The United States is on the brink of a crisis in elder care. Reports of an aging population have not been exaggerated – it is no longer the case that a relatively small population of older adults can be supported physically and financially by a much larger population of working adults. Thanks to both the Baby Boom and lifespan-enhancing advances in medicine, these groups are now more similar in size. 

Where does that leave older adults today – especially those who struggle with ADLs, or activities of daily living? 

Many older adults are cared for in nursing homes. These facilities are exorbitantly expensive (the average yearly price for a private room in a nursing home in Connecticut exceeds $200,000, according to CareScout) and often understaffed.

“You’d think that with that amount of money, staying in a nursing home should be like staying in a five-star hotel, but no,” says Delia Furtado, professor of economics.

Furtado is interested in how an unexpected variable – immigration — may impact the quality of care that nursing home residents receive. 

“I’ve been working on immigration my entire career — over 20 years now,” says Furtado. Her previous research has explored the assimilation process of immigrants and their impacts on the native population via their work in childcare and housekeeping. 

Furtado’s recently published research in the Journal of Human Resources found that when more people immigrate to a certain geographic area, it leads to better care outcomes for nursing home residents in that area. 

State of the Field

A 2022 report from the National Academies of Sciences concluded that “the way in which the US finances, delivers, and regulates nursing home care is ineffective, inefficient, inequitable, fragmented, and unsustainable,” according to Furtado. And when nursing homes are poorly managed or understaffed, it can lead to disastrous outcomes for residents, like fatal falls. 

“If nothing changes, either we’re going to have to spend a lot more money on long-term care, or decrease the quality of care provided,” says Furtado. But “An additional policy lever is to use immigration policy, at least to temporarily address these concerns.” 

Furtado’s research tracked the impacts of immigration on nursing home statistics, including falls, pressure ulcers (bedsores), and the use of restraints. 

When nursing homes are understaffed, workers have less time to monitor and assist each resident. This can increase the risk of falls and pressure ulcers among residents, says Furtado. Well-staffed nursing homes can often calm agitated residents by having a nurse or aide soothe them through conversation, whereas understaffed facilities may resort to restraints to manage distress, she explains. 

Furtado’s research found that the arrival of 1,000 immigrants to a local area leads to a 4% decrease in falls, a 33% decrease in the use of restraints, and a 20% decrease in pressure ulcers. 

“This seems to be caused by immigrant-induced increases in the number of workers in nursing homes — mostly foreign-born workers, but also native-born,” Furtado says.   

Why would the number of native-born workers in nursing homes increase (rather than decrease) in response to immigrant inflows to a local area? According to Furtado, “Many immigrants provide informal, under-the-table care for the elderly in their own homes. When such jobs become less available, native-born workers, who can more easily obtain the credentials required for nursing home employment, are more likely to accept nursing home jobs.”  

This research resonates in this political moment, says Furtado, when immigration enforcement efforts have reached unprecedented levels of visibility, force, and funding. Within the last year, Immigrations & Customs Enforcement (ICE) funding ballooned from $10 billion to $85 billion. Its financial resources far outstrip all other US law enforcement agencies, such as the FBI. 

“This is your tax money,” says Furtado. “Is this money well-spent?” To answer this question, she says, it is important to think about all the costs and benefits of having a larger immigrant population, including benefits to the nation’s elderly population.  

If nothing changes, either we’re going to have to spend a lot more money on long-term care, or decrease the quality of care provided.

She points out that, given immigrants’ proven positive impact on nursing home residents, immigration policy could be leveraged to support the health of America’s aging population. 

One potential solution could be to create a specialized visa category for caregiving workers, similar to the H2-A visa program that sponsors seasonal agricultural workers.  

Another could be improving the recognition of credentials needed for nursing-home work, such as registered nurse (RN) and nursing assistant certifications. Many times, immigrants’ credentials earned in other countries are not recognized in the United States, leading them to take positions for which they are overqualified. Someone who has an RN-equivalent certification from another country may have to work as a nursing assistant in the US.  

Furtado’s research on this topic has been supported by UConn’s Alan R. Bennett College of Liberal Arts & Sciences Public Health Policy Research Funding Opportunity. She is also a recent recipient of a grant from the Russell Sage Foundation for a related project, exploring how immigration may impact the working conditions for nursing home employees.