September 11, 2024 Washington, DC — As older Americans and their families face a crisis in access to much-needed care and services, new approaches to strengthen and build the nation’s long-term care workforce are needed. 

The Immigration Imperative: Recommendations for Strengthening the Aging Services Workforce, a new white paper released today by LeadingAge, the national association of nonprofit and mission-driven providers of aging services, explores how reforms to the country’s outdated and inefficient immigration system can address the urgent need to bring more foreign-born workers to long-term service and supports (LTSS) care teams, legally, and expand access to care. 

“America is in the midst of a demographic crisis. The population of older adults with complex needs is growing by leaps and bounds while the pool of available workers is declining at a dangerous rate–a mismatch that is harming older adults and their families,” said Katie Smith Sloan, president and CEO, LeadingAge. “We’ve got to think boldly; systemic changes are needed to address the shortage of professional caregivers for the long term. September–when we observe National Workforce Development Month–is an opportune time.” 

Foreign-born caregivers already make up a significant proportion of team members in the LTSS sector compared to other workplaces. Immigrants working as direct care professionals come to the U.S. from at least 163 countries, with the most significant number of foreign-born workers hailing from Mexico (14%), the Philippines (9%), the Dominican Republic (7%), Jamaica (7%), and Haiti (7%).  While immigrants make up 17% of the total U.S. labor force, they comprise 31% of the home care workforce, 21% of the residential care aide workforce, 21% of the nursing assistant workforce, and 30.3% of the nursing home housekeeping and maintenance workforce.

But the absence of substantive immigration reform leaves many qualified and in-demand caregivers stuck in an antiquated immigration process. It also obstructs the pipeline of qualified caregivers, elevates the cost of care, and denies older adults the services and support they need. “Thoughtful reforms can help us meet the increasing care needs of a growing population of older adults, support the providers who serve this population, and help foreign-born workers embark on fulfilling careers in aging services,” Sloan adds.

The Immigration Imperative outlines four primary challenges facing the LTSS sector and LeadingAge’s recommendations for addressing those challenges through a restructured immigration system.

• Challenge 1: A Shortage of Professional Caregivers
  • Solutions: Raise immigration caps; Expand refugee status; Expand work opportunities for international students
• Challenge 2: A Restrictive Immigration System
  • Solutions: Modify the EB-3 Program to designate LTSS nurses as “skilled workers”; Expand the EB-3 program so foreign-born workers can enter the U.S. as direct care professionals; Create a new ElderCare Exchange Visitor category within the J-1 Visa Program; Enact a new “H2Age” Temporary Guest Worker Program; Expand the Use of USMCA Professional Visa
• Challenge 3: Lack of Support for Workers
  • Solutions: Expand the National Apprenticeship Program (NAP) to include funding for programs that provide training and support to foreign-born workers; Allow direct care professionals to receive training and testing in their native language; Review outdated English proficiency testing requirements; Authorize and encourage training and testing centers to open international facilities to train and certify professionals seeking to immigrate to the U.S.; Expand programs that support and reduce barriers for foreign-born workers seeking to enter the nursing and allied health care workforce; Establish a center of excellence to help employers support foreign-born workers; Request Office of Refugee Resettlement report outlining culturally concordant best practices for organizations employing recently immigrated foreign-born workers in the aging services sector.
• Challenge 4: Lack of Worker Protections
  • Solutions: Direct the Secretary of Labor to provide Congress with a report detailing the state of the immigrant workforce in the aging services sector; Require all employers hiring foreign-born workers to provide relevant employment documents in English and the worker’s primary language; Require international nurse recruitment agencies to provide relevant information to immigrant nurses about the proposed employer; Provide a report to Congress outlining tools and strategies that HCBS providers can use to recruit and retain the foreign-born workforce. Develop legal pathways for foreign-born caregivers participating in the “Gray Market” economy.