As long-term care staffing crisis worsens, immigrants can bridge the gaps

When Margarette Nerette arrived in the United States from Haiti, she sought safety and a new start.

The former human rights activist feared for her life in the political turmoil following the military coup that overthrew President Jean-Bertrand Aristide in 1991. Leaving her two small children with her sister in Port-au-Prince, Nerette, then 29, came to Miami a few years later on a three-month visa and never went back. In time, she was granted political asylum.

She eventually studied to become a nursing assistant, passed her certification exam, and got a job in a nursing home. The work was hard and didn’t pay a lot, she said, but “as an immigrant, those are the jobs that are open to you.”

A few years later her family joined her, but her children didn’t want to follow her career path. When she was a teenager, Nerette’s daughter, now 25, would ask, “Mom, why are you doing that?” Nerette said. Her daughter considered the work underpaid and too physical.

After many years, Nerette, now 57, left nursing home work for a job with the Florida local of the labor union SEIU1199, which represents more than 25,000 health workers. As the local’s vice president for long-term care, she is keenly aware of the staffing challenges that have plagued the industry for decades and will worsen as aging baby boomers stretch the limits of long-term care services.

The U.S. is facing a growing crisis of unfilled job openings and high staff turnover that puts the safety of older, frail residents at risk. In a tight labor market where job options are plentiful, long-term care jobs that are poorly paid and physically demanding are a tough sell. Experts say opening pathways for care workers to immigrate would help, but policymakers haven’t moved.

In the decade leading up to 2031, employment in health care support jobs is expected to expand by 1.3 million, a nearly 18% growth rate that outpaces that of every other major occupational group, according to the federal Bureau of Labor Statistics. These direct care workers include nurses of various types, home health aides, and physical therapy and occupational therapy assistants, among others.

Certified nursing assistants, who help people with everyday tasks like bathing, dressing, and eating, make up the largest proportion of workers in nursing homes. In the decade leading up to 2029, nearly 562,000 nursing assistant jobs will need to be filled in the United States, according to a far-reaching report on nursing home quality published last year by the National Academies of Sciences, Engineering, and Medicine.

But as the U.S. population ages, fewer workers will be available to fill those job openings in nursing homes, assisted living facilities, and private homes. While the number of adults 65 and older will nearly double to 94.7 million between 2016 and 2060, the number of working-age adults will grow just 15%, according to an analysis of census data by PHI, a research and advocacy organization for older and disabled people that conducts workforce research.

Immigrants can play a crucial role in filling those gaps, experts say. Already, about 1 in 4 direct care workers are foreign-born, according to a 2018 PHI analysis.

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