President Donald Trump dismisses immigrants from Africa and Haiti as coming from “shithole countries,” and even asked, “Why do we need more Haitians?”
I can answer that question from a long-term care advocate’s perspective. Simply put, the future of our health care system requires more immigrants to fill caregiving roles. Currently, research shows one-fifth of the more than 600,000 nursing assistants working in nursing homes were born outside this country. Most have become naturalized citizens.
And research shows immigrants are an even more prominent part of the home care workforce – comprising fully one-quarter of those providing social support, personal care, and assistance with the activities of daily living for seniors and those with disabilities in homes throughout the United States. As is true in nursing homes, most of these workers choose to become U.S. citizens. As infants and toddlers, my own two nephews, both of whom have disabilities, benefited from home care provided by an immigrant.
To work on the front line of caregiving is demanding work, for which you are marginalized by state Medicaid reimbursement that generally fails to afford living wages.
A study published last year by the University of Washington found that the four top birthplaces for immigrant workers in health care settings included the Caribbean (which includes Haiti) and Africa, or precisely the regions President Trump disparaged. In Boston, a 2003 Boston Globearticle had reported that more than half of Haitian women worked as nursing assistants, accounting for as many as 90 percent of certified nursing assistants in the greater Boston area.
According to the Census Bureau, by 2030 there will be 3 million more Americans 85 and older than there were in 2012. This is a demographic where one commonly has long-term care needs, and has exhausted resources to pay for them. By 2026, the Bureau of Labor Statistics projects the number of home health aides will have risen 47 percent in just a decade’s time.
Where are we expecting to get the workers? Native-born citizens are not lining up for these jobs, nor are they being filled by the Norwegian immigrants President Trump expressed a preference for. A Trump spokesperson stated the president favored “welcoming those who can contribute to our society, grow our economy and assimilate into our great nation.” All of those qualities describe the dedicated caregivers I have met who were born in other countries.
Nationally, Medicaid funding for nursing homes, according to federal government analysis, had a projected 1.6 percent decrease in 2016, while, for 2017, Medicaid funding was projected to rise just .4 percent. In New Hampshire, nursing home residents on Medicaid saw a funding increase averaging only a nickel a day on Jan. 1. It is awfully hard to improve caregiver wages by spreading around a nickel a day. In New Hampshire, as is true in too many other states, to care for the poor risks making you poor too.
Medicaid underfunding has created a crisis in caregiver recruitment and retention, particularly where there is low unemployment. Rather than spend 100 hours training, and passing two criminal background checks, to become a licensed nursing assistant, a New Hampshire resident pursuing a career can find many easier work opportunities with the unemployment rate at 2.7 percent.
As a society we need to place a higher value upon caregiving. But even if we do, especially in an aging state where we lament our exodus of young adults, it is unrealistic to suppose that we will not continue to have a large, and growing, share of caregiving roles filled by immigrants. They should be welcomed, not disparaged.
(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)