With the aging baby boom population, there is a growing shortage of potential caregivers in the US. One part of the solution to the caregiving shortage could be increasing the number of immigrants in the US, which reached nearly 48 million in 2022. As many immigrants come to the US seeking better economic opportunities, they are often willing to take on labor-intensive direct care roles, such as those of certified nursing assistants (CNAs) in nursing homes.

CNAs play a pivotal role in nursing home resident care and in their absence, residents endure longer wait times for essential services such as bathing, dressing, and toileting. However, due to the challenges of this work, there is a high turnover rate for these roles.

A recent study in Health Affairs led by postdoctoral research fellow, Hankyung Jun, and co-authored by Professor of Health Care Policy, David Grabowski, examined the prevalence and effect of the growing immigrant workforce in nursing home care. They examined national and state-level trends in the percentage of immigrant CNAs working in nursing homes using data from 2000 to 2021 and used pre-pandemic data to determine how a higher share of immigrant workers affected patient care.

The study found that the share of foreign-born CNAs increased from 13.6 percent in the 2000s to 19.1 percent during the pandemic, which can be explained by a decrease in the number of native-born staff. The share varied substantially across states, from less than 1 percent in West Virginia to more than 70 percent in Hawaii. Additionally, nursing homes in regions with a higher share of immigrant CNAs were associated with better patient care; high percentages of immigrant CNAs resulted in more direct care staff hours per resident day and better overall nursing home quality performance.

Such findings advocate for immigration policy reform that would retain and attract foreign-born workers. Drawing inspiration from past initiatives for foreign-trained registered nurses, the authors suggest prioritizing visa issuance in states facing the most severe staffing challenges. Additionally, they advocate for providing pathways to permanent residency for direct care workers. The authors also make the point that these immigration reforms should be paired with other measures to improve pay and working conditions in these positions.

With the US’s aging population projected to surge, amending policy to allow immigrant workers to enter and stay in the US is a central concern. The study’s findings support the pressing need for comprehensive immigration reforms, acknowledging the growing demand for long-term care services and the essential role of immigrant workers in filling critical labor gaps.