Brendan Williams is the president and CEO of the New Hampshire Health Care Association.
The Paraprofessional Health Institute has projected that from 2018 to 2028 there will be 8.2 million job openings nationally for those providing direct care to seniors and disabilities. Much of this will be due to workers moving out of direct care, a churn exacerbated by the COVID-19 pandemic and the so-called “Great Resignation” of job changes.
But who will fill these jobs? New Hampshire already has the nation’s sixth-worst staffing shortage for nursing home care in an overheated job market where all health care providers, including hospitals, are competing for an inadequate number of licensed health care workers.
Nationally, 31% of home care workers are immigrants, as are 22% of nursing assistants in nursing homes. It is projected that there will be nearly a million new workers needed in the home care workforce alone between 2020 and 2030, more than any other occupation in the United States (cooks will be a distant second).
All the photo-ops and TV commercials at our southern border, and the political theater of relocating undocumented immigrants from border states to other locales, obscure the fact that we need more immigration, not less. We need a pathway to citizenship for those, for example, fleeing a Venezuelan dictatorship only to be tricked onto planes to Martha’s Vineyard.
In part due to the COVID-19 pandemic, the Census Bureau found we had a decades-low number of new lawful immigrants between 2020 and 2021. This fact gets lost in the furor over undocumented immigration, which resulted in U.S. Customs and Border Protection turning away, or apprehending, the most people since 2000.
We can all agree that our borders need to be secure, and I understand the frustration of border communities and states. Yet as the U.S. Chamber of Commerce has written, “Fewer immigrants coming to the U.S. means that critical sources of talent for American businesses are drying up, contributing to the significant workforce problems companies are currently facing.” Our system now is so bottlenecked that I have members who can’t get work visas for desperately needed legal immigrants.
It is disappointing that in our hyperpolarized political environment we cannot build any consensus in Congress as to how to address immigration. No less a conservative than Ronald Reagan signed the Immigration Reform and Control Act of 1986, which allowed undocumented immigrants to seek legal status, and around 3 million did.
Indeed, in his final speech as president, Reagan extolled immigration, saying that “[t]hanks to each wave of new arrivals to this land of opportunity, we’re a nation forever young, forever bursting with energy and new ideas” and warning that “[i]f we ever closed the door to new Americans, our leadership in the world would soon be lost.”
On Wednesday, November 9, this year’s election will be behind us, along with all the attack ads and political posturing about who is toughest on border security. It may be futile to wish this, but I wish for the benefit of our economy in general, and an aging population in particular, that we use the limited window before 2024 attack ads and political posturing to reach some consensus about admitting new citizens in numbers sufficient to keep us the great nation President Reagan believed in.
Any immigration reforms may not provide an immediate fix for New Hampshire’s health care workforce, as we still struggle with housing for existing residents, a problem Governor Sununu’s $100 million InvestNH Housing Fund will help address. But it would give us hope for the future.