Stephen M. Golant, Professor Emeritus at the University of Florida, has published a research paper titled, "Women Caring for Our Aging in Place Seniors Will Lose Out because of U.S. Immigration Policies." 1
Admitting that a direct line from immigration to staffing may be less than obvious, Professor Golant opens his 2,000-word essay with:
Women are the pre-eminent family caregivers of our older population. They are the go-to persons when an elder parent or husband needs help performing their household activities, self-care, and mobility tasks. Their assistance makes it possible for three out of four frail older persons to stay put in their current dwellings and communities rather than transitioning to an assisted living or a nursing home facility (Freedman & Spillman, 2014).
However, caregiving has become ever more demanding and complex (Reinhard, Feinberg, Choula, & Houser, 2015). Aging in place older persons now suffer from difficult-to-manage chronic health problems, physical disabilities and memory losses. Not all family members have the abilities, time, or even the inclination to help. Others feel physically and emotionally overwhelmed and burnt out.
Consequently, even the most well-intentioned women often concede that they cannot do it alone. They seek out paid help to ensure that their loved ones benefit from needed long-term services and supports (Freedman & Spillman, 2014). Although the connection may not appear obvious, this country’s immigration policies will make it more challenging for older persons and their families to hire these workers.
The entire document is available from ResearchGate.net
Quoting from Professor Golant's abstract:
Most older people experiencing chronic health problems, physical disabilities, and memory losses are still able to age in place in their own homes. However, they often need help from others to enjoy healthy, active, and independent lives. They turn mostly to family members, mainly women and usually their daughters, daughters-in-law or wives. But caring for frail elders has become more demanding and complex, and these family members often feel physically and emotionally overwhelmed and burnt out.
They concede that they cannot do it alone. Others find it more difficult to hold full- or even part-time jobs. Hiring home (direct) care workers to assist their loved ones can be an effective solution to ease their caregiving responsibilities. However, these personal care aides, home health aides, and nursing assistants are already in short supply.
Moreover, going forward, the aging of the baby boomer population will result in an even greater demand for their services even as these jobs are often unattractive to American-born workers and turnover is high. This country's immigration policies will make it even more difficult for women caring for older persons to hire these workers. Over 25 percent of home care workers are low-skilled immigrants or foreign-born. However, the Trump administration's policies reduce the number of immigrants entering the U.S. and specifically choke off the various pathways that enable low-skilled persons to be hirable in the home care sector. Female caregivers seeking relief from their caregiving responsibilities will lose out unless we remove these immigration barriers.
Finally, Golant draws the following conclusion:
Immigration policies that contribute to the future shortage of low-skilled home care workers do not bode well for the women who care for our frail old. We should not jeopardize their opportunities to hire paid help. We should not make it harder for them to get well-deserved relief from their caregiving responsibilities – their health is at stake. We should not make it more difficult for them to remain in the workforce, thereby crippling their income and career opportunities. They deserve more enlightened public policies.
These policies include giving undocumented workers a pathway to legal residency and creating a permanent employment visa program targeting low-skilled home care workers. However, these solutions would be highly controversial and met with stiff legislative opposition. In the meantime, eliminating the aforementioned immigration barriers constructed by the Trump administration would be a start.
Almost simultaneously, CNBC's Bob Woods gathered and published the numbers on the caregiver shortage. He appears to have drawn the same conclusion, underscoring his argument with data from NAHC President Bill Dombi.2
Woods cites data from the Federal Bureau of Labor Statistics, noting that their numbers combine home health aides and non-medical personal care workers.
"As of 2016, they numbered 2,927,600. In 2018 their median pay was $11.12 per hour. Overall employment of in-home aides is projected to grow 41 percent from 2016 to 2026 — translating to 7.8 million job openings — a much faster clip than the average 7 percent for all occupations. Nearly 60 percent work full time; turnover rates are around 50 percent.
"According to the Paraprofessional Healthcare Institute, a New York-based organization that studies the home health industry nationwide, 46 percent of this workforce is ages 45 to 64, 87 percent are women, 60 percent are people of color, and 29 percent are immigrants, though how many are undocumented is unknown."
Based on these statistics, Woods' conclusion echoes the one Golant came to. "Immigration issues erupting throughout the U.S. culture and economy have spread to the home health-care industry, where 1 in 4 aides hails from another country, according to Paraprofessional Healthcare Institute. As public anti-immigrant sentiments fester and proposed federal policies to severely restrict immigration gain traction — especially among low-skilled immigrants — workforce shortages in the industry could be further exacerbated."
He added his opinion on one of the easier paths government might take as well. "One solution would be to initiate a guest-worker visa program for in-home care aides, similar to the current H-2A program for the agriculture industry that allows foreign nationals to enter the U.S. legally to fill temporary or seasonal agricultural jobs."
Woods quoted PHI vice president of policy, Robert Espinoza, "It is impossible to imagine that the sector would survive without immigrants." Then spoke with national home health and home care leaders who see immigration reform as the only solution to their own staffing crisis.
"We, along with our industry, would work to create an overall increase in immigration levels," said Jeff Huber, CEO of Omaha-based Home Instead Senior Care, which oversees 612 in-home care franchises in all 50 states and employs nearly 65,000 caregivers.
"We certainly would encourage good policies at the national level to make sure that in this marketplace we watch excess demand for workers and, if there is clearly wage inflation, we would advocate for sound solutions," said Bruce Greenstein, chief strategy and innovation officer at LHC Group in Lafayette, Louisiana, which operates 780 locations in 36 states with more than 25,800 clinical and non-medical employees.
Finally, Woods's CNBC piece got around to technology, citing forecasts that the global smart home health-care market will reach $30 billion by 2023, up from $4.5 billion in 2017, according to Research & Markets. Health-related exhibitors at this year's CES in Las Vegas were up 25 percent over 2018, he learned.
Woods sees growing adoption of smart speakers and other voice-activated devices from Google, Amazon, Apple, Microsoft, and Samsung to provide medication and doctor appointment reminders, activate TVs, appliances and therapeutic equipment, and communicate with remote physicians and nurses. He predicts smart watches and other wearables gaining more acceptance to monitor vital signs in real time and transmit data to practitioners. He ranges from current technologies such as telemedicine and future, robot-like gadgets that will serve as companions and dispense medications.
In his 2017 book "Who Will Care for Us: Long-Term Care and the Long-Term Workforce" MIT Sloan School of Management professor Paul Osterman summed up both Golant's and Woods' conclusions. "Technology can improve the quality of home care. It can help make aides more effective and improve communications. Yet tech won't replace aides anytime soon. It's not going to resolve the current shortage issue."
1 Golant, Stephen. (2019). Women Caring for Our Aging in Place Seniors Will Lose Out because of U.S. Immigration Policies. Journal of Aging & Social Policy. 1-8. 10.1080/08959420.2019.1603535. Click here for full report
2 Woods, Bob. (2019). America’s $103 billion home health-care system is in crisis as worker shortage worsens
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