Immigration Ruling Could Prolong Home Care Staffing Woes

Between wage pressures and work that can take an emotional and physical toll, home care agencies are scrambling to recruit and retain staff. A dwindling labor force has many looking to immigration reform as the sector’s saving grace—but a recent federal ruling has effectively staved off any possibility of changing immigration laws in the immediate future.

A three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans on Monday ruled that President Barack Obama overreached his legal authority in attempting to shield up to 5 million immigrants from deportation. In a 2-1 vote, the majority argued that Obama’s executive action goes beyond merely providing a safeguard from deportation and instead allows a select group of immigrants to be “lawfully present” in the U.S.

Stark conditions in the senior care space, though, have prompted lawmakers and industry leaders to consider alternate labor outlets. Despite the legal ruling passed down on Monday, a clear consensus within the industry is that there soon won’t be enough caregivers for the United States’ aging population, and immigrant workers could be a key part of the solution.


No Easy Solutions

The ratio of caregivers to those over age 80 is expected to drop drastically over the next 20 years, according to a recent AARP study. Whereas that ratio was seven-to-one in 2010, it’s likely to plummet to four-to-one by 2030, a decrease that could propel the industry into crisis mode.

To close that gap by 2030, at least 2.5 million more workers will be needed to provide long-term care to an increasingly older population in the United States, according to a study conducted earlier this year by the University of California-San Francisco. The study’s authors predict this demand for workers will remain steady, even if there’s a significant shift from institutional to home-based care.


“With this aging population, we need to have a workforce available,” said U.S. Rep. Jim Renacci (R-OH) last month at the National Investment Center for Seniors Housing & Care (NIC) National Conference in the Washington, D.C. area. “How are we going to take care of the aging population moving forward when we know we don’t have growth in that younger workforce?”

That’s a question that the senior care industry must confront to address this impending labor shortage.

“I’ll be honest—I don’t think it’s an easy issue to address,” Teresa Lee, Executive Director of the Alliance for Home Health Quality and Innovation, tells Home Health Care News. “There are relatively easy levers to pull when it comes to health care delivery, but it’s a more complex thing when dealing with workforce.”

One potential solution rapidly gaining traction is the possibility of changing the nation’s immigration laws, which were last updated in 2005 with the REAL ID Act, a measure that has primarily affected asylum seekers.

Immigrants comprised 28% of the home health care workforce as of February 2013, according to a report released by the Institute for Women’s Policy Research. Of that share, one in five direct care employees were living in the country illegally.

“This industry should be cheerleaders for immigration reform—It’s a caregiver opportunity,” U.S. Rep. John Delaney (D-MD) said at the conference. But exactly what immigration reform would look like—and when it would take place—is up in the air.

In November 2014, Obama issued an executive order that granted temporary legal status to parents of U.S. citizens and those brought here as children without proper documentation. A coalition of 26 states filed a lawsuit challenging Obama’s action on the grounds that it was unconstitutional and would saddle states with increased law enforcement, health care and education costs.

A Texas judge granted a temporary injunction against the executive order this past February, and the appellate court’s ruling Monday upholds that move. Otherwise, there’s been limited movement in terms of immigration reform, and Congress remains at odds over how to best tackle it.

Direct Recruitment on the Horizon

Though there’s been little talk as of late in regard to exactly how comprehensive reform might be shaped to benefit the industry, most aren’t shying away from tapping an immigrant labor pool. Holiday Retirement, a national operator of more than 300 independent living communities, is actively forging partnerships outside of the U.S. to prepare for imminent labor shortages ahead.

“We have to think openly and realize that we may have to import people to get things done,” President and CEO Kai Hsiao tells HHCN. “There are plenty of folks in other countries who would be willing to do so and to have the opportunity to live here in the States.”

Specifically, Holiday affiliates itself with a community that opened in China and has avid interest in select nursing and training facilities in Costa Rica, though it doesn’t yet have formal partnerships there, Hsiao says.

“There’s definitely potential labor to look at out there, and we certainly have our eyes open to it,” he says. “Are we actively [recruiting] today? The answer is no. Are we going to start doing that? The answer is yes.”

Increasingly advanced technology has allowed for more streamlined care and the more efficient deployment of staff, but Hsiao says technology is hardly a reliable solution.

“Technology will allow us to be a little more efficient so that we can look at alternative ways of how we use our labor pool, but you’re never going to be able to replace having a live person there who can see and assess things,” he says.

Beyond ‘Filling the Gap’

While immigration reform might seem a long way off, there are steps providers can immediately take to improve hiring practices, says Mark Woodka, president of OnShift, a software company focusing on human capital management solutions in long-term care and senior living. In the short-run, creating an employee-centric workplace environment is crucial, he says.

“Most aren’t hiring the right people to begin with, and too many have a ‘fill-the-gap’ mentality,” Woodka says. “That’s the reality of it. They need to get better at communicating and recognizing employees.”

Overall, in situations such as this, the labor climate might get worse before the industry gets actively vocal about immigration reform, says Cecil Rinker, a senior consultant with Old Pueblo Placement Services, a senior living consulting and placement firm based in Tucson, Arizona.

Rinker points to the agriculture industry, where immigrants form the backbone of the workforce and leaders are now advocating for reform to ensure economic stability. If the senior care sector follows suit before shortages reach emergency status, he says labor supply issues won’t be as pressing a concern.

“Sometimes things don’t change until it gets really bad, and this is going to get really bad. It’s just a matter of when,” Rinker tells SHN. “If we get proactive now, we can save ourselves a lot of grief.”

Written by Kourtney Liepelt

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