Congress is debating whether to impose new restrictions on immigration as the price of a deal to provide new aid to Ukraine and Israel. But some of the biggest victims of this misguided policy will be frail older adults, younger people living with disabilities, and their families. For their sakes, Congress should make immigration easier, not harder, for the nurses and personal care aides who help them.

The US faces a desperate shortage of care workers. Hospitals, nursing homes, assisted living facilities, and home care agencies and families all are competing for a shrinking number of willing workers. And the US is vying with the rest of the rapidly-aging developed world for the same aides and nurses.

Yet, Republicans, encouraged by former president Donald Trump’s incendiary rhetoric about immigrants “poisoning the blood” of America, are demanding harsh new border curbs. And President Biden and many congressional Democrats seem willing to go along.

Walking And Chewing Gum

Trump has it all wrong: These care workers are not poisoning the blood of Americans. They are cleaning up their blood and bandaging their wounds. Congress could curb uncontrolled illegal immigration while opening our doors to those willing and able to do critical work that native-born Americans won’t. It could, for example, make special visa programs more available for nurses and direct care workers.

The research and advocacy group PHI predicts that as the US population ages, the US will need 9.3 million new direct care staff by 2031 to replace existing workers and meet the demand for new ones. Nursing homes alone will need nearly 800,000 new aides just to replace those projected to leave their jobs through this decade.

The government estimates the nation will need 177,000 new registered nurses alone over the same period.

PHI estimates one-third of today’s direct care workers are immigrants. About 19 percent are naturalized citizens and 13 percent are on work visas. And that doesn’t include an unknown number of off-the-books gray market aides, some of whom may be here illegally.

Hard Work, Low Pay

Care workers have among the highest injury rates of any occupation in the US. An estimated 3,000 nursing home aides died from Covid-19 during the pandemic. Many now face increased assaults and other violence. Many live in poverty.

In 2022, the median hourly wage for home care workers was about $14.50, just barely above fast food workers and well below warehouse workers, according to the Bureau of Labor Statistics. About 43 percent of home care workers are part-time, often because they must care for their own children. Thus, their median wage is about $20,600.

Nursing home aides make about $17-an-hour, or about $25,750 annually.

Demand will only grow if the Biden Administration adopts proposed new rules to require nursing homes to hire enough staff to provide a minimum of about 3 hours of daily care for each resident.

Operators insist they cannot find enough workers to meet these standards. Paying them more would help. But the money would have to come from government programs such as Medicaid and Medicare, which pay for nearly all nursing home stays, or out of the pockets of families.

Keep in mind, that $14.50 wage for home care aides tells only part of the story. An agency will charge a client twice that much, or about $30, with the difference used to cover benefits, payroll taxes, training, overhead, and profit.


How can government expand immigration to fill the need for these important workers? To start, it can reform existing programs.

For example, asylum seekers must wait six months or more to get a work permit. A bipartisan bill in Congress aims to reduce that time to 30 days. Why not let people provide needed services while they await adjudication of their asylum request?

A limited number of EB-3 work visas technically are available to nurses and other skilled workers who already are sponsored by US employers. But the government has slowed its processing of the paperwork, leading to big backlogs and a freeze on applications. A recent Washington Post article (paywall) described a nurse who had to wait 14 months for a one-hour visa interview before she could get a hospital job. Politics aside, this pathway to work should be fixed.

The H-1B program makes work visas available for people in certain high-need specialty occupations. But more than 60 percent go to tech workers. In 2021, only 5,800 health care workers got these permits, and nearly half were physicians and surgeons.

Another bill would give government more flexibility in dispensing visas, allowing it to shift unused permits to nurses and other health care workers.

There are plenty of simple ways to make it easier for essential foreign workers to come to the US. Unfortunately, all are swimming against a powerful anti-immigrant tide in Washington. And, sadly, frail older adults, younger people with disabilities, and their families will be the victims of this short-sighted politics.