Immigration Reform May Solve Staggering Senior Care Worker Shortage

Demand for senior care workers is expected to far outpace the pool of those available to fill positions such as home health aides, personal care aides, and nursing assistants, but immigrants are expected to help pick up the slack, according to recent reports.

“Personal care aides and home health aides are projected to be the fastest-growing occupations in the country between 2010 and 2020, increasing by 71% and 69%, respectively,” says a report from the Paraprofessional Healthcare Institute (PHI).

Positions for nursing aides, orderlies and attendants are expected to increase by 20%.


Projected demand for the direct-care workforce calls for an additional 1.6 million new positions, bringing the total to just under 5 million, in the next seven years.

While these kinds of workers are employed in multiple settings, including assisted living communities, skilled nursing facilities, and at home, employment growth is expected to be the highest in home- and community-based care. Aides in these settings tend to earn lower wages and have fewer benefits compared to facility-based settings, and the growth in this sector “demands particular attention,” according to PHI.



This shift is expected to continue throughout upcoming decades, says the PHI fact sheet, but that could pose a problem: Unless job quality in this field is improved, demand for new workers won’t be met.

“Our analysis indicates that demand for direct-care workers…will continue to outpace supply dramatically—unless policymakers and employers work together to make these jobs competitively attractive compared to other occupations,” the report says.

Demand for services is growing faster than the labor pool, says PHI, as the number of women aged 25-54—the main labor pool that supplies direct-care workers—will only increase by about 1% compared to demand for these workers increasing by 48%.

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Immigrants will fill the healthcare worker shortage, suggests a report from the Institute for Women’s Policy Research making a case for reforming the U.S. visa system to increase the pathways to legal status for undocumented immigrants interested in providing long-term care services. Immigrants make up 28% of all in-home healthcare workers, according to the report, and more than 20% of all immigrants employed in the direct-care field are in the country illegally.

The labor shortage problem will only get worse as more seniors and disabled persons need care, says the report, but immigrants could actually solve the shortage of people available to fill these positions.

Senior care trade groups such as the American Health Care Association (AHCA) are supportive of immigration reform that would increase the supply of long-term care workers.

“We have critical staffing needs. There are chronic shortages throughout the nursing home industry,” said Fred Benjamin, chief operating officer of AHCA member Medicalodges, Inc., in written testimony submitted on Thursday before the House Committee in Education and the Workforce on Thursday. “If you are in the business of caring for our nations’ elderly, whether you are for-profit, non-profit, or government managed, it is a daily struggle to find enough dedicated caregivers to care for the people in your charge.”

The job’s difficulty and a general industry-wide inability to increase wages or prices means long-term care is a high turnover industry, according to Benjamin, who says that his company’s turnover rate in lower skilled nursing categories is about 60% annually—”significantly lower than most companies in the industry.”

To increase the supply of labor, Benjamin said in his testimony, special consideration should be given to permitting new entry for immigrants with nursing skills, and the pool of unskilled labor needs to be increased.

“We need a new immigration system that serves the economic needs of the U.S. economy,” he said. “If an American employer is offering a job that American citizens are not willing to take, we ought to welcome into our country a person who will fill that job – especially a job that has the capacity to improve the health and well being of a vulnerable senior, or person with disabilities.”

Written by Alyssa Gerace