Immigrants As Solution?

Staffing Crisis

AARP released a good article on the industry’s labor shortage. Staff turnover was already “astronomically high,” says Ashvin Gandhi, a health economist at UCLA and coauthor of a national study that found the median annual turnover rate for nearly all U.S. nursing homes in 2017 and 2018 was 94 percent. Decades of chronic understaffing has meant unpredictable schedules, regular overtime and little support for training and professional development.

The nation’s nursing home industry has shed roughly 235,000 jobs since March 2020, according to an analysis of U.S. Bureau of Labor Statistics data. Workers say their exits are driven by dangerous working conditions, poor pay and benefits, limited opportunities for advancement, burnout and the respect deficit for their profession.

Wages Increase, Quality Declines

The New Hampshire Health Care Association released data showing New Hampshire nursing homes on average paid about 20% more in labor costs per day from 2019 to 2021. Not enough to retain safe staffing levels.

As staff flee the industry, the health of nursing home residents has deteriorated, according to an analysis of federal data by the National Consumer Voice for Quality Long-Term Care. Nursing home jobs saw the largest wage increases in 2020 and 2021, according to a study in JAMA Health Forum. But the ongoing shortage of workers needed to fill more than 400,000 long-term care positions may come from elsewhere.

The nation’s two largest provider organizations have been lobbying for immigration reform over the last several months, embracing the idea of helping resettle Afghan refugees and those fleeing war in Ukraine.

Immigration

A larger pool of immigrants in the U.S. would improve nursing homes’ ability to hire for frontline positions. The U.S. immigration policy hasn’t kept up with labor trends especially in the healthcare industry. Wage discrepancy among foreign caregivers is a problem.

“The presence of a robust immigrant workforce is really an important component of thinking about the decision of Americans to age in place or stay in the community,” said economist Tara Watson. 

A 2020 paper linked a five-year increase in local immigration to multiple quality improvements in nearby nursing homes, including a 4% decrease in falls, a 33% reduction in use of restraints and a 20% drop in pressure injuries.

“It seems reasonable to believe that a more open immigration policy is a less costly way to increase staffing compared to other policy tools, like minimum staffing standards and policies aimed to increase nurse wages.”