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Can home health companies continue without hiring more migrant workers? Many say no


America is getting older. A fifth of the country will be over 65 when the next decade starts, and a recent government study says most of those people are going to need long-term care, either at their own homes or in nursing homes. There's a big shortage of long-term care workers, with about 900,000 openings. Companies that provide long-term care say they need to be allowed to hire more migrants. Kathy Ritchie with member station KJZZ in Phoenix reports.

KATHY RITCHIE, BYLINE: Long-term care is tough work.

DAVID VOEPEL: A lot of folks in the United States don't necessarily want that kind of job.

RITCHIE: David Voepel is the CEO of the Arizona Health Care Association, which represents skilled nursing facilities.

VOEPEL: Huge kudos to the folks that can do it. I know I couldn't do it. And for them, we need more of them.

RITCHIE: Because taking care of another human being, well, it can be physically and emotionally exhausting for low pay with few benefits like paid sick leave.

VOEPEL: It's similar to what we find in the agricultural sector, you know, where we don't have a lot of folks in the U.S. - U.S. born folks that want to take those jobs, which is fine, because we have - we need the immigrant side of things to help fill those in.

RITCHIE: In January, arrests for illegally crossing the southwestern border hit an all-time high at nearly a quarter-million. Many of those people are requesting asylum in the U.S., fleeing violence or repression in their home countries. And the Arizona Health Care Association is recruiting some into caregiving jobs.

CHINGENEYE NYILABAGENI: So when we're done with this, we're going to do hand washing today. Anyone watch the hand-washing video from last night?

RITCHIE: At Tempe Post Acute, a skilled nursing facility in Tempe, Ariz., 22-year-old Chingeneye Nyilabageni is training to become a certified nursing assistant along with her two older sisters. She's a refugee and can legally work in the U.S. She arrived here about seven months ago from Uganda.

NYILABAGENI: My goal is to graduate. I help these people with disabilities. And after I go into medicine, on to become a nurse.

RITCHIE: There are a lot of migrants who, like Nyilabageni, would like training for health care jobs, but only a relative handful are legally allowed to work. Some refugees are, but not the vast majority of people who enter the U.S. illegally. Robert Espinoza would like to see that change. He's the CEO of the Washington, D.C., based National Skills Coalition, a bipartisan organization that advocates for skills training for America's workforce.

ROBERT ESPINOZA: And so I think offering a pathway to citizenship for undocumented workers who are already here and I think would welcome the opportunity to support a sector that needs them would be one major intervention.

RITCHIE: In 2023, Espinoza authored a study about the role of immigrants in the caregiving workforce. He estimated that, at the time, the long-term care sector would need to fill 9.3 million job openings by 2031.

ESPINOZA: Another opportunity is for the U.S. Department of State to create a special caregiver visa for direct care workers.

RITCHIE: Ideas like Espinoza's are unlikely to gain traction in an election year, especially when border crossings are at an all-time high and expanding America's border wall with Mexico is a popular idea.

VOEPEL: We're trying to break the wall down.

RITCHIE: David Voepel, head of the Arizona Health Care Association.

VOEPEL: We want people to come in here and to help because they're the ones that have the know how to do it because they are very family oriented.

RITCHIE: In 2030, all of America's baby boomer generation will be 65 or older. If the country can't start filling hundreds of thousands of long-term care jobs, the responsibility for elder care will fall on family members. Research shows that has a big impact on people's ability to earn a living, especially women. For NPR News, I'm Kathy Ritchie in Phoenix.


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Kathy Ritchie