Immigrant workers may very well provide us with the labor we desperately need to support our aging society. But, writes Robyn Stone, we need to do more than simply fill direct care jobs with “warm bodies” from other countries. Rather, we must provide immigrant workers with the tools they need to succeed.
It’s not just about “warm bodies.”
My colleagues are getting a little tired of hearing me use this refrain every time they ask panicked questions about the workforce crisis in the field of long-term services and supports.
Yes, we will need many more direct care workers in a variety of care settings to provide increasingly complex services and supports to a growing and increasingly frail population of older Americans.
But simply filling our caregiver vacancies with “warm bodies” isn’t going to address our workforce challenges.
We can’t put just anyone in these caregiving roles. Instead, we need to find direct care workers who have the commitment and compassion it takes to succeed in this very important and very demanding occupation. We also need to train and support these workers so they have the skills to do their jobs well — and the desire to make caregiving a career.
Don’t get me wrong. It will take a lot of these well-trained workers to meet the growing demand for long-term services and supports over the next decades. And we need to find these dedicated workers as soon as possible.
So, how do we meet this challenge?
A new research brief from the LeadingAge Center for Applied Research explores the possibility that an expanded immigrant direct care workforce could represent one way to meet our future workforce needs.
A STABLE IMMIGRANT WORKFORCE
With Help from Afar: The Role of Immigrant Home Health Aides in Meeting the Growing Demand for Long-Term Services and Supports relies on the 2007 National Home Health Aide Survey (NHHAS) to present an eye-opening snapshot of immigrant workers who are currently employed by Medicare-certified and Medicaid-certified or state-licensed home health and hospice agencies.
The data paint a surprisingly stable picture of this workforce.
First, these workers aren’t kids just starting out in our field. The majority of them are married females of color who are over age 45.
Prior research demonstrates that these older women, many of whom have already played a nurturing role within their own families, have the potential to be better direct care workers than younger people who do not have these life experiences.
Second, these immigrant workers are relatively well educated. More than half (51.1%) has some college education. In addition, we know anecdotally that some immigrant workers received high levels of education in their countries of origin.
They work in direct care jobs because U.S. licensing regulations keep them from taking the higher skilled jobs for which they are qualified.
Finally, these immigrant workers like their caregiving jobs and they think they’re pretty good at those jobs.
IT’S STILL NOT ABOUT WARM BODIES
Despite these attributes, immigrant home health workers earn less per hour than the average U.S. worker. In addition:
- Almost half of the immigrant home health workers in the NHHAS sample said they experienced communication problems with care recipients due to language issues.
- More than one-fifth (21.8%) felt they had experienced discrimination at work because of their race or ethnicity.
To me, these last 2 findings confirm the validity of my decades-old response to workforce challenges.
Immigrant workers may very well provide us with the labor we desperately need to support our aging society. But we need to do more than simply fill direct care jobs with warm bodies from other countries.
Instead, we need to provide our immigrant workers with the tools they need to succeed. These tools include cultural competency training for these workers, for their colleagues in the field, for the people who run the organizations where they work, and for the individuals who receive the care they provide.
PAVING THE WAY TO CULTURAL RICHNESS
Diversity is already having an impact on every American long-term care setting, even as our nation’s immigration policies remain in flux.
More non-white consumers are choosing to use our services in their homes or move into our residential settings. In addition, we are relying more and more on immigrant workers from around the world to deliver our services and supports.
There’s no doubt that the melding of many cultures creates the potential for a variety of challenges in all care settings. But I prefer to see an equally strong potential to enrich our care settings by inviting people from different cultures to work and live together while appreciating the gifts that all bring to nursing homes, assisted living communities or community-based settings.
Will your care setting remain mired in the problems that diversity can create? Or will it benefit from the richness that multicultural interactions can bring to work environments and care delivery?
This is a choice that every organization can and must make.
CULTURAL COMPETENCE TAKES WORK
Creating a rich culture of diversity doesn’t happen by itself. It’s takes:
- Intensive training of workers and family members alike — and of care recipients, when possible — so they understand each other better and know how to make the most of their interactions.
- Deliberate efforts to create an organizational culture that respects, appreciates and celebrates diversity, rather than viewing diversity as a problem or a challenge.
- Proactive strategies to help immigrant workers succeed, including language and life skills training, adequate pay and benefits, and other supports to help immigrants navigate life in the American workplace.
MELDING POLICY AND PRACTICE
Immigration reform could help us meet the growing needs of our aging society by allowing more immigrant workers to take on direct care jobs in residential and home care settings.
But let’s not stop there.
Providers of long-term services and supports — and the families we serve — must also advocate for public policies and adopt organizational practices that help immigrant direct care workers succeed in the important jobs we ask them to do after they gain admission to the U.S.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.