Even as a shortage of U.S. workers who care for the elderly and disabled grows, proposed limits on immigration may worsen the situation, researchers say.
As of 2017, immigrants accounted for more than 18% of U.S. healthcare workers, researchers report in the journal Health Affairs. In nursing homes, nearly one in four workers who directly care for patients are immigrants, as are nearly one in three housekeeping and maintenance workers.
“We rely heavily on immigrants to care for the elderly and disabled, particularly in their everyday care,” said the study’s lead author, Dr. Leah Zallman, an assistant professor of medicine at the Harvard Medical School and director of research for the Institute for Community Health at the Cambridge Health Alliance. “Therefore, any policies trying to reduce immigration are likely to make what is already a workforce shortage worse.”
Currently, Zallman said, “there are not enough people willing to do these jobs and we are going to need a lot more people in the future. This is an industry that needs people round the clock. And immigrants disproportionately take the night shifts. They are really filling the gaps.”
The issue becomes increasingly important as the elderly population grows, with experts predicting it will double by 2050, Zallman and her colleagues noted.
To take a closer look at the role of immigrants in healthcare, the researchers turned to the Annual Social and Economic Supplement of the 2018 Current Population Survey, a nationally representative survey conducted by the Census Bureau and the Bureau of Labor Statistics, which collected data on 180,084 people in March of 2017.
Compared to U.S born healthcare workers immigrant workers were older; 51.6% were older than 44, compared to 43.8% of U.S. born healthcare workers. Immigrant workers were also more likely to have completed a four year college degree and more likely to be Hispanic, non-Hispanic Asian or non-Hispanic Black.
Nearly one in three immigrant healthcare workers – 30.4% – were employed in long term care settings, compared to 22% of U.S. born workers. Overall, 1 million workers, or 23.5%, in the formal and non-formal long term care sector were immigrants.
Among unauthorized immigrant healthcare workers, 43.2% were employed in these types of settings.
Immigrant workers were also more likely than those born in the U.S. to be employed with home health agencies (13.1% versus 7.9%) – and in the non-formal sector (6.8% versus 4.6%).
The new study is “very important and timely,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins School of Public Health. “I hope it will encourage us to be more thoughtful about political decisions as they have an impact on all of us. The current proposal to restrict immigration to more skilled or professional applicants runs directly counter to the need for this category of worker.”
Those proposals are coming at a time when the U.S. birthrate is falling, Wu said. “Looking 10 years ahead, there’s a huge projected shortfall in people who do hands-on face-to-face caregiving for older and disabled adults.”
That’s exactly what’s already happening in Japan, said Dr. John W. Rowe, a professor in the Mailman School of Public Health at Columbia University. “Immigration has been limited by Japan’s preference for an ethnically homogeneous society,” Rowe said in an email. “With the rapid aging of the Japanese, who have the longest life expectancy in the world, this shrinking population has yielded major shortages in the elder care workforce and in manufacturing.”
In response, “the Japanese government in December 2018 relaxed the long-standing immigration restriction and established a program of five-year visas for several hundred thousand workers, Rowe said. “This was seen as a major social change in traditionally xenophobic Japan.”