Immigration ‘Pathways’ Vital to Home Care Industry’s Future

Home care has a huge immigrant workforce, so policies restricting immigration may only worsen recruitment and retention problems, providers and researchers warn.

Across the board, the health care sector often relies on immigrant labor — especially for the care of older adults. In fact, immigrants accounted for more than 18% of U.S. health care workers in 2017, according to a new study published in the journal Health Affairs.

“People that are in health care know that we have a strong reliance on immigrants to take care of our patients,” Dr. Leah Zallman, the study’s lead author, told Home Health Care News. “The magnitude of that reliance is in some ways surprising, but in some ways not.”


In terms of the home care industry, more than 27% of workers are immigrants, according to the Health Affairs study.

For an industry that is already struggling to find and keep caregivers, proposed legislation that prohibits or restricts immigration could have major impacts, according to Zallman, an assistant professor of medicine at the Harvard Medical School and director of research for the Institute for Community Health at the Cambridge Health Alliance.

“Any policies that are discouraging immigration are likely to undermine an industry that already has severe workforce shortages,” she said.


Supporting 24-hour care

Even outside of health care, immigrants make up a significant portion of the U.S. population.

Currently, more than 40 million people living in the U.S. were born in another country, accounting for over 13% of the total population. Of those who were originally born outside of the U.S., 76% are documented, while roughly a quarter are individuals without legal documentation, according to the Pew Research Center.

As it relates to jobs, 28 million immigrants are either working or attempting to find work, accounting for 17% of the labor force in 2016. The majority of these workers actively participating in the national workforce are documented, according to Pew.

But as the people living in the United States grow older and develop more chronic conditions, the need for more caregivers is increasing, creating an opportunity for immigrants to continue to step in and fill these roles, Zallman said.

“[There is a growing] need for 24-hour care,” she said. “We know that immigrants disproportionately take on the shifts that U.S. born citizens typically don’t want. Night shifts and weekend shifts are ones that go unfilled without people who are willing to step in and do that.”

Further compounding matters, the past few years have seen a move to push forward legislation that would curtail immigration.

One major move on the federal level was the introduction of the Reforming American Immigration for Strong Employment (RAISE) Act in the Senate in 2017.

Co-sponsored by Senators Tom Cotton (R-Ark.) and David Perdue (R-Ga.), the bill sought to replace the current employment visa system with a skills-based point system, eliminate the diversity visa program and cap the annual number of refugees given permanent resident status at 50,000. The bill was last referred to the Senate Judiciary Committee after its introduction.

Additionally, under the Trump administration, there has been a continued rise in the number of arrests and deportations of undocumented immigrants.

Additionally, the White House previously announced plans to cap the number of refugees allowed into the country at 30,000 for 2019.

A health care ‘pathway’

Given that recruitment and retention is an industry-wide challenge, home care providers are voicing their support for immigration reform, and are willing to throw their weight behind meaningful employment-based visa policies.

“Numbers show that a huge percentage of our caregivers are immigrants,” Peter Ross, CEO and co-founder of Senior Helpers, told HHCN.

Maryland-based Senior Helpers is an international home care franchise with more than 300 locations worldwide, serving roughly 25,000 clients. In addition to his role with Senior Helpers, Ross also serves as president of the Home Care Association of America’s board of directors (HCAOA).

Washington, D.C.-based HCAOA is a home care industry trade association that represents nearly 3,000 home-based care companies in state and federal advocacy efforts.

“That’s why we, both as an industry and as an association, have really tried to prompt Congress to open their eyes to the need for finding a pathway for immigrants to work in the health care field based on the demand that we have with our aging population,” Ross said.

Already, there aren’t enough caregivers to comfortably support the preference of older adults to safely age in place.

If the flow of immigration isn’t supported — or if it is reduced — that preference would become a pipe dream, according to Ross.

“If there is no proper immigration reform … and no workers to do the work, families will be forced to put their loved ones into a facility,” he said. “There are some wonderful facilities out there, but that’s not what the people want. That senior wants to age in place for the rest of his or her life.”

When it comes to advancing immigration reform that would benefit the home care industry, the current administration poses challenges, according to Ross.

“Unfortunately, in Washington, it’s a very polarizing situation between the democrats and republicans,” he said. “I’m sure you’ve heard ‘build a wall’ and ‘stop illegal immigration.’”

While immigration efforts have been slow, experts point to the passage of the American Dream and Promise Act of 2019 as a step in the right direction.

The U.S. House of Representatives passed the piece of legislation — H.R.6 — on Tuesday. In general, the bill seeks to create a legal path for young undocumented immigrants who were brought to the U.S. as minors.

“That was positive immigration reform effort,” Ross said. “We see some glimmer there relative to what Congress is doing, but we are are also looking at what else we could be doing, specifically regarding the potential for other legislation. That’s something that could be on the horizon based on what Congress did yesterday.”

For now, there is nothing else on the table that HCAOA can throw its support behind, but the association is keeping a close eye on legislation that could negatively impact the home care industry through immigration restriction.

“Right now, there is nothing that we are supporting specifically related to visa-reform, but in general we support the concept,” Phil Bongiorno, executive director of HCAOA, told HHCN

Besides Senior Helpers, immigration reform has also been a point of focus for Moorestown, New Jersey-based home health company Bayada.

“A curtailed immigration policy is going to affect the supply of our home care nurses and aides throughout the country,” Bayada Chief Government Affairs Officer David Totaro previously told HHCN.

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