Changes to Immigration Policy and its Effects on Caregiving

The following are excerpts from a Kaiser Health News (KHN) article, “As Trump Targets Immigrants, Elderly Brace To Lose Caregivers”, by Melissa Bailey, 3/26/18. Changes in immigration policy exacerbate the ability to hire caregivers for people who need Long Term Services and Supports (LTSS). The emphasis here is mostly on the effects on the elderly population, but it applies also to people with disabilities who rely on Medicaid to pay for caregivers.

There have been many alarming stories about the shortage of caregivers and the reasons for it: low pay, lack of respect for the work that these people do, and few incentives to attract reliable high quality workers to care for our loved ones.

Read the full story to get an idea of the impact of immigration changes on the personal lives of people needing the services of caregivers and the caregivers themselves. Many of the excerpts below are a reminder of how big a problem this is and how little has been done to improve the situation.

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"Nirva [a Haitian caregiver] is one of about 59,000 Haitians living in the U.S. under Temporary Protected Status (TPS), a humanitarian program that gave them permission to work and live here after the January 2010 earthquake devastated their country. Many work in health care, often in grueling, low-wage jobs as nursing assistants or home health aides"

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“Ending TPS for Haitians ‘will have a devastating impact on the ability of skilled nursing facilities to provide quality care to frail and disabled residents,’ warned Tara Gregorio, president of the Massachusetts Senior Care Association, which represents 400 elder care facilities, in a letter published in The Boston Globe. Nursing facilities employ about 4,300 Haitians across the state, she said.

“‘We are very concerned about the threat of losing these dedicated, hardworking individuals, particularly at a time when we cannot afford to lose workers,’ Gregorio said in a recent interview. In Massachusetts, 1 in 7 certified nursing assistant (CNA) positions are vacant, a shortage of 3,000 workers, she said.”

“Nationwide, 1 million immigrants work in direct care — as CNAs, personal care attendants or home health aides — according to the Paraprofessional Healthcare Institute, a New York-based organization that studies the workforce. Immigrants make up 1 in 4 workers, said Robert Espinoza, PHI’s vice president of policy. Turnover is high, he said, because the work is difficult and wages are low. The median wage for personal care attendants and home health aides is $10.66 per hour, and $12.78 per hour for CNAs. Workers often receive little training and leave when they find higher-paying jobs at retail counters or fast-food restaurants, he said.

“The country faces a severe shortage in home health aides. With 10,000 baby boomers turning 65 each day, an even more serious shortfall lies ahead, according to Paul Osterman, a professor at Massachusetts Institute of Technology’s Sloan School of Management. He predicts a national shortfall of 151,000 direct care workers by 2030, a gap that will grow to 355,000 by 2040. That shortage will escalate if immigrant workers lose work permits, or if other industries raise wages and lure away direct care workers, he said.”

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“It’s not clear how many direct care workers rely on TPS, but PHI calculates there are 34,600 who are non-U.S. citizens from Haiti, El Salvador, Nicaragua (for which TPS is ending next year) and Honduras, whose TPS designation expires in July. In addition, another 11,000 come from countries affected by Trump’s travel ban, primarily from Somalia and Iran, and about 69,800 are non-U.S. citizens from Mexico, PHI’s Espinoza said. Even immigrants with secure legal status may be affected when family members are deported, he noted. Under Trump, non-criminal immigration arrests have doubled.”

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“'What people don’t seem to understand is that people from other countries really are the backbone of long-term care,' said Sister Jacquelyn McCarthy, CEO of Bethany Health Care Center in Framingham, Mass., which runs a nursing home with 170 patients. She has eight Haitian and Salvadoran workers with TPS, mostly certified nursing assistants. They show up reliably for 4:30 a.m. shifts and never call out sick, she said. Many of them have worked there for over five years. She said she already has six CNA vacancies and can’t afford to lose more.”

KHN’s coverage of these topics is supported by Gordon and Betty Moore Foundation and John A. Hartford Foundation

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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For more information see:

PHI (Paraprofessional Healthcare Institute)

"Severe Shortage of Home Health Workers Robs Thousands of Proper Care" by Judith Graham, 4/26/17