A colleague just came back from a tour of long-term care facilities in Minnesota. She reported that many nursing homes and home care agencies were reducing their business because they could not find staff to hire, even if they dropped their standards. That’s today.
Now fast-forward to the demographic forecasts that predict a much lower ratio of working-age people to older people than we have ever had. Forget about what that means for Social Security and Medicare for a moment, and just think about the pool of caregivers.
We are headed for a crisis.
Around the world, long-term care is provided largely by immigrants, who are willing to undertake hard personal care at minimal wages. We see it in Europe; we see it in Asia. We see it every day in the United States. Policies that foster immigration, or even just tolerate it, are crucial to addressing caregiving.
Politicians discussing immigration tend to focus on attracting those with the greatest skills, who can presumably strengthen our economic competitive position globally. Our universities actively recruit overseas graduate students in math and sciences because we do not have enough native-born students with these skills or inclination for these fields. Companies want to hire computer scientists and engineers.
But we need people at the other end of the educational spectrum as well. They are the ones who are willing to undertake the messy, unpleasant caregiving chores that most of us shun. Many do so to gain a toehold that can lead to a better career for themselves or their children. That is an American ideal.
One of the ugly, poorly-kept secrets about long-term care is that it has always relied on exploitation. We exploit family caregivers, and we exploit paid workers. Pressures for a higher minimum wage will help a little, but we will never pay them what they are worth.
Fortunately, many are motivated by a higher cause. They opt for caregiving over fast-food work, but they are only a minority of those who enter at the bottom of the socioeconomic ladder.
We need immigrants to meet the needs of an aging population. Help educate your legislators.