I recently returned from my last visit to the retirement community where my dad lived from 2005 until he died in December. Set amid woods and ponds, with birds, deer, rabbits, and the occasional coyote, it’s peaceful, even beautiful in a low-key, Ohio kind of way. The facility itself, cottages and apartments plus a “care center” for the frailest residents, is comfortable but not ostentatious.
That’s all fine, but it’s not the physical surroundings I value most; it’s the staff. From the high school students who wait tables in the dining room to the nurses and aides in the care center to the management, everyone is efficient, friendly, warm, and present. The more I learn about elder care, the more certain I become that it’s all about staffing. Everything else is secondary.
I’ve been thinking about this amid the onslaught of immigrant-hating rhetoric and actions that have made news in recent months. In the part of Ohio where my dad lived, most elder care workers are US-born white or African American. But in many parts of the country, immigrants are a backbone of this workforce. The nursing home on my street in DC, for example, employs many nurse aides from Africa, the Caribbean, and Latin America. Without them, the Baptist-run home, which serves poorer residents on Medicaid, would have to close its doors.
Nationwide, a quarter of in-home caregivers and a fifth of nursing home caregivers were born outside the United States. This raises urgent questions. Within a few years, my entire generation – all 73 million of us boomers – will have reached retirement age. Many of us will live into our eighties or nineties and will need care. Already, there’s a severe shortage of people to do this low-paid, arduous work. If we choke off the flow of immigrants, as many politicians are demanding to do, who’s going to take care of us all?
Families and caregivers under stress
Last fall the New York Times ran a series titled Dying Broke: The Financial Drain of Long-Term Care. It lays out a dismal scenario in which families scramble for care and old people watch their life savings disappear. The New York Times spoke with Gay Glenn of Topeka, Kansas:
It was costing us $8,000 [a month] out of pocket to have people come into my mom’s house to help her, and that was only eight hours a day. I’m watching her savings just dwindle. And then she fell. ... She was in rehab for the maximum number of days that Medicare will cover and couldn’t return home. ... In one year, she had to pay $65,000 for her care at the nursing home and spend down an additional $37,000 to be able to be eligible for Medicaid.
Once someone qualifies for Medicaid, they may go on a waiting list for an aide. Natasha Lazartes of Brooklyn, New York, told the newspaper:
[My grandmother] is 97, diagnosed with moderate dementia, and is considered high risk to be left home alone. We had been applying for Medicaid long-term care to receive a home health aide since early November 2021. She finally got a home health aide in January 2022.
Since then, Lazartes said,
It’s been a nightmare. ... She was left without an aide on many random days with a late-notice telephone call or text message from the aide needing the day off and the agencies not able to find a replacement in time. I have changed agencies multiple times ... It is emotionally and physically draining.
While families are stretched thin, caregivers are exhausted and underpaid. The work, which includes feeding, bathing, and toileting adults, and dealing with the challenging behavior of those with dementia, is grueling. While home care agencies charge families an average of $30 an hour, the median pay for aides is about $14 an hour. Many aides earn so little that they qualify for Medicaid or food stamps. Most are women, many with children of their own to care for as well. A sick child who needs to stay home from school may mean that the aide cannot go into work that day.
As a result, the elder care industry faces high turnover and labor shortages. Long-term care facilities, particularly those that accept Medicaid, struggle to find enough nurses and aides to meet federal and state standards for adequate care. It’s only going to get worse. The need for care workers is expected to increase by 22 percent over the next decade as all of us boomers hit old age. The country will need at least 684,000 caregivers to join the workforce each year. To come anywhere close to that, we will need a robust supply of workers from abroad.
Detention camps and razor wire
So why, then, are so many Republican politicians, and some Democrats, trying to run immigrants out of the country and sharply curtail the flow of new entrants? There are threats of detention camps, of deporting people by the millions, of a militarized border. Republican Governor Greg Abbott of Texas installed razor wire along his state’s border with Mexico and placed lethal spiked buoys in the Rio Grande. He says the only reason Texas doesn’t shoot border crossers is that the Biden administration would charge state officials with murder. Trump, meanwhile, spews Nazi rhetoric about immigrants “poisoning the blood of our country.” His base cheers.
Many people who don’t support such viciousness nonetheless insist that immigrants must come in legally. Certainly, that would be best. I have no doubt it’s what most immigrants want: safe, legal entry, rather than the life-threatening journey many now endure; ability to work, earn, and pay taxes; a path to permanent residency and citizenship. But the legal immigration system barely functions. The Washington Post recently described “a broken immigration system untouched by Congress for 33 years ... Getting a coveted pass to enter the United States means waiting in backlogs for years in a neglected bureaucracy of overlapping, resource-starved federal agencies.”
Four bipartisan immigration reform bills have been negotiated in Congress over the past two decades. Each has gone down to defeat in the face of hard-right opposition. In the most recent bill, introduced just this month, congressional Democrats caved and gave Republicans everything they demanded: a harsh border crackdown without any path to citizenship, even for the Dreamers, undocumented youth brought to the US as children. Determined to prolong chaos at the border so that Trump can run on the issue in November, Republicans trashed the very bill they said they wanted.
The right to move
While I was visiting my dad, a young Latina woman, barely out of her teens, stopped by his cottage to change the bed linens. It was her first day on the job, she spoke almost no English, and she was visibly frightened. She relaxed as I rolled out my imperfect Spanish to welcome her and show her where Dad kept his sheets. When I saw her several weeks later, she seemed more confident, and said she was being tutored in English by a resident volunteer.
As she gains seniority in housekeeping she may eventually train for a better-paying position, such as nurse aide in the facility’s care center. My dad’s previous housekeeper did just that. If the young worker stays in the United States and has children here, these US-born, US-educated, English-speaking citizens will bring their youthful energy and skills to our workforce.
The US labor pool is shrinking as the population ages. We need more people of working age to fill gaps up and down the occupational ladder. It’s not only elder care that depends on immigrants; other sectors such as medicine, science and technology, agriculture, and construction do as well. My dad was hospitalized for a few days, and all but one of the doctors who treated him appeared to be foreign-born. I’m grateful they were there. Many US-trained physicians don’t want to work in small community hospitals. Over 180 rural hospitals have closed since 2005, and 600 more are at risk, due in no small part to staffing shortages.
Many Americans see immigration as a zero-sum game in which foreigners come to take our wealth, leaving less for those who – according to this narrative – were “here first.” I don’t agree. I see people coming to this country to work and produce, creating more wealth for all of us. These new residents also buy goods and services, circulating cash through the US economy. Towns across the US heartland are losing population as younger residents leave to seek opportunity elsewhere. In some of these places an influx of immigrants has saved the local economy – providing workers for local industry, buying goods from local businesses, and opening new businesses that employ local residents.
The bottom line for me, though, is that people have a right to move, to seek safety and economic security for themselves and their families. I would do the same if my family’s safety or livelihood were threatened. Yes, immigrants should come in legally, but for this to be possible, immigration systems have to function in an efficient, fair, and predictable way. If enough of us demand that government officials negotiate in good faith to find a solution, maybe they’ll finally act. There’s no time to lose.
All very logical arguments and explanations BUT our lawmakers don’t look at logic And what they are doing in Texas is murder I truly don’t understand all the hatred people have
Wonderful blog. Immigrants enrich our workforce and our lives. You offer so many good points to use in letters to the editor and among friends. Thank You!