Access To Immigrant Workforce Remains Vital In Meeting Rising Home-Based Care Demand

The immigrant workforce could be one of the keys to mitigating staffing woes in home-based care.

That is one of the main takeaways from a new PHI report that outlines the importance of building up – and supporting – the immigrant workforce in home care.

“Immigrants are an important labor pool for the home care workforce,” Robert Espinoza, executive vice president of policy at PHI, told Home Health Care News in an email. “Yet without enough workers to fill these jobs, home care recipients don’t receive the care they need. Already, far too many older adults and people with disabilities can’t access high-quality, continuous care to live in good health at home because home care jobs remain unstaffed.”


PHI is a New York-based advocacy organization for direct care workers. The organization launched a direct care workforce initiative itself in 2020, aimed at advocating for better policy at the state level when it comes to the caregiver workforce.

According to PHI, at least 27% of direct care workers in the U.S. are immigrants. In the entire U.S., immigrants make up 17% of the labor force.

That number is even higher in home care, where immigrants make up 32% of the workforce.

Source: PHI

The share of immigrants in the overall direct care workforce is growing, too: up from 21% in 2011 to 27% in 2021.

Meanwhile, PHI estimates that between 2021 and 2031, the long-term care sector will need to fill 9.3 million direct care job openings. That includes new jobs and job vacancies from workers leaving the field or retiring.

In order to meet the growing home care demand, the workforce has to be strengthened as a whole, Espinoza argues. Doing so will require enacting a wide range of policy measures that improve compensation, training, advancement opportunities and other aspects of the job.

However, current immigration policy makes it hard for providers to access that pool of workers.

Espinoza and his colleagues argue that poor job quality in direct care is at the root of the staffing crisis.

Home care aides and other direct care workers still deal with low wages, inadequate training, limited advancement opportunities and a general lack of respect.

The study’s authors outlined four key recommendations that would help the immigration workforce in home care: pathways to citizenship, workforce innovation, immigrant worker support and data collection.

One of the specific recommendations is to create a special caregiver visa for direct care workers that would hopefully strengthen the pipeline of workers and, in turn, provide immigrants who received the visa with an opportunity to live permanently in the U.S.

“A caregiver visa that has strong worker protections and a pathway to citizenship will support employers who want to recruit workers from abroad,” Espinoza said. “It will provide those workers who contribute to this sector with a hard-earned opportunity to live permanently in this country. It’s a win-win solution — especially since it also benefits the older adults and people with disabilities who need this care yet can’t find workers.”

In order to enact such a policy, Espinoza said the U.S. will need a committed and bipartisan group of federal leaders who recognize the solution that could help the country’s health care system.

The report also suggests Congress should enact the Citizenship for Essential Workers Act, which would allow undocumented people who worked as essential workers during the COVID-19 pandemic to be eligible for a path to citizenship.

“Immigrants are essential to the future of home care,” Espinoza said. “But if we don’t create ways to support them and their employers, we won’t meet the surge in demand for home care over the next decade and beyond.”

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