As one of its strategic priorities, LeadingAge has been working to identify solutions to our severe workforce shortage. We are acutely aware of the reality today. We have a demographic misalignment—a shrinking population of working-age adults juxtaposed against a growing older population. Unemployment rates as low as 1% in some counties and 3.6% nationally. Fewer family caregivers and more chronic conditions. We are also aware that foreign-born workers have long played a significant role in our workforce. Twenty-five percent of direct care workers in the U.S. are foreign-born. On average, 24% of certified nurse aides (CNA) were born in other countries and 5% of nurses in LTSS settings were born outside the U.S. A small sample of LeadingAge members interviewed for a 2018 study indicated that the percentage of foreign-born workers in their personal care assistant workforce ranged from 25% to as high as 95%.

With this as a backdrop and a growing need to increase the number of qualified workers, we began to explore legal avenues that have been successful in bringing foreign-born workers to the U.S. to do meaningful work. The result is IMAGINE – International Migration of Aging and Geriatric Workers in Response to the Needs of Elders. This multi-faceted workforce initiative is a targeted set of policy recommendations.

IMAGINE’s key proposals—taken together or separately—include expanding the existing guest worker program for CNAs and home care aides, what we are calling H2Age; enactment of “Carer Pairer” as a new authority under the existing program that brings in childcare workers as au pairs; and expanding or modifying the existing EB-3 visas to specifically address LTSS needs. Our strategy is to build on existing programs that have proven their success over the years to create an opportunity to fill a growing need in LTSS.

What is apparent through our work with the Global Ageing Network is that we, in the U.S., are not alone with this challenge. It is being felt throughout the developed world. The struggles are the same. Countries are entering into bilateral agreements with other countries to bring in workers for LTSS, they are influencing the training that takes place so workers can be prepared when they migrate as LTSS workers and a host of other measures. We had a unique opportunity to exchange ideas with providers from Canada, Australia, Czech Republic, UK, and other countries when we were together at our recent conference in Toronto. There is no magic bullet but there is a lot of creativity—both in policy and in practice—to address the gaps.

We are in the early stages of talking to members of Congress and have received genuine interest. We are simultaneously starting to build a broad coalition to work with us to advance these legislative proposals. In parallel, we will continue the dialogue with our colleagues around the world to share ideas. We will take full advantage of our unique platform that spans 60 countries and liberally share what we learn with LeadingAge members through our Center for Workforce Solutions. And, we’ll call on you for grassroots support when the time comes. The magnitude of this challenge is simply that great.

Please take a moment to read the paper and let me know what you think.


Katie Smith Sloan