Care For America's Elderly And Disabled People Relies On Immigrant Labor.

Leah Zallman,Karen E Finnegan,Sharon Touw,David U Himmelstein,Steffie Woolhandler

doi:10.1377/hlthaff.2018.05514

Abstract

As the US wrestles with immigration policy and caring for an aging population, data on immigrants' role as health care and long-term care workers can inform both debates. Previous studies have examined immigrants' role as health care and direct care workers (nursing, home health, and personal care aides) but not that of immigrants hired by private households or nonmedical facilities such as senior housing to assist elderly and disabled people or unauthorized immigrants' role in providing these services. Using nationally representative data, we found that in 2017 immigrants accounted for 18.2percent of health care workers and 23.5percent of formal and nonformal long-term care sector workers. More than one-quarter (27.5percent) of direct care workers and 30.3percent of nursing home housekeeping and maintenance workers were immigrants. Although legal noncitizen immigrants accounted for 5.2percent of the US population, they made up 9.0percent of direct care workers. Naturalized citizens, 6.8percent of the US population, accounted for 13.9percent of direct care workers. In light of the current and projected shortage of health care and direct care workers, our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans.

Highlights

As the US wrestles with immigration policy and caring for an aging population, data on immigrants’ role as health care and long-term care workers can inform both debates
Health Care Workers The 3,296,560 immigrant health care workers we identified accounted for 18.2 percent of all health care workers in 2017, somewhat larger than immigrants’ 15.5 percent share of the US population
Direct Care Workers In 2017, 27.5 percent of direct care workers were immigrants, including 31.1 percent of direct care workers employed in home health agencies, 24.2 percent of those employed in nursing homes, and 25.7 percent of those in the nonformal sector

Summary

Introduction

As the US wrestles with immigration policy and caring for an aging population, data on immigrants’ role as health care and long-term care workers can inform both debates. We calculated the numbers and characteristics of health care workers among US-born people and immigrants, including three mutually exclusive immigrant populations: naturalized citizens, legal noncitizens, and unauthorized immigrants.

Results

Conclusion