Want to Protect the Health of Older Americans? Increase Immigrant Labor

Almost 10% of nursing home residents in the United States died of COVID-19 during the first year of the pandemic, an alarmingly high rate that far exceeds that of elderly Americans overall.

Many families are understandably hesitant to move aging loved ones into group care facilities as the virus continues. But even before the pandemic, most older Americans said they would prefer to age in place, according to AARP, living in their own homes and communities for as long as they can.

Doing so often means relying on regular home health aide visits or other at-home or community-based care — care that is disproportionately provided by immigrant workers. Immigrants are overrepresented in both lower-paid and higher-paid occupations in the health care field. Thirty-eight percent of all home health aides in the U.S. are foreign born, as are 28% of doctors.

Most states have taken advantage of flexibility in the Medicaid program to provide waivers that allow older Americans to receive covered care in their own homes or in local centers. Medicaid spends $95 billion a year on these nonresidential services, more than it spends on institutional long-term care.

The success of such efforts relies upon the availability of caregivers who can assist with the activities of daily living, as well as provide help with chores around the house. But our dysfunctional immigration system has slowed the flow of foreign-born health care workers into the United States, limiting options for aging Americans who wish to stay at home, and adding costs and stresses to families caught in the middle. We need policy solutions to address this problem now.

Family caregiving is a partial solution, and each year an estimated 40 million Americans, mostly women, provide unpaid care to relatives over age 50. Though many caregivers are devoted to this work and may find purpose and connection through it, anyone who has served as a caregiver to an aging mom, dad or grandparent knows family caregiving can take a toll. Almost a quarter of family caregivers report that their own health has deteriorated as the result of caregiving, and more than a third say the situation results in high emotional stress.

By: Tara Watson
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