How Immigration Policy Affects the Hospice Workforce

Current immigration policies are straining the ability of hospices to grow and retain their workforce amid widespread shortages.

Immigrant workers help fill some of the greatest labor supply needs in hospice and palliative care. But national policies are contributing to a shrinking pool of such workers, putting pressure on providers’ ability to accept patients, according to OpusCare President and CEO Dr. Ismael Roque-Velasco.

“What’s been happening in our country over the past few years with immigration has really had an impact on the healthcare workforce,” Roque-Velasco told Hospice News. “What we’ve seen is that immigration policies don’t help, they undermine access to health care without enough workers to provide care.”

OpusCare offers palliative and palliative care in Florida, Texas and Georgia. Two of those states — Florida and Texas — along with California, are home to nearly half (45%) of the country’s overall immigrant population, according to data from the Pew Research Center.

National immigration policies limit the scope for hospice workforce growth in these states, as well as many others nationwide, Roque-Velasco said.

According to the National Forum on Immigration, foreign-born workers make up 38% of hospice and home care aides, a quarter of health care aides and 28% of all “highly skilled health professionals” such as physicians and nurse practitioners.

Additionally, immigrant workers make up 22% of the nation’s practical nurses and 17% of the entire health care and social services industry, the Migration Policy Institute reported.

With fewer immigrants available to fill these jobs, hospices can be particularly vulnerable.

Immigration policies have a disproportionate impact on hospice employees compared to other health care settings, according to Mollie Gurian, vice president of home and home and community services policy at LeadingAge.

“There’s an extra step and layers to having qualified people, and immigration is a big part of that,” Gurian told Hospice News. “We have heard from hospices that use immigration-specific programs to help with the process of obtaining worker visas that it can be more difficult to hire and train someone who has just arrived in the country. to provide the necessary care at the end of life.

US immigration laws are a complex web of rules. Typically, the federal government bases them on principles that include admitting workers with skills that are “valuable to the American economy” and “promote diversity,” among other things, according to the American Immigration Council.

The duration and eligibility requirements for visa classifications vary, but some allow employers to hire foreign-born workers on a permanent or temporary basis.

The Immigration and Nationality Act (INA) requires annual caps on the number of work visa recipients in various business categories. The law states that the president must consult with Congress each year on setting these thresholds. The annual limit for employment-based permanent immigrants is 140,000, including eligible family members.

Prospective employers can sponsor an individual for a visa, but the US Department of Labor in some cases requires them to first prove a labor market need before even filing a petition.

Immigration processes can take a lot of time and effort. According to Ben Marcantonio, interim president and CEO and chief operating officer of the National Hospice and Palliative Care Organization, this, along with different eligibility levels, can hamper hospices’ ability to recruit and retain this workforce.

“It can take years or even decades to navigate the system to get to the United States on a work permit,” Marcantonio told Hospice News in an email. “While there hasn’t been significant immigration reform in decades, the Trump administration’s policies, put in place during the COVID-19 pandemic, have increased the backlog of people waiting to come to work in the US Our aging population and workforce have only exacerbated this labor shortage.

The Trump administration has tightened immigration restrictions and stepped up deportations. Among other policies, the administration has imposed stricter limits on incoming workers from certain countries like Mexico and India, among others.

In total, the White House implemented more than 470 administrative changes during Trump’s presidency, an “unprecedented” pace compared to previous executive actions, the Migration Policy Institute reported.

Fluctuations in immigration policies create a “self-perpetuating cycle” of pressures on access to labor and patients, Gurian said.

“It’s important to have a national and international pipeline of workers,” Gurian told Hospice News. “We need all the people we can get specifically for aging services in our demographic and make it easier to come to the country by providing them with blanket funding and support when they get here.”

Congress and the Biden administration over the past two years have tried to speed up hiring processes for immigrant workers, including some specific to health care.

In early 2021, the US Citizenship Act died in committee. The bill would have increased the green card limit, eliminated country caps and excluded dependents from the annual maximum on employment-related immigration.

Report language associated with the State Department’s 2023 appropriations bill, recently approved by the U.S. House of Representatives, urged the agency to streamline the visa process as a whole, as well as to take steps to improve the processing of immigration applications for health professionals.

Through “report language,” Congress makes recommendations to federal agencies on how to use their resources. However, agencies are not required to implement these recommendations.

The United States Department of Homeland Security’s Appropriations Bill 2023 contains similar language regarding the United States Citizenship and Immigration Services (USCIS) processing of pending and delayed applications. It also increased USCIS’s budget by $273 million above 2022 levels, but falls short of the agency’s funding request of $230.0 million.

The current immigration environment creates dangerous and detrimental situations for those who want to work in health care in the United States, according to Roque-Velasco. Organized and controlled immigration is needed to help create pathways for personnel change in critical illness and end-of-life care, he added.

“The only thing we’re doing is making a lot of criminals really rich,” Roque-Velasco said. “Some of these immigrants pay thousands of dollars just to cross the border and risk their lives in certain areas. If we had a way to get people into training and education programs with some kind of controlled immigration, to create incentives for an immigration policy that would provide legal avenues for obtaining licenses in different areas , then we could find a great solution to the problems we are facing now.

In the absence of reform, hospices can take steps in their own training and education programs to include immigrant pathways into clinical, caregiving and other support roles, Roque-Velasco said. .

For example, they may offer sponsorship programs for health care aides or home health aides to receive nursing or other clinical training in hopes of advancing their careers in those professions, a he declared. The education process could begin remotely before they enter the United States, he added.

Advocates of the palliative care space have said training and education pathways need to be incorporated into immigration policy.

If the current immigration system isn’t “fixed,” then the nation could see more eligible patients die while waiting for hospice care without enough workers to provide it, according to Marcantonio.

“We need to renew a pathway specifically for those with a health background and training to come to work,” Marcantonio said. “The need for more health workers is more urgent.”

Michael A. Bynum