Training Program for Immigrants Helping to Solve Home Care’s Workforce Problem

In-home care organizations continue to look for new and innovative ways to combat the increasingly dire workforce shortage. One program is trying to solve the industry-wide pain point by helping immigrant students become home health caregivers through specialized training.

The home health aide program is housed out of Stamford, Connecticut-based Building One Community’s Center for Immigrant Opportunity. Specifically, the program at Building One Community (B1C) — administered in partnership with Norwalk Community College — places local immigrants in a six-month cohort that completes both an English language component and skills training course focused on home health care.

As part of the partnership, Norwalk Community College — a public, two-year college that serves southwestern Connecticut — provides the program with a dedicated instructor.


“The home health aide program was started in 2016 after we [launched] a survey that asked, ‘What kinds of skills do workers need to learn and grow,’” Ivonne Zucco, the workforce development director at B1C, told Home Health Care News. “[We] determined that workers wanted something that offered them a career path. We also found out that the surrounding area needed a lot of home care.”

To qualify for the home health aide training program, applicants must undergo an interview process that takes into account likability, English language proficiency, previous health care experience and overall desire to work in the booming home-based care field.

Typically, the program garners around 60 to 70 applicants per cohort; about 25 are chosen to become students.


Because B1C is a nonprofit organization, its immigrant training program is set at a fixed cost, with tuition usually hovering around $300. The total mostly includes uniforms and course books, according to Zucco.

Once applicants officially become students, they attend classes twice a week. The classes — split up into a lecture session and study group session — take place at B1C’s office headquarters.

“Students come in and study with a tutor,” Zucco said. “For immigrants who are sometimes juggling jobs, family and so on, sometimes it’s hard to find the time to concentrate and study.”

The most recent cohort had 20 graduates, she said.

As part of the program, B1C also runs a lab portion taught at Norwalk Community College. The lab portion includes clinical simulations and trips to elderly care facilities.

“[Immigrants] may take on cases that are really challenging,” Zucco said. “I think that our program is bringing in a population that is willing to sacrifice and work hard so that they can move ahead.”

The backbone of home health care

Compared to other sectors, health care often relies more heavily on immigrant labor. For example, immigrants accounted for more than 18% of U.S. health care workers in 2017, according to a recent Health Affairs study.

This trend is especially true when it comes to the care of older adults, with immigrants making up a large portion of the home care workforce. In the home care industry today, more than 27% of workers are immigrants, according to Health Affairs.

“We know that immigrants disproportionately take on the shifts that U.S.-born citizens typically don’t want,” Dr. Leah Zallman, an assistant professor of medicine at Harvard Medical School, previously told HHCN. “Night shifts and weekend shifts are ones that go unfilled without people who are willing to step in and do that.”

With immigrants making up a large part of the home care workforce, experts say that policies restricting immigration may have a negative impact on an industry that is already facing recruitment and retention challenges.

Last month, Sen. Rand Paul (R-Ky.) introduced a bill aiming to bring more high-skilled workers to the U.S. The Backlog Elimination, Legal Immigration and Employment Visa Enhancement (BELIEVE) Act would implement what the senator called a “merit-based immigration system.”

Among other things, the legislation would double the amount of employment-based visas, eliminate the country cap and exempt children and spouses from being counted against the worldwide limitation on the number of employment-based visas.

Sen. Paul highlighted the legislation during a July press conference, noting that the passage of the BELIEVE Act would be “a major boon” for the home care industry.

“We are at a time now where we need more workers,” Paul told HHCN during the press conference. “A lot of health care workers from foreign countries have come in and trained. This bill, by doubling the amount of employment-based visas, would allow much more lawful immigration based on those who want to work.”

Measuring success

Once students graduate from B1C’s program, the nonprofit helps them get started in the field professionally. B1C hosts job fairs throughout the year, invites recruitment agencies to meet with students while also connecting them with local homeowners and caregivers.

It’s still too early to measure the success of the program, according to Zucco. Even so, B1C is already working to improve the program for future students based on emerging knowledge and best practices.

“We are working to improve and extend our conversation classes so that students feel more confident about speaking,” Zucco said.

Additionally, the program has complimentary classes including job search courses, where students learn to network and put together a resume. Another class teaches students about cultural differences and effective communication.

Language gaps with caregivers have been shown to put home health patients at higher risk of adverse events, including a higher risk of 30-day readmissions and trips to the emergency room.

Broadly, the in-home care industry is seeing record high turnover rates and low retention. Last year, the median caregiver turnover rate climbed to 82%, a 15% increase over the previous year, according to Home Care Pulse.

“We are training students who really connect with the profession and think that this is something they want to do,” Zucco said. “They have a desire to help others. Generally, our students are more likely to stay in a [home care] job, as opposed to other places where they go and learn this just because they need a job.”

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