Fellowship Senior Living is looking for a few good home care workers — 75 to be exact. Since the pandemic began, the New Jersey-based senior living nonprofit has seen its roster of home caregivers shrink from 200 people to 125, as workers left due to child care problems and fears over the coronavirus.

Elizabeth Fandel, senior vice president of the firm’s home- and community-based services unit, finds herself in a dilemma common to many home care providers today: The demand for home care is far outpacing the supply of available workers.

“I don’t even advertise. I can barely keep up with the inquiries and requests,” Fandel told McKnight’s Home Care Daily Pulse. “People seek out our services because of our reputation and I’m telling them I can barely staff cases that I currently have.”  

An aging nation, a shrinking labor force, a global pandemic and tougher immigration policies have all collided to create a mammoth caregiver crisis. According to the Bureau of Labor Statistics, the United States will need to fill 600,000 direct care jobs this year and every year for the foreseeable future.

Like a lot of low-wage industries, immigrants have become the backbone of home care. PHI National, which tracks long term care, estimates this group makes up about 30% of the nation’s 2.3 million home care jobs. The percentage is even higher at some companies. Fandel estimated that nearly 90% of the home care staff at Fellowship Senior Living are immigrants. 

Smaller numbers

But in the last five years, tougher immigration policies under the Trump administration and continuing restrictions due to the COVID-19 pandemic under President Joe Biden have drastically reduced the number of immigrants coming into the U.S. to fill jobs. In a recent podcast, David Bier, associate director of immigration studies at the Cato Institute, estimated those policies prevented approximately 2 million immigrants from coming into the U.S. for work since 2017. 

“We’re still seeing tight visa policies even in a time of a truly unprecedented labor shortage,” Bier said. “We’re at a place where every component of our immigration system is so paralyzed with backlogs that future immigrants applying face such a great hurdle compared to the great hurdles before the pandemic.”  

As a result, immigration reform has become the rallying cry for the long-term care industry as it looks to fill an estimated 7 million caregiver jobs over the next decade.

“When you look at the workforce shortage, you cannot look at it without considering immigration,” Home Care Association of America CEO Vicki Hoak told McKnight’s Home Care Daily Pulse. 

Increasing supply

HCAOA, along with aging service nonprofit LeadingAge, say the most promising option for bringing immigrants to the U.S. for direct care jobs is through a new visa category for direct care workers. They say the  nation’s most common visa categories don’t adequately address the direct care worker crisis. For instance, the H1B visa focuses on highly skilled workers, while the H1A and H12B categories cover agricultural and seasonal workers respectively. 

HCAOA lobbyist Patrick Cooney told McKnight’s Home Care Daily Pulse the organization favors a new visa category specifically for direct care workers that would allow providers to sponsor a worker who is either living outside the U.S now, working here under another visa category or is coming to the U.S. as a refugee.  

“We have reached out to the Department of Homeland Security and said, with recent developments with Ukraine, we are an industry that has available jobs for temporary refugees, Cooney said.

Three years ago, LeadingAge recommended a new visa category in its International Migration of Aging and Geriatric Workers in Response to the Needs of Elders plan, better known as IMAGINE. The proposed visa, tentatively titled H2Age, would allow migrants to work temporarily as guest workers in direct care and could include a path to citizenship. Ruth Katz, senior vice president of public policy for LeadingAge, told McKnight’s Home Care Daily Pulse the visa might also apply to undocumented caregivers currently working in the U.S. for cash as part of the so-called gray economy

“When you have a high-quality caregiver and you help them find a path to documentation to stay in this country, it is possible that they may say they like this work,” Katz explained. “Maybe they could work in a nursing home, a memory care unit or in assisted living or a home health agency. They could have a regular salary and benefits. That would be great.”

Immigration reform is also beginning to grab the attention of both parties on Capitol Hill. Last month, Senate Judiciary Chairman Sen. Richard Durbin (D-IL) called on colleagues to address immigration reform before the midterm elections in an effort to ease the worker shortage that is contributing to the spike in inflation. Last March, Rep. Lloyd Smucker (R-PA) introduced the Essential Workers for Economic Advancement Act which would provide up to 85,000 visas annually for immigrants in essential jobs that are not currently being filled by American workers. 

While all of these efforts hold promise, it could still be months or even years before any legislation addressing immigration reform advances to the White House for passage. That simply isn’t soon enough for some home care providers, such as Fellowship Senior Living, who need staff now.

“We don’t have the luxury of waiting for the long-term solution of immigration,” lamented Fandel.

Editor’s note: In terms of labor problems, there has never been a time like today. In this ongoing series, McKnight’s Home Care will explore the various facets of the workforce shortage, how home care is responding to it and the innovation that is propelling the field forward with new and sometimes unconventional solutions. Read a new installment each month until the end of the year.