Posted on 03/26/2018 9:08:05 AM PDT by spintreebob
People living with disabilities, serious illness and the frailty of old age are bracing to lose caregivers due to changes in federal immigration policy.
About 59,000 Haitians live in the U.S. under Temporary Protected Status (TPS), a humanitarian program that gave them permission to work and live here after the January 2010 earthquake devastated their country. Many work in health care, often in grueling, low-wage jobs as nursing assistants or home health aides.
Now these workers’ days are numbered: The Trump administration decided to end TPS for Haitians.
In Boston, the city with the third-highest Haitian population, the decision has prompted panic from TPS holders and pleas from health care agencies that rely on their labor. The fallout offers a glimpse into how changes in immigration policy are affecting older Americans in communities around the country, especially in large cities.
Ending TPS for Haitians “will have a devastating impact on the ability of skilled nursing facilities to provide quality care to frail and disabled residents,” warned Tara Gregorio, president of the Massachusetts Senior Care Association, which represents 400 elder care facilities, in a letter published in The Boston Globe. Nursing facilities employ about 4,300 Haitians across the state, she said.
“We are very concerned about losing dedicated, hardworking individuals, particularly at a time when we cannot afford to lose workers,” Gregorio said in a recent interview. In Massachusetts, 1 in 7 certified nursing assistant (CNA) positions are vacant, a shortage of 3,000 workers.
Nationwide, 1 million immigrants work in direct care — as CNAs, personal care attendants or home health aides — according to the Paraprofessional Healthcare Institute. Immigrants make up 1 in 4 workers, said Robert Espinoza, PHI’s VP of policy. Turnover is high, he said, because the work is difficult and wages are low. The median wage for personal care attendants and home health aides is $10.66 per hour, and $12.78 per hour for CNAs. Workers often receive little training and leave when they find higher-paying jobs at retail counters or fast-food restaurants, he said.
The country faces a severe shortage in home health aides. With 10,000 baby boomers turning 65 each day, an even more serious shortfall lies ahead, according to Paul Osterman, a professor at MIT Sloan School of Management. He predicts a national shortfall of 151,000 direct care workers by 2030, a gap that will grow to 355,000 by 2040. That shortage will escalate if immigrant workers lose work permits, or if other industries raise wages and lure away direct care workers, he said.
Nursing homes in Massachusetts are already losing immigrant workers who have left the country in fear, in response to the White House’s public remarks and immigration proposals.
“What people don’t seem to understand is that people from other countries really are the backbone of long-term care,” said Sister Jacquelyn McCarthy, CEO of Bethany Health Care Center in Framingham, Mass, which runs a nursing home with 170 patients. She has 8 Haitian and Salvadoran workers with TPS, mostly CNAs. She already has 6 CNA vacancies and can’t afford to lose more.
“There aren’t people to replace them if they should all be deported,” McCarthy said.
In addition to seeing Dicenso, Nirva works 3 shifts a week at a chiropractor’s office. Five nights a week, she works the overnight shift at a rehab center in Boston run by Hebrew SeniorLife. CEO Louis Woolf said Hebrew SeniorLife has 40 workers with TPS, out of 2,600.
It’s not clear how many direct care workers rely on TPS. PHI calculates 34,600 are from Haiti, El Salvador, Nicaragua and Honduras. 11,000 from countries affected by Trump’s travel ban, primarily from Somalia and Iran, and about 69,800 from Mexico.
The “totality of the anti-immigrant climate” threatens the stability of the workforce — and “the ability of older people and people with disabilities to access home health care,” Espinoza said.
A DHS official said “economic considerations are not legally permissible.” TPS designation hinges on whether the foreign country faces adverse conditions, war, environmental disaster.
The biggest hit to the immigrant workforce may come from another program — family reunification, said Robyn Stone of research at LeadingAge, an association of nonprofit groups that care for the elderly. Trump is seeking to scrap the program, which he calls “chain” migration, in favor of a “merit-based” policy.
Osterman, the MIT professor, said the sum of all of these immigration policy changes may have a serious impact. If demand for workers exceeds supply, he said, insurers may have to restrict the number of hours of care that people receive, and wages may rise, driving up costs.
“People aren’t going to be able to have quality care,” he said. “They’re not going to be able to stay at home.”
Angelina Di Pietro, Dicenso’s daughter and primary caretaker, disagreed. “There’s not a lot of people in this country who would take care of the elderly,” she said.
In response to your post 59:
Good comments.
1 - As long as there is government money involved in any segment of the economy there is no pure capitalism and free market.
The money distorts the market and market forces are overrun.
Just look how government money and government loan guarantees have damaged higher education.
2 - As long as there is a good supply of illegals willing to work for low wages there is little pressure to pay more.
And the government has seen to it that there is a good supply through intentional lax enforcement of immigration law.
Nice threat.
Go pound sand.
“1. Care of the elderly and disabled in the US is currently far from Capitalism. Talk of “letting the free market fix it” means changes to Medicare and Medicaid, and to Regulation far bigger than tweaking immigration and ending TPS.”
“2. If FReepers support ending TPS, then they had better put top priority on alternatives such as increasing take home pay of the working poor, not penalizing the working poor for working, and not rewarding the lazy for gaming the system to draw welfare.”
I agree. It’s such a large order, that IMHO, anything short of a 2nd revolution will fail to restore Rule of Law and serve only to prolong the collapse.
Govt fixes always end up going badly
Markets always drive pay
Get the cheats out of home care....you know the ones who expect the taxpayer to fund their relatives largess
I believe Medicare and Medicaid should be abolished, along with every other social welfare program.
"Caring facilities" directors are traditionally given bonuses based on keeping costs down. The most common correlation with elder abuse in care facilities is ‘short staffing’. That's the major conflict.
When employees call in ‘sick’ the director has a choice of calling in ‘pool help’ at three times the normal hourly rate - OR doubling up on workers present. The 'saving money' choice is incentivized - abuse happens. Good people are uncomfortable in that environment and leave. People who don't care are left. The director's ‘rewarded’ with a bonus for keeping costs down.
The solution is random variable inspection replacing annual inspection - AND inspections tied to financial incentives. Medicare and Medicaid should PAY Less per patient when 6 random items checked are deficient.
The advantage is the Care facility MAKES MORE PROFIT if they make ethical choices. So the facility polices themselves and abuse drops, turnover drops and dependent people receive better care.
Medicare and Medicaid should PAY Less per patient when 6 random items checked are deficient.
How about M&M (and private LTC) don’t pay for conditions that origninate inside the facility. A person enters with illness A and injury B. But while there breaks a leg and acquires Sepsis. Why should the provider be paid for treating the broken leg and the Sepsis?
Good luck finding Congress critters with the cajones.
Lots of ways to create positive tax incentives for private long term care facilities. The State inspects all of them - those that take medicare and those that don’t.
Same with multidrug-resistant pathogens in a hospital setting? If the Sepsis rate’s statistically higher than other facilities that fact could be included in the ‘incentive plan’. Put it on the list of random variables that will be checked... and adjust the pay rates or tax incentives accordingly. As far as the ‘insurance companies and Hospital payments, bills etc... that’s a mess no one should wade into.(I have opinions on that but it’s too complicated to write up - now or ever)
“Workers often receive little training”
“Ending TPS for Haitians “will have a devastating impact on the ability of skilled nursing facilities to provide quality care to frail and disabled residents,” warned Tara Gregorio, president of the Massachusetts Senior Care Association, ”
Are they skilled or untrained?
The author seems clueless.
Skilled Nursing Facility is an oxymoron. Nursing Facilities are heavily regulated. One of their big overhead costs is Regulatory Agency harassment. As a sweetener, SNFs are allowed to use the term Skilled so as to impress the family of the elderly who want to dump their problem person there.
Actually most of the staff are unskilled in the meaning that normal people understand. There is supposed to be RNs and LPNs on duty. If they know when the media is coming with cameras,the skilled people will be there.
SNF have always had severely disabled as well as the elderly. But increasingly, SNF are taking in the addiction types on SSI/SSDi/Medicaid.
I’m probably dating myself here, but way back when I remember there were nurses and there were nurses aids. An LVN was never called a nurse. They were a nurses aide. Now all of a sudden they have been elevated in status. So we’re really having people that are fairly unskilled doing what used to be a skilled job.
Unless I’m missing something, remembering wrong, or their education has changed. It could be, because I never really paid that much attention.
An LVN Licensed Vocational Nurse is far below a LPN Licensed Practical Nurse, who is below and RN Registered Nurse. Of course, most nursing home workers are far below LVN. They are unskilled.
The important thing to understand is that the License in no way guarantees the skill level, competence and most importantly, the attitude of the care worker. There are unlicensed workers who are very good. There are licensed workers who are very bad. And of course there are those on a continuum to the other extremes.
How do the illegals pass a backround check?
What my GA Medicaid is doing with HHS-CMS money.
Georgia State U gets $1.6 million to improve nursing homes statewide
https://www.ajc.com/news/local-education/georgia-state-gets-million-improve-nursing-homes-statewide/ToT1orPVSlVYBS0ifyylNP/
Georgia State University has been awarded $1.6 million for a three-year training and development project to improve the state’s nursing homes, the university announced Tuesday.
The project, called “Building Resources for Delivering Person-Centered Care in Georgia Nursing Homes,” builds on work done by the non-profit Culture Change Network of Georgia to support culture change and person-centered care in long-term care services and support organizations, the university said in a news release.
The work will include a needs-based assessment of Georgia’s 374 nursing homes and interactive competency-based online continuing education training for nursing home staff, residents and informal care partners.
Related
Georgia among last states to post nursing home investigation reports
Lax oversight leaves patients at risk in Medicaid rides program
Georgia’s 2018 commencement schedule and speakers
Want to be the next Bill Gates? Georgia State has a place for that
“Nursing homes do not always have adequate support and resources to improve the education of their staff and to sustain a robust continuous quality improvement cycle,” said Jennifer Craft Morgan, an assistant professor of gerontology who will help lead the study. “Residents of nursing homes can experience loss of autonomy, independence and loneliness when care isn’t tailored to their personal needs and preferences.”
A U.S. Department of Health and Human Services report last year found the state is often slow to investigate nursing home patients who may be at imminent risk of serious injury or death.
The money, going to GSU’s Gerontology Institute, is coming from the Centers for Medicare and Medicaid Services and Georgia State Survey Agency.
OMG, all the sob stories coming out about how awful it will be without illegals in our midst, now we are supposed to feel sorry for the elderly since they wont be able to hire illegals for nursing duties...nevermind the stories about illegal caretakers robbing and even snuffing out their charges... Is anybody besides me tired of the drama?
I guess those low skilled medical staff are necessary. The problem I see is we have so many elderly on Medicaid. That’s just a free handout. Why should the rest of us taxpayers pay for these people when they didn’t bother to earn or save enough money throughout their life times? The church I go to has a lot of poor older people. Most of them have no clue they are living off of others. They just see it as they are entitled.
Medicaid doesn’t pay much most likely, so they have to hire the cheapest people they can.
Unfortunately this scenario is likely also the same for people on Medicare who have worked hard and saved money. They’ll end up with the same low level nursing staff.
I have no idea what the answer is. You can’t make people be responsible – especially not when they get free handouts right and left.
Short range, we need to limit who gets on Medicaid.
We need to limit who gets on SSI, SSDI.
We need to increase the age for collecting Medicare and SS from 62 and 65 to 70 and 72... maybe in steps ... maybe in one big step... whatever gets the votes.
Short range can only have a 10% or 20% impact. Long range? Americans don’t think long range, which is why we are in this mess.
I agree, you have my boat :-)
The Social Security age has been increased, mine is 67 I believe. But I don’t think it goes much higher than that. With people living so long now, people are taking Social Security for decades. And all the people that never paid in and get it? That’s just so wrong!
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.