Findings from an analysis of the 2007 National Home Health Aide Survey are featured in a brief entitled, With Help from Afar: The Role of Immigrant Home Health Aides in Meeting the Growing Demand for Long-Term Services and Supports.
The majority of immigrant home health workers participating in the 2007 National Home Health Aide Survey (NHHAS) were married women of color who were over age 45, had some college education, but earned less per hour than the average U.S. worker.
These are the latest findings to emerge from an ongoing analysis of the NHHAS by the LeadingAge Center for Applied Research and Social and Scientific Systems, Inc.
The findings are featured a new brief entitled With Help from Afar: The Role of Immigrant Home Health Aides in Meeting the Growing Demand for Long-Term Services and Supports.
In addition to presenting a profile of immigrant home health workers, With Help from Afar also explores:
- The potential role that immigrant direct care workers could play in filling vacancies in home health and other direct care jobs.
- How current and proposed U.S. immigration policy affects immigrant workers and American families.
- The policy and practice implications of an expanded immigrant direct care workforce.
The NHHAS is a national probability survey of home health aides conducted as a supplement to the National Home and Hospice Care Survey. It is the first national survey of home health aides ever to be conducted in the U.S.
Key Characteristics
NHHAS data suggest that the majority of immigrant home health workers are:
- Older: More than half (57.4%) were 45 years and older.
- Non-white: Less than a fifth (16.8%) of immigrant home health workers identified themselves as “White.”
- Educated: More than half (51.1%) of immigrant home health workers had some college education, while 38.9% were high school graduates.
- Struggling financially: Almost three-quarters of immigrant home health workers had household incomes of less than $50,000 per year — 37.3% had household incomes between $10,000 and $29,999 and 31.8% had household incomes between $30,000 and $49,999.
Assimilation: Language and Discrimination
Language and discrimination remain major barriers to assimilation among immigrant home health workers, according to the NHHAS data. More than half of these workers (56.3%) reported that English was their primary language. Among those who spoke more than one language:
- 45.5% reported that they always or sometimes used a language other than English on the job.
- 46.2% reported that they had experienced communication problems with care recipients due to language issues.
More than one-fifth (21.8%) of immigrant home health aides perceived they had experienced discrimination and language-related communication barriers at work because of their race or ethnicity.
On the Job
Most immigrant home health aides found their job through prior work as a home health aide or nursing assistant, through newspaper or other media, and/or through a family member or friend.
Once they were on the job:
- Immigrant home health workers were paid for an average of 32.6 hours of work per week.
- Three-quarters (73%) reported that their initial training was a “combination of hands-on training and classroom study.”
- Almost two-thirds reported that their agencies offered health insurance coverage. More than half (54.1%) of those respondents participated in this coverage.
- Almost three-quarters (70%) were very confident in their ability to do the job.
Policy and Practice Implications
With Help from Afar maintains that America’s aging society is spurring a major expansion of long-term care at a time when the demand for direct care workers is outpacing supply dramatically.
“The sheer number of workers needed to care for the future population of older adults makes it imperative that new sources of workers be considered,” write the authors. “An expanded immigrant direct long-term care labor pool presents one solution to meeting the future needs of our society.”
Authors Natasha Bryant, Robyn Stone and Janet P. Sutton cite research on a variety of immigration policy reforms that may help to increase the future labor pool of direct care workers in long-term care.
In addition, they explore a number of practical steps that employers in the long-term care sector could take to enhance the role that immigrant home health workers play in the delivery of long-term services and supports.
These actions include:
- Actively recruiting immigrant home health workers. Research suggests that immigrants find jobs through word-of-mouth from families, friends and communities.
- Creating culturally diverse work environments. This can be accomplished by strengthening training programs and workplace policies to improve worker assimilation, accommodate language and cultural differences, and value employee diversity.
- Creating training programs that are sensitive to the needs of immigrant direct care workers. Cultural competence—the ability to interact effectively with people of different cultures and socioeconomic backgrounds—should be required training for all direct care workers.
- Taking a unified approach to competency development, including cultural competence. The Centers for Medicare and Medicaid Services National Direct Service Workforce Resource Center identified core competencies including “cultural competence” and other specializations across sectors. These competencies may serve as a foundation for policy and practice guidance
About the Study Sample
A total of 241 immigrants (a weighted sample of 23,027) responded to the NHHAS and represent 14.5% of all home health workers in the study sample. The study sample includes home health aide immigrant workers employed by Medicare- and/or Medicaid-certified or state-licensed home health and hospice agencies.
Workers in the sample are likely to be legal immigrants because their employment is publicly financed and requires specific reporting standards.