How Immigration Adjustments Could Alter The Entire Home-Based Care Landscape

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More immigration – and changes to U.S. visa stipulations – would be a major boost for home-based care.

It’s no secret that agencies across the country are struggling to meet demand. Tapping into the large pool of workers outside the U.S. will have to be a part of the strategy that helps meet that unmet demand. in

Replacing the retirees with U.S. workers appears to be a losing battle, Carlo Ortiz, a shareholder with the law firm Polsinelli, recently said on a webinar. Ortiz focuses his practice primarily on employment compliance, immigration and mobility.


From now until 2031, it’s estimated that 332,000 home health and personal care aides will drop out of the workforce each year.

Another relevant aspect of the conversation is that more young adults are obtaining bachelor’s degrees than they were decades ago. Traditionally, those who obtain bachelor’s degrees haven’t ventured into careers as field staff in home-based care, though that could change.

The number of individuals who are 25 years and older, and holding a bachelor’s degree, has increased from 5% in 1940 to 33% in 2015.


That, coupled with the fact that demand for home care workers will only increase in the coming years, is a further indication that immigrant workers will have to fill some massive gaps.

“The reliance on immigrant workers in the home health care sector would represent a continuation of current practices since currently, about 2.1 million immigrants are already working in the field,” Ortiz said. “However, even though the sector is already highly dependent on the foreign-born workforce, the U.S. immigration system lacks temporary, non-immigrant and immigrant visa categories designated for low-skilled home care workers.”

What changes can be made

One change — or addition — to the U.S. immigration system that would help would be the inclusion of a visa category for non-skilled, temporary status for workers from other countries.

Similar visas exist, but they don’t check all the necessary boxes for home care workers.

“H2As and H2Bs are seasonal visas and I think we’re all aware of the fact that the need for home care aides is not something that can be tied to a particular season,” Ortiz said. “Unlike, for instance, landscapers who — at least here in Chicago — certainly can be tied to a certain part of the year.”

Another example is an R-1 visa, which is for religious workers.

“Clearly that’s not applicable to home care aides, but we mention these examples to drive our point home, which is that right now our immigration system is completely lacking any type of visa that is specifically targeted to this industry,” Ortiz said.

One visa that Ortiz pointed to was the TN visa. The TN visa is a non-immigrant classification that allows qualified Canadian and Mexican citizens to seek temporary entry into the U.S. to engage in “professional” activities.

“Most of these individuals tend to be professionals, and one applicable job field that could be related to home care would be a registered nurse,” Ortiz said. “That would require the foreign worker to either have a state or provisional license — or a degree in nursing. This, filed under the TN, has the potential to be what we’re calling a quick option because, for instance, Canadians can apply for the TN visa at the border and get accepted at the spot.”

Mexican citizens have to wait a little longer but go through a similar process, Ortiz said.

If these visas become more flexible and allow individuals to work in home care — whether on a temporary or permanent basis — that could drastically change the shortages in home-based care.

Immigration to meet unmet demand

Earlier this year, a new National Bureau of Economic Research paper pointed to immigration as a means to not only fill the excess demand for long-term care, but also a way to improve patient outcomes.

For many immigrant groups, long-term care services — including both nursing homes and home care — represent a disproportionate share of employment. Less than 2% of individuals who were not born in the U.S. work in home care or nursing home care.

However, those immigrants make up 25% and 19% of direct care workers in these industries, respectively.

“Public opinion is much more favorable towards high-skilled or highly-educated immigrants coming here and much less so for the low-skilled or low-educated,” Brian McGarry, a professor and researcher at the University of Rochester, told Home Health Care News. “But these workers are hugely important for the current state of the long-term care workforce.”

McGarry and his colleagues found that a 10% increase in the female immigrant population resulted in a 0.4% reduction in a metropolitan area’s nursing home population. Those numbers were “consistent with the fact that immigrants also often work as home health or personal care aides, professions that allow older adults to remain in their home longer.”

Through extensive research, McGarry feels confident that more immigration leads to better care for patients.

“We find very compelling evidence that the influx of immigrants has important implications for the size of the labor market and that has direct impacts on the quality of care,” McGarry said. “We also found there were modest reductions in the size of the nursing home population when there’s an influx of immigrants in a metropolitan area. We interpret this as more people working in the home care sector and some of them will find work as personal care aides, either through an agency or hired privately.”

Like Ortiz, McGarry was quick to note that although local advocacy for agencies is important, immigration will always be a top-down issue.

“A broad takeaway of mine that I keep coming back to is that federal immigration policy is long-term care policy, whether you want it to be or not,” McGarry said.

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