The Caregiver Shortage and Immigration

In reaction to the Trump administration’s recent immigration ban, Lori Porter, founder and CEO of the National Association of Health Care Assistants, pointed out a connection between the immigration issue and LTC staffing levels. In a recent Facebook post, she stated:

“A large percentage of CNAs are from the banned countries. Long Term Care is always testifying before congress for immigration to solve their staffing issue… I know nursing homes in this country who are largely staffed by those affected. Did anyone stop to think about who would care for the residents? Especially in a country who will not come out in sufficient numbers to take care of their own OLD citizens! … I have heard from nursing homes all day who will not have enough CNAs to staff their building because so many CNAs have left out of fear.”

In support of Lori Porter’s assessment, we do know two facts:  that over 50 percent of CNAs leave their jobs every year (PHI Factsheet) and over 20 percent of caregivers in the U.S. were not born in this country (Market Watch).

My concerned is about the vulnerability of caregivers coming into this country on work visas, especially if their legal status is tied to their employment. Since advocating for our elders is such a big part of what we do as caregivers, we need workers who feel secure enough to speak out within the facility and, when appropriate, in the public forum. Sometimes, we are the last line of defense for our residents and if we do not speak, no one will. Too often, incidents and issues that should be dealt with in the open are swept under the rug, mainly out of fear of some form of retaliation.

If Long Term Care is to rely on immigration to solve the caregiver shortage in this country, what kind of protections can we provide these workers so that they feel secure enough to speak out and advocate for our elders when necessary?


2 thoughts on “The Caregiver Shortage and Immigration

  1. aortigaraA

    In addition to the issue of staff available to come and care for our elders in care settings, I am also hearing that staff from other countries are disheartened and sad as they feel unwelcome and vilified in our country. I wonder how these feelings translate into a workforce that is vulnerable and frustrated. There are so many unintended consequences of each action.

  2. minstrel

    In every long-term care home I know of, there is a high ratio of immigrant- to native-born-American aides. As Yang has said in his comment, we rely on immigrants to solve the problem of caregiver shortages. A few thoughts:

    The caregiving field, because the work doesn’t require extensive education or technical skills, is one that is inviting to many newly-arrived immigrants. If they don’t have mainstream credentials, they often gravitate toward jobs as caregivers, where required credentials are minimal. Alas, wages are also minimal. I fear that as in other areas of work such as farm work, employers may turn to immigrants for the wrong reason: they will work for lower wages. They they don’t make waves. They are grateful to be hired. They don’t try to negotiate for a higher wage. They don’t demand better working conditions. They don’t report safety violations. Many migrants come from countries where authority dare not be questioned. They don’t know their rights, which at least in theory are considerable. (In this regard they aren’t very different from their American-born co-workers.) Let’s not turn to immigrant labor as a stopgap while we’re solving the problem of substandard caregiver wages, or we’ll get stuck in that rut of low wages.

    Many immigrant aides have come from countries where there is a much stronger, warmer culture of care for the elderly. Families see this and appreciate their warmth. But these prospective caregivers often come with limited spoken English-language skills, which makes for difficulties in communicating with hearing-impaired, cognitively-impaired residents. One resident with dementia recently said to me, “She’s always shouting at me to do what she says, but I can’t understand what she says.” What are employers doing to bolster the language skills of aides whose first language isn’t English? Employers will do themselves as well as their aides a favor if they would provide aides the tools for becoming proficient in English pronunciation, at the very least.

    It’s tricky to balance the value of maintaining one’s original cultural identity with that of adopting an American identity. We want migrants to feel welcome, safe, free to be their Italian or Irish or Somalian or Thai or Pakistani selves. And we want them to want to become American. (But heaven knows, we don’t want newcomers to rush to learn from our national leaders and celebrities, “It’s all about me. Me first. Me Me Me.”) How do we encourage this balance, the duality of selfhood, in the workplace and in our culture of care?


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