Immigration Pathway Could Boost Home-Based Care Workforce

Home-based care agencies in the U.S. have thrown a lot at the wall these past two years to try to ease their staffing situations.

They’ve tried to nab workers from other sectors of health care. They’ve done everything to keep their own workers from entering other industries, such as retail or fast food.

But logically, given the amount of workers that are needed in home-based care now and in the future, outside of the U.S. is where the largest pool of potential workers lies.

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However, current immigration policy makes it hard to access that pool of workers, Kristie De Peña, vice president for policy and director of immigration at the Niskanen Center, told Home Health Care News

“Americans don’t want to do this work for a number of reasons, and so it often falls to foreign workers,” De Peña said. “This has sort of been this slow-growing emergency that we have an opportunity to prepare for, but it doesn’t seem like it’s not capturing enough attention.”

The Niskanen Center is a Washington, D.C.-based think tank that advocates for environmentalism, immigration reform, civil liberties and strengthening social insurance around market-oriented principles.

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Over 7 million more direct care workers will be needed by 2029 in the U.S., according to a 2021 report from PHI. At least 4.5 million of those will need to be home care workers, –and potentially more given rising demand.

Of course, there are plenty of Americans that already do home care work and do it well, and De Peña acknowledged that the reasons why other Americans don’t want to do this work is another topic on its own.

But given the sheer number of workers that will be needed to make the home-based care workforce sustainable, the pool of talent just simply may not be large enough domestically.

Already, more than a quarter of home health aides and nearly half of “housekeepers” were born outside of the U.S., according to the research and policy analysis portal VoxEU.

While the share of non-U.S. born workers in home-based care has increased steadily since 1980, an under-the-radar policy change has thwarted continued growth in the last decade, according to De Peña.

There used to be a visa program that had home health aide specifically mentioned as a qualified occupation, but that was discontinued in 2009.

“The U.S. doesn’t have any visa categories that are designed for either non-immigrant, temporary or immigrant workers that want to be in home health,” De Peña said. “Instead, they come through different kinds of immigration channels. In many cases, they come on family-based visas or as a spouse, and it’s almost impossible for them to get an employment-based visa.”

The visa construction that was discontinued in 2009 allowed aides to come to the U.S. and work for up to three years whenever there were shortages. In home-based care, there’s virtually always shortages.

A lot of different factors played into the discontinuation of the pathway, politics being one of them. But a lack of awareness did, too.

“It was kind of underutilized and so it got cast aside,” De Peña said. “The underutilization of it wasn’t reflective of the need, it was just reflective of people not knowing about it. It just wasn’t a widely known program. So Congress said, ‘Okay, well, if it’s not being used, then we’re going to get rid of it.”

If that pathway was reenacted, it would immediately help home-based care providers.

Other short-term fixes include a mimicking of the Au Pair program, which allows immigrants to care for U.S. children. Instead of children, in this case, it would be seniors.

That change would not need to go through Congress, but instead just the State Department. Still, that would only make a dent in the overall workforce challenges, De Peña said.

“This is issue will rapidly [exacerbate] in the next few years,” De Peña said. “And if we are not planning for it now, we are not going to have the immigrant labor that’s necessary to fill all of these needs.”

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