LeadingAge Urges Less Restrictive Immigration, More Worker Supports

WASHINGTON—LeadingAge, a national association of nonprofit and mission-driven aging services providers, released “The Immigration Imperative: Recommendations for Strengthening the Aging Services Workforce.” The Immigration Imperative is a new white paper that explores how the country’s immigration system can be reformed, addresses the need to increase foreign-born workers in long-term service and supports (LTSS) care teams and aims to expand access to care.

“America is in the midst of a demographic crisis,” said Katie Smith Sloan, president and chief executive officer of LeadingAge. “The population of older adults with complex needs is growing by leaps and bounds, while the pool of available workers is declining at a dangerous rate—a mismatch that is harming older adults and their families. We’ve got to think boldly; systemic changes are needed to address the shortage of professional caregivers for the long term. September—when we observe National Workforce Development Month—is an opportune time.” 

Older Americans are often faced with a crisis in accessing necessary care and services, resulting in a need for new approaches to strengthen and build the nation’s long-term care workforce, the company said. Foreign-born caregivers make up a significant proportion of team members in the LTSS sector. While immigrants make up 17% of the total U.S. labor force, they comprise 31% of the homecare workforce, 21% of the residential care aide workforce, 21% of the nursing assistant workforce and 30.3% of the nursing home housekeeping and maintenance workforce.

However, a lack of immigration reform leaves many qualified and in-demand caregivers stuck in an antiquated immigration process, the company said. The current immigration process can obstruct the channel of qualified caregivers, elevate the cost of care and deny older adults essential services and support. 

The Immigration Imperative outlines four primary challenges facing the LTSS sector, as well as LeadingAge’s recommendations for addressing those challenges within a restructured immigration system.

• Challenge 1: A shortage of professional caregivers.
  • Solutions: Raise immigration caps; expand refugee status; expand work opportunities for international students.
• Challenge 2: A restrictive immigration system.
  • Solutions: Modify the employment-based third (EB-3) program to designate LTSS nurses as “skilled workers”; expand the EB-3 program so foreign-born workers can enter the U.S. as direct care professionals; create a new “ElderCare” exchange visitor category within the exchange visitor visa program; enact a new “H2Age” temporary guest worker program; expand the use of United States-Mexico-Canada Agreement professional visa.
• Challenge 3: Lack of support for workers.
  • Solutions: Expand the national apprenticeship program to include funding that provides training and support to foreign-born workers; allow direct care professionals to receive training and testing in their native language; review outdated English proficiency testing requirements; authorize training and testing centers to open international facilities that train and certify professionals seeking to immigrate to the U.S.; expand programs that support and reduce barriers for foreign-born workers entering the nursing and allied health care workforce; establish a center of excellence to help employers support foreign-born workers; request that the Office of Refugee Resettlement report culturally concordant best practices for organizations employing recently immigrated foreign-born workers in the aging services sector.
• Challenge 4: Lack of worker protections.
  • Solutions: Direct the U.S. Secretary of Labor to provide Congress with a report detailing the state of the immigrant workforce in the aging services sector; require all employers hiring foreign-born workers to provide relevant employment documents in English and the worker’s primary language; require international nurse recruitment agencies to provide relevant information to immigrant nurses about the proposed employer; provide a report to Congress outlining tools and strategies that home- and community-based providers can use to recruit and retain the foreign-born workforce; develop legal pathways for foreign-born caregivers participating in the “gray market” economy. 

“Thoughtful reforms can help us meet the increasing care needs of a growing population of older adults, support the providers who serve this population and help foreign-born workers embark on fulfilling careers in aging services,” said Sloan.