Immigration Bill Could Jeopardize Future of Home Health Care Workforce

A new bill that seeks to cut immigration into the U.S. could make an already high workforce deficit in home health care dramatically worse, industry insiders and experts fear.

The Reforming American Immigration for a Strong Economy (RAISE) Act, co-authored by Republican Sens. Tom Cotton of Arkansas and David Perdue of Louisiana and supported by President Trump, could result in a 50% reduction in legal immigration — cutting the number of new green card holders per year from 1 million to just 500,000, according to the Washington Post.

If passed, the new bill would initiate a skills-based points system that would prioritize immigrants that have higher levels of education, better English language abilities, and high-paying job offers.


The proposed law would be detrimental to the already strained home health care workforce, according to executives of the Paraprofessional Healthcare Institute (PHI), a New York City-based nonprofit organization that works to improve long-term care services for seniors.

“As the demand for paid caregivers surges over the next decade, and the workforce shortage in home care worsens, immigrants will be key to ensuring that families can take care of their loved ones,” Robert Espinoza, PHI vice president of policy, told Home Health Care News. “This short-sighted bill will devastate immigrant workers, their families, and the millions of Americans who desperately need home- and community-based services.”

Roughly one in four direct care workers are immigrants, totaling approximately 1 million immigrants in the field, according to research PHI released in June.


“Attacking workers who already occupy low-paying jobs with minimal protections will make it more difficult to stabilize a workforce critical to the U.S. economy,” said PHI president Jodi M. Sturgeon in the June press release.

Long-term care (LTC) operators will need 69% more maintenance workers, 68% more nursing assistants, and 67% more food preparation workers to accommodate demand by 2030, a recent study from provider association LeadingAge found. By that same year, LeadingAge estimates that care providers will have to boost total staff by 2.5 million people.

Many senior care businesses, like home health care providers, are limited by their inability to raise wages because two-thirds of their revenues come from fixed government payment systems, said Fred Benjamin, president of Lexington Health Network’s skilled nursing division. Based in Lombard, Illinois, Lexington Health Network is a provider of post-acute and long-term skilled care services.

In April 2013, as the COO of SNF operator Medicalodges, Benjamin testified before a congressional subcommittee on behalf of the American Health Care Association (AHCA), expressing support for a proposed W visa program to admit low-skilled foreign workers.

These workers could fill open positions such as certified nurses’ aides, licensed practical nurses, housekeepers, activity aides, and dietary and kitchen workers, Benjamin told HHCN.

“We simply cannot find enough American workers to fill these jobs, despite having good benefits and many different kinds of outreach programs,” Benjamin said. “We need more workers, and traditionally unskilled immigrant laborers are the people that end up filling many of these roles. Cutting the number of legal immigrants in half would make an already difficult situation much worse.”

Written by Elizabeth Jakaitis

Photo credit: “President of the United States Donald Trump speaking at the 2017 Conservative Political Action Conference (CPAC) in National Harbor, Maryland” by Gage SkidmoreCC BY-SA 2.0

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