Medical Update Blog

Wall Street Journal article from Thursday Jan 23, 2018

Nursing Home Administrators and Assisted Living Managers  Read This Prediction! Then find one of Medical Update's Millennial courses or Peter Drucker's marketing ideas for the future or a new course on Turnover. CEU's earned while you plan for your surviving your staffing retention.

How Immigration Could Affect Grandma's Care

By

Gerald F. Seib

• ▲

• BiographyGerald F. Seib

• @GeraldFSeib

• Jerry.Seib@wsj.com

  Updated Jan. 22, 2018 11:48 a.m. ET

  104 COMMENTS

  The emotional struggle over immigration policies, which has helped shutter the government, represents not just a debate but a collision of social trends, American values and basic economic realities.

  Consider its potential impact on a growing piece of American life, one woven through a growing number of families: the need for long-term care for the elderly.

  We are a nation with an increasing population of elderly parents and grandparents needing care their families can’t offer directly. Immigrants play a big and growing part of providing that care. The question quietly running beneath the surface is whether the changes now being debated in immigration laws and policies will upset all that.

• Live Coverage: Government Shutdown

• Kinship Emerges as Immigration Flashpoint

• John Kelly Forges Role as Immigration Hard-Liner

• Border Wall Recedes as Issue in Immigration Fight

  .

  First, some facts: America is getting older. Some 10,000 baby boomers reach the age of 65 each day. By 2050, a fifth of the U.S. population will be age 65 or older, the Congressional Budget Office projects, up from 12% in 2000 and 8% in 1950.

  Moreover, this large contingent of Americans isn’t simply retiring; it will live longer after retiring. The number of people aged 85 or older will make up 4% of the population by 2050, 10 times more than a century earlier. As Americans get older and live longer, they will require more long-term care: The Department of Health and Human Services has estimated that 52% of Americans turning 65 today will develop a disability requiring long-term care services.

  So who provides, and who will provide, the help the elderly need getting in and out of bed, bathing, dressing, cooking, taking medication and simply coping? A growing number of immigrants provide that care.

  A recent study by PHI, an organization that works with the long-term and home care industry, found that one in four “direct-care” workers is an immigrant. That universe includes home health aides, personal-care aides and nursing assistants.

  That means some 860,000 immigrants fill these jobs in the industry. Add in workers who provide such services independently and the number rises to 1 million.

  Moreover, the share of these workers who are immigrants has been rising, to 24% in 2015 from 20% in 2005. In some of the nation’s biggest states—New York, California, New Jersey and Florida—40% or more of these workers are immigrants. Among these immigrant workers nationwide, the PHI study found, 56% are citizens by naturalization, and 44% aren’t citizens.

Related Video

A big question in Washington: What is going to happen next for the Dreamers? The legal reprieve for these young undocumented immigrants starts to run out in March. WSJ's Gerald F. Seib explains the likely scenarios. Photo: Getty

.

There already is a shortage of such workers, and that problem may become more acute as demand grows. “The demand for direct-care workers is just going to explode in coming decades as more people turn 65,” said Robert Espinoza, vice president of policy at PHI and author of the workforce study. “The rate of disability and chronic conditions is increasing…We will need more people to fill that workforce gap, and immigrants are part of that solution.”

Perhaps not surprisingly, many of these care workers come from countries that are in the crosshairs of the immigration debate. The largest shares come from Mexico, the Philippines, Jamaica, Haiti and the Dominican Republic.

So how might the changes in immigration policies now being debated affect this workforce? The goal of many immigration reformers is to reduce legal immigration, not merely to cut off the flow of illegal immigrants. Ending a controversial visa lottery system would reduce the number of immigrants from some of the countries that currently provide workers, as would closing off so-called “chain migration” in which family members of current immigrants are allowed in.

And failure to provide a path to legal status for “Dreamers”—immigrants who were brought here illegally as children but have since moved into schools and jobs—could compel some of them to depart from the country and the workforce.

A reduction in the immigrant workforce might drive up wages as providers scramble for help, perhaps drawing in native-born Americans who aren’t currently attracted to relatively low-paying care jobs. That, in turn, would drive up the cost of care. Already, as The Wall Street Journal reported last week, insurance companies are declining to provide long-term care insurance as costs outstrip forecasts.

All that has experts worrying. “Immigrants make up a vital part of the nation’s health-care workforce, holding hard-to-fill jobs such as nursing care for the frail, elderly and disabled,” said Clifton J. Porter II, senior vice president of government relations for the American Health Care Association, an organization of long-term care providers. In a statement, he added: “Many have lived and worked in the United States for years and deserve a chance to continue their productive lives here for the good of the U.S. economy and our aging population…Forcing dedicated, qualified people from other countries to leave will be a blow to many, including those who rely on their care.”

Corrections & Amplifications
Some 10,000 baby boomers reach the age of 65 each day. An earlier version of this article incorrectly stated that some 10,000 baby boomers reach the age of 65 each year. (Jan. 22, 2018)

Write to Gerald F. Seib at jerry.seib@wsj.com

 

By

Gerald F. Seib

• ▲

• BiographyGerald F. Seib

• @GeraldFSeib

• Jerry.Seib@wsj.com

  Updated Jan. 22, 2018 11:48 a.m. ET

  104 COMMENTS

  The emotional struggle over immigration policies, which has helped shutter the government, represents not just a debate but a collision of social trends, American values and basic economic realities.

  Consider its potential impact on a growing piece of American life, one woven through a growing number of families: the need for long-term care for the elderly.

  We are a nation with an increasing population of elderly parents and grandparents needing care their families can’t offer directly. Immigrants play a big and growing part of providing that care. The question quietly running beneath the surface is whether the changes now being debated in immigration laws and policies will upset all that.

• Live Coverage: Government Shutdown

• Kinship Emerges as Immigration Flashpoint

• John Kelly Forges Role as Immigration Hard-Liner

• Border Wall Recedes as Issue in Immigration Fight

  .

  First, some facts: America is getting older. Some 10,000 baby boomers reach the age of 65 each day. By 2050, a fifth of the U.S. population will be age 65 or older, the Congressional Budget Office projects, up from 12% in 2000 and 8% in 1950.

  Moreover, this large contingent of Americans isn’t simply retiring; it will live longer after retiring. The number of people aged 85 or older will make up 4% of the population by 2050, 10 times more than a century earlier. As Americans get older and live longer, they will require more long-term care: The Department of Health and Human Services has estimated that 52% of Americans turning 65 today will develop a disability requiring long-term care services.

  So who provides, and who will provide, the help the elderly need getting in and out of bed, bathing, dressing, cooking, taking medication and simply coping? A growing number of immigrants provide that care.

  A recent study by PHI, an organization that works with the long-term and home care industry, found that one in four “direct-care” workers is an immigrant. That universe includes home health aides, personal-care aides and nursing assistants.

  That means some 860,000 immigrants fill these jobs in the industry. Add in workers who provide such services independently and the number rises to 1 million.

  Moreover, the share of these workers who are immigrants has been rising, to 24% in 2015 from 20% in 2005. In some of the nation’s biggest states—New York, California, New Jersey and Florida—40% or more of these workers are immigrants. Among these immigrant workers nationwide, the PHI study found, 56% are citizens by naturalization, and 44% aren’t citizens.

Related Video

A big question in Washington: What is going to happen next for the Dreamers? The legal reprieve for these young undocumented immigrants starts to run out in March. WSJ's Gerald F. Seib explains the likely scenarios. Photo: Getty

.

There already is a shortage of such workers, and that problem may become more acute as demand grows. “The demand for direct-care workers is just going to explode in coming decades as more people turn 65,” said Robert Espinoza, vice president of policy at PHI and author of the workforce study. “The rate of disability and chronic conditions is increasing…We will need more people to fill that workforce gap, and immigrants are part of that solution.”

Perhaps not surprisingly, many of these care workers come from countries that are in the crosshairs of the immigration debate. The largest shares come from Mexico, the Philippines, Jamaica, Haiti and the Dominican Republic.

So how might the changes in immigration policies now being debated affect this workforce? The goal of many immigration reformers is to reduce legal immigration, not merely to cut off the flow of illegal immigrants. Ending a controversial visa lottery system would reduce the number of immigrants from some of the countries that currently provide workers, as would closing off so-called “chain migration” in which family members of current immigrants are allowed in.

And failure to provide a path to legal status for “Dreamers”—immigrants who were brought here illegally as children but have since moved into schools and jobs—could compel some of them to depart from the country and the workforce.

A reduction in the immigrant workforce might drive up wages as providers scramble for help, perhaps drawing in native-born Americans who aren’t currently attracted to relatively low-paying care jobs. That, in turn, would drive up the cost of care. Already, as The Wall Street Journal reported last week, insurance companies are declining to provide long-term care insurance as costs outstrip forecasts.

All that has experts worrying. “Immigrants make up a vital part of the nation’s health-care workforce, holding hard-to-fill jobs such as nursing care for the frail, elderly and disabled,” said Clifton J. Porter II, senior vice president of government relations for the American Health Care Association, an organization of long-term care providers. In a statement, he added: “Many have lived and worked in the United States for years and deserve a chance to continue their productive lives here for the good of the U.S. economy and our aging population…Forcing dedicated, qualified people from other countries to leave will be a blow to many, including those who rely on their care.”

Corrections & Amplifications
Some 10,000 baby boomers reach the age of 65 each day. An earlier version of this article incorrectly stated that some 10,000 baby boomers reach the age of 65 each year. (Jan. 22, 2018)

Write to Gerald F. Seib at jerry.seib@wsj.com