by Katie Smith Sloan, President and CEO, LeadingAge
By 2030, the United States will need 2.5 million caregivers working in the field of long-term services and supports (LTSS) to keep up with the growing needs of our rapidly aging population. There are simply not enough American-born workers to meet this need due to stalled labor force participation, historically low unemployment, low birthrates, early retirement and a host of other factors. We need, therefore, to explore creative strategies to address a caregiver shortage that is already reaching crisis proportions.
LeadingAge proposes a multi-faceted, targeted set of policy recommendations aimed at engaging foreign-born workers to help meet this growing need: IMAGINE – International Migration of Aging and Geriatric Workers in Response to the Needs of Elders. This is intended to build on the valued role that foreign-born workers already play in LTSS. In fact, more than one-quarter of the current nursing home and home care workforce are people born in other countries.
IMAGINE’s key proposals include:
- Enact an “H2Age” temporary guest workers program for certified nurse aides (CNA) and home care aides.
- Expand the EB-3 visa program to allow more foreign-born direct care workers to enter the United States.
- Modify the EB-3 visa to increase the number of visas available specifically to address LTSS needs.
- Modify the R-1 visa program to provide religious visas to temporary workers in faith-based organizations.
- Enact “Carer Pairer,” a new authority to the J-1 visa program (known as the au-pair program) to include aging services workers in additional to childcare workers.
- Amend the North American Free Trade Agreement (NAFTA) to include aging services workers.
- Increase the number of refugees permitted to enter the U.S. and take steps necessary to employ these refugees in the LTSS sector.
Under all these proposals, employers would be required to demonstrate that they have tried and failed to hire American-born workers. In addition, they would commit to:
- Pay a living wage
- Provide comprehensive benefits to full time caregivers
- Meet the training needs of immigrant caregivers around language and cultural competency
- Help address housing and transportation for immigrant caregivers
- Help cover immigration and travel expenses for immigrant caregivers, and
- Support and employ the family members of caregivers to keep families intact.
At the present time, aging services providers have limited legal avenues to hire workers born in other countries. Most existing authorities have strict numerical quotas or scope restrictions, such as childcare only or guest workers specifically for agriculture. The IMAGINE proposals largely builds on existing programs that have proven to be successful by expanding their authority to explicitly include LTSS, a path that we believe will be more palatable in a highly charged political environment around immigration.
The United States has not created the kind of managed migration frameworks that other countries increasingly use to address the increasing demand for LTSS workers. Some countries have created permanent channels and special visas for LTSS workers. These organized programs allow the host country to facilitate recruitment, govern worker training and protect the rights of LTSS users and workers. In Israel, for example, private agencies recruit foreign-born workers and train them while they are still in their country of origin. Once in Israel, they must register with the Israeli government, which permits them to work in the caregiving sector for up to five years, after which time they must leave the country. Israel has bi-lateral agreements with both Sri Lanka and Nepal to fill the gap. Japan has had a similar agreement with Indonesia and recently added Vietnam and the Philippines. Japan’s agreement includes language training. Since COVID-19, Canada, UK and other countries have followed with a similar set of agreements – some with a path to citizenship and some for a limited number of years.
Based on research conducted by the Global Ageing Network and LeadingAge in 2018, we know that foreign-born LTSS workers tend to be older than native-born LTSS workers. They are also more likely to: work full-time, earn lower wages, hold positive attitudes about their supervisors, be satisfied with workplace morale, have a strong work ethic, have higher educational levels and more advanced qualifications than normally required for the work they perform. They also tend to have informal caregiving experience. In addition, they often come from countries that revere their elders, a significant added bonus to employing foreign born workers in the United States.
Our current workforce crisis will be with us for years to come unless we adopt creative approaches including expanding the pool of potential professional caregivers by tapping those who wish to come to the United States from other countries. LeadingAge is calling on Congress and the Administration to adopt IMAGINE – either in whole or in part – as a critical step to fill the gap. Simply put, the number of U.S. workers in declining – and not just in LTSS. Therefore, there simply aren’t enough American– born people to meet our future LTSS workforce needs. Let’s work together to advance IMAGINE – International Migration of Aging and Geriatric Workers in Response to the Needs of Elders.
