STUDY: Foreign-Born Direct-Care Workers Highlighted in New Research

A study published in the November issue of Health Affairs examines the substantial portion of health care workers in the United States — physicians, nurses, and direct-care workers — who are foreign-educated and/or foreign-born, and offers policy solutions to address the projected shortage of direct-care workers.

In the study, Policy Solutions to Address the Foreign-Educated and Foreign-Born Health Care Workforce in the United States, researchers from the RAND Corporation and Yale School of Public Health report that between 2001 and 2009 the number of foreign-born direct-care workers in the U.S. nearly doubled from 375,820 to 676,200 due to the demands of the growing aging population.

In the U.S., 20.9 percent of direct-care workers are foreign-born. Of these workers, 20 percent are undocumented, the study shows. Mexico, the Philippines, Jamaica, Haiti, and the Dominican Republic are the top five countries of origin for direct-care workers.

The researchers also studied the immigration routes of health care workers, finding that most direct-care workers who enter the country legally do so through family-sponsored visas. There are no employment-sponsored visas for direct-care workers, as there are for nurses and doctors.

Foreign-born direct-care workers are typically U.S. residents with low socioeconomic status, who become direct-care workers once they immigrate to the U.S., the researchers write. These workers are not recruited from other countries for their medical skills like nurses and doctors.

While there is limited data on the geographic distribution of foreign-born direct-care workers, available data indicates that states with a large foreign-born population also have a large foreign-born direct-care workforce, the researchers found.

Policy Strategies

The researchers review policy strategies that have the potential to increase the benefits of health care worker migration and also note the criticisms of these polices.

Given that the need for direct-care workers will outpace the supply, creating a care gap, the authors suggest adopting policies that that will help to facilitate direct-care workers’ entry into the U.S., such as access to a J-1 visa.

However, the researchers caution that criticisms of the J-1 visa option — such as insufficient oversight into the duties of the work required and concerns about wages and room and board fees — would have to be addressed before extending this option to the direct-care workforce. Additionally, allowing direct-care workers to enter the U.S. for a temporary job without a pathway to permanent residency “might raise ethical concerns,” the authors point out.

They also cite a Canadian program that permits immigrants to be live-in caregivers for two years, at which time they can apply for permanent residency. However, the authors say this program has been criticized by policymakers and immigration advocates for being “exploitive and unnecessarily restrictive.” Furthermore, they report that providing cheap in-home labor weakens “the motivation for employers to find alternative, domestic labor solutions,” for example, improving the quality of direct-care jobs.

— by Deane Beebe