Care Homes Hiring More Foreigners

Foreign nannies long have helped to raise American children. Now immigrants are moving into another aspect of caregiving in increasing numbers: tending to the needs of nursing-home residents. And they are winning a larger share of the highly skilled positions, according to a report to be released today by AARP.

The ability to recruit nurses and other trained health workers overseas, the report said, will be a crucial factor in determining whether millions of baby boomers receive high-quality care in their old age.

“The quality of the long term care received by older persons in developed countries will depend increasingly on the quality of engagement with the less developed countries that are likely to supply more of the workers in the future,” the report said.

In particular, by the time those in the baby boom generation reach their mid-70s and 80s, many nurses and aides may come from China, say industry officials, who regard that country as the new recruitment frontier.

The U.S. trend is part of a worldwide phenomenon in which rich countries with aging populations are turning to immigrant caregivers from the developing world, the report found.

Immigrants long have occupied such low-paying U.S. jobs as farm work, and in recent years they have moved into higher-paying construction jobs. But in big cities they now account for more than one-fourth of the nurses and aides in nursing homes, the report said.

Across the country, the number of immigrant nurses providing long-term care has nearly quadrupled since 1990, while the number of nursing aides has more than doubled, the report found. About 64,000 immigrant nurses were working in nursing homes in 2003, along with 145,000 foreign-born aides.

Hiring immigrant workers has helped nursing homes meet staffing needs, but has also raised concerns about language and cultural barriers between caregivers and elderly patients, some of whom suffer from debilitating illnesses such as dementia.

“We’re talking about the care of the oldest and frailest people in the country, so it does raise questions about training and cultural exchange,” said Elizabeth Clemmer, associate director of the AARP Public Policy Institute, which sponsored the study.

About 12% of foreign-trained nurses report problems understanding English-speaking patients and staff, according to research cited in the report. This is the case despite requirements that nurses be proficient in English.

Foreign nurses are seen as less likely to speak up if a doctor’s orders seem confusing or wrong. “American-trained nurses are more assertive,” said Louise Maus of the American Assn. of Homes and Services for the Aging, which represents nonprofit facilities. “The ones who are coming [from abroad] are well-trained clinically, but there still can be questions as to cultural differences.”

There also are concerns in the immigrants’ home countries. Many of these nations have weak healthcare systems, even greater shortages of skilled professionals and a higher burden of illness among their citizens. The draining off of trained workers by developed countries that can offer higher pay and better working conditions is exacerbating all those problems, experts say.

In the United States, the demand for foreign caregivers is the result of historically low unemployment, said Ron Hoppe, a founder of WorldWide HealthStaff Associates, a North Carolina firm that recruits healthcare professionals from overseas.

Low-skilled jobs are particularly hard to fill. “Burger King is paying as much or more as the local nursing home is able to pay nursing assistants,” Hoppe said. “Employers just have a very, very difficult time.”

Nursing-home work is demanding, and calls for overnight and weekend shifts. Many Americans see it as low-status employment. “These kinds of jobs are considered unattractive,” AARP’s Clemmer said. “If the United States were to treat these jobs differently, there would be less of a need for immigration.”

Foreign nurses come here under an immigration program for skilled workers. There is no equivalent program for less-skilled workers, such as nurse’s aides, although President Bush’s proposed guest worker plan would change that. The number of illegal immigrants working as caregivers in nursing homes is thought to be relatively low, because states require employees who deal with patients to undergo background checks.

For years, the Philippines has provided many of the foreign nurses in U.S. hospitals and nursing homes. But now the industry is looking at China as a prime source for immigrant workers, Maus and Hoppe said.

As China joined the world economy, its universities launched English-language programs for skilled workers, including healthcare professionals, Hoppe said. Leading Chinese hospitals have international units that cater to Western residents, with English-speaking medical staffs.

“The Chinese have learned from the Philippine experience, and they realize they have a valuable resource that is in demand in many Western countries: educated people,” Hoppe said. His company expects to place its first Chinese nurses in U.S. facilities next year.

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Long-term caregivers

Immigrants account for a growing share of the workforce in America’s nursing homes. How that increase has occurred:

Nurses

*--* Year Number % of total nurses 1980 9,900 6% 1990 17,700 7 2000 51,000 13 2003 64,000 16

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Nurses’ aides

*--* Year Number % of total aides 1980 34,000 6% 1990 71,000 9 2000 115,000 14 2003 145,000 16

*--*

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Top regions of origin for foreign caregivers in 2000:

Nurses

Asia 40%

Central America, Mexico 26%

Europe 13%

Africa 11%

Other 10%

Nurses’ aides

Central America, Mexico 46%

Asia 19%

Europe 11%

Africa11%

Other 13%

Source: AARP Public Policy Institute