Ted Hesson reports for Politico:
“One of the biggest future crises in U.S. health care is about to collide with the hottest political issue of the Trump era: immigration.
As the largest generation in American history – the baby boom – heads into retirement and old age, most of those aging boomers will need someone to help take care of them for at least some portion of their twilight years. Demand for home health aides is expected to outstrip the growth for nearly all other jobs in coming decades, with the Bureau of Labor Statistics projecting the number of home health aide positions will increase 38 percent by 2024. That puts it among the top five fastest-growing U.S. occupations.
So who’s going to do it? The question is one of the biggest uncertainties looming over not only the health care, but the labor market overall. Health policy experts have been raising the alarm for some time: No matter how you look at it, the United States is going to need a lot more caretakers and home health aides. And we’re going to need them soon.
Right now, immigrant workers fill a significant share of the formal and informal caretaker workforce. In health care overall, immigrants (both legal and undocumented) make up roughly 17 percent of workers, on par with their representation in the broader labor force. When it comes to home health care, however, that figure is considerably higher: about 24 percent, according to the nonpartisan Migration Policy Institute.
There’s a reason foreign-born workers take so many home health jobs: they’re low-paid, low-skilled and increasingly plentiful. Barriers to entry are low; a high school degree is not usually a requirement and neither is previous work experience. Much caretaking comes from family members, of course. But with families getting smaller, more Americans living alone and chronic diseases growing more complex, a lot of that care in the future will need to come from professionals.
The job also isn’t easy. Home health aides can be tasked with bathing and feeding clients, cleaning the person’s house, driving them to doctor’s appointments and even helping with trips to the bathroom. It’s one of those occupations that comes to mind “when people say that immigrants do the jobs that Americans don’t want to do,” notes Patricia Cortés, an assistant professor of markets, public policy and law at Boston University’s Questrom School of Business.
Bianca Frogner, an associate professor at the University of Washington School of Medicine, said the low barriers to entry make it a natural fit for immigrants who are new to the U.S. workforce. “It’s easy to get into and they’re in high demand,” she said.
This is where politics comes in: The current move to curb immigration threatens to cut off the main supply of potential new workers to care for aging Americans.
Illegal immigration isn’t the issue. The home health care immigrant workforce is vastly legal. The Pew Research Center found that just 4 percent of nursing, psychiatric and home health aides are in the country without legal status, based on an average from 2005 to 2014. Some home health aide positions require certification, which may drive down the ranks of undocumented immigrants in those positions.
The question for the health care system is what will happen to the flow of legal immigrants. Trump and immigration hawks in Congress have endorsed a bill that would cut legal immigration in half over a decade. The bill would also refocus the immigration system to prize better-educated and more highly skilled immigrants — potentially choking off the supply of lower-skilled workers who are the likeliest candidates to fill the home health aide jobs of the future.
In theory, native-born Americans could take some of those jobs, but there are reasons to assume they won’t.
. . . .
The strange thing about home health care work is that immigrants don’t appear to drive down wages, as happens in some other fields. If anything, they tend to push wages higher. Naturalized citizens who worked as nursing, psychiatric and home health aides earned 22 percent more than their U.S.-born counterparts, according to 2015 American Community Survey data analyzed by the University of Washington Center for Health Workforce Studies.
Lindsay Lowell of Georgetown University’s Institute for the Study of International Migration, said the wage phenomenon and the fact that the work is a natural fit for new immigrants make it a no-brainer: Immigrants are our best caretaking option for the foreseeable future. “You put all that together,” Lowell said, “and I think it’s a good thing.”
Read the complete article at the link.
In a sane system led by competent individuals with the common good in mind, this would be a “no brainer.” Legalize the existing undocumented workforce to provide some “upward and sideways” mobility to staff these jobs in the short run, while expanding legal immigration opportunities for these positions in the future. More legal immigration would also contribute to the tax coffers and add needed workers to the Social Security contribution base. Moreover, it would conserve considerable Government funds now being squandered on counterproductive immigration enforcement and unnecessary detention, as well as relieving the pressure on the overwhelmed Immigration Courts. That, in turn, would free up enforcement resources to concentrate on removing serious criminals and shutting down international smuggling cartels.
However, when policy is driven by bias, prejudice, and irrationality, as with guys like Trump, Sessions, Bannon, Miller, and the “RAISE Act Bunch” the results are a lose – lose.