the U.S. without legal permission during a Dec. 8 interview with NBC News. “I think you have to do it, and it’s hard … but you have to have rules, regulations, laws,” Trump said.

Nursing homes and home care companies declined to comment on the possible impact mass deportations could have on their businesses. However, Nicole Howell, director of workforce policy at LeadingAge, said the impact could be devastating. The nonprofit trade group represents more than 5,400 providers of senior care nationally.

“The [family member] may have been the driver or helped out with child care, so the [direct care worker] could go to work,” Howell explained. “If there is a change in the household, the individuals remaining may not be able to work in aging services anymore for a variety of reasons.”

The loss of immigrant direct care workers could affect hospital-at-home programs that sometimes rely on home care aides to provide nonmedical services to patients getting acute-level care where they live, said PHI National President and CEO Jodi Sturgeon.

“Statistically, eight out of every 10 hours of hands-on care is provided by a direct care worker whether it’s in the home or a facility. Without that foundational support, these programs will not succeed,” Sturgeon said.

The prospect of mass deportations or tougher visa requirements could also have a chilling effect on foreign-born nurses hoping to find work in the U.S.

Duluth, Minnesota-based Benedictine Living, which operates 26 nursing homes among its 34 senior living facilities in Minnesota, Wisconsin, Illinois, Missouri and North Dakota, has extended job offers to more than 130 registered nurses and nurse aides from the Philippines, Ghana, Nigeria, Kenya, Taiwan, the United Arab Emirates, Vietnam and Canada, said Kathleen Murray, the nonprofit’s director of organization learning and development. She said the nurses’ visas are still being processed.

Murray said Benedictine has successfully placed about 160 foreign-born nurses in its facilities over the past decade, but has lost some recruits to other countries because the U.S. visa process takes up to two years. She doesn’t think talk of tougher U.S. immigration policy is discouraging such nurses from wanting to come to the U.S. But immigration policies that would make it harder for foreign-born nurses to work in the U.S could be problematic, especially in rural communities where nurses are hard to find, Murray said.

“Over 50% of the full-time RNs that are in our rural North Dakota communities are international RNs, so it would be a challenge for those communities staffing-wise if we did not do international recruitment,” Murray said.

Providers and trade groups are mobilizing to advocate for immigration policies that would be less restrictive.

LeadingAge is preparing requests to both the new administration and Congress that include expanding the number of visas available to foreign-born nurses and nurse aides, Howell said.

The American Health Care Association is calling on the incoming Congress to pass the Healthcare Workforce Resilience Act, which would recapture unused visas from previous years to bring doctors, nurses and their families to the U.S. The bill also directs the Homeland Security Department to expedite the processing of visa applications.

“When it comes to meeting the needs of our aging population, we need to think beyond our borders,” the association said in an email.

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