There’s a storm brewing in senior housing: Between wage pressures and work environments that can take an emotional and physical toll, senior living providers are scrambling to recruit and retain staff. A dwindling labor force, though, has many looking to immigration reform as senior living’s saving grace.
The stark conditions in the sector have prompted lawmakers and industry leaders to consider alternate labor outlets, with the CEO of the nation’s largest independent living provider among the most vocal advocates of an immigrant workforce. Kai Hsiao, President and CEO of Holiday Retirement, suggests that directly recruiting overseas workers is inevitable.
But whether or not that comes to pass, a clear consensus within the industry is that there soon won’t be enough caregivers for the United States’ aging population—and immigrant workers could be a key part of the solution.
From Bad to Worse
The ratio of caregivers to those over age 80 is expected to drop drastically over the next 20 years, according to a recent AARP study. Whereas that ratio was seven-to-one in 2010, it’s likely to plummet to four-to-one by 2030, a decrease that could propel the industry into crisis mode.
To close that gap by 2030, at least 2.5 million more workers will be needed to provide long-term care to an increasingly older population in the U.S., according to a study conducted earlier this year by the University of California-San Francisco. The study’s authors predict this demand for workers will remain steady, even if there’s a significant shift from institutional to home-based care.
“With this aging population, we need to have a workforce available,” said U.S. Rep. Jim Renacci (R-OH) earlier this month at the National Investment Center for Seniors Housing & Care (NIC) National Conference in the Washington, D.C. area. “How are we going to take care of the aging population moving forward when we know we don’t have growth in that younger workforce?”
That’s a question that the senior housing industry must confront to address this impending labor shortage. One potential solution rapidly gaining traction is the possibility of changing the nation’s immigration laws, which were last updated in 2005 with the REAL ID Act, a measure that has primarily affected asylum seekers.
“This industry should be cheerleaders for immigration reform—it’s a caregiver opportunity,” U.S. Rep. John Delaney (D-MD) said at the conference. But exactly what immigration reform would look like—and when it would take place—is up in the air.
In November 2014, President Barack Obama issued an executive order that granted temporary legal status to parents of U.S. citizens and those brought here as children who aren’t living in the U.S. legally. A coalition of 26 states filed a lawsuit challenging Obama’s action on the grounds that it was unconstitutional and would saddle states with increased law enforcement, health care and education costs.
A Texas judge granted a temporary injunction against the executive order this past February. Since then, there’s been limited movement in terms of immigration reform, and Congress remains at odds over how to best tackle it.
Holiday’s International Play
In April 2013, those in the senior housing space voiced their ideas about improving immigration laws to attract labor. Medicalodges COO Fred Benjamin testified in a congressional subcommittee on behalf of the American Health Care Association, touting the potential of a proposed W visa program to admit low-skilled foreign workers. AHCA, the nation’s largest association of long-term care providers, has also urged increased access to temporary work visas for nurses and physical therapists.
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Though there’s been little talk as of late in regard to exactly how comprehensive reform might be shaped to benefit the industry, most aren’t shying away from tapping an immigrant labor pool. Holiday Retirement, a national operator of more than 300 independent living communities, is actively forging partnerships outside of the United States to prepare for imminent labor shortages ahead.
“We have to think openly and realize that we may have to import people to get things done,” Hsiao tells Senior Housing News. “There are plenty of folks in other countries who would be willing to do so and to have the opportunity to live here in the States.”
Specifically, Holiday affiliates itself with a community that opened in China and has avid interest in select nursing and training facilities in Costa Rica, though it doesn’t yet have formal partnerships there, Hsiao says.
“There’s definitely potential labor to look at out there, and we certainly have our eyes open to it,” he says. “Are we actively [recruiting] today? The answer is no. Are we going to start doing that? The answer is yes.”
Increasingly advanced technology has allowed for more streamlined care and the more efficient deployment of staff, but Hsiao says technology is hardly a reliable solution.
“Technology will allow us to be a little more efficient so that we can look at alternative ways of how we use our labor pool, but you’re never going to be able to replace having a live person there who can see and assess things,” he says.
What Can Be Done Today
While immigration reform might seem a long way off, there are steps providers can immediately take to improve hiring practices, says Mark Woodka, president of OnShift, a software company focusing on human capital management solutions in long-term care and senior living. In the short-run, creating an employee-centric workplace environment is crucial, he says.
“Most aren’t hiring the right people to begin with, and too many have a ‘fill-the-gap’ mentality,” Woodka says. “That’s the reality of it. They need to get better at communicating and recognizing employees.”
Overall, in situations such as this, the labor climate might get worse before the industry gets actively vocal about immigration reform, says Cecil Rinker, a senior consultant with Old Pueblo Placement Services, a senior living consulting and placement firm based in Tucson, Arizona.
Rinker points to the agriculture industry, where immigrants form the backbone of the workforce and leaders are now advocating for reform to ensure economic stability. If the senior housing sector follows suit before shortages reach emergency status, he says labor supply issues won’t be as pressing a concern.
“Sometimes things don’t change until it gets really bad, and this is going to get really bad. It’s just a matter of when,” Rinker tells SHN. “If we get proactive now, we can save ourselves a lot of grief.”
Written by Kourtney Liepelt